Table 3.

Brain stimulation techniques for the treatment of schizophrenia in older adults.

Publication	Aim	Subjects (n, sex)	Age (Mean (StdDev) [Range])	Diagnosis	Technique	Method	Outcome Measures	Findings
(Botteron et al., 1991)	To describe the clinical course and brain imaging findings of older adults with late age onset psychosis receiving ECT.	3 (F=3)	76 (4.4) [71–79]	Late age onset psychosis.	ECT, bilateral	Case series	Clinical assessment	Pre-existing brain changes present in all three cases No response to ECT in the two patients with more severe structural changes (lateral ventricular enlargement, deep-white-matter hyperintensities)
(Figiel et al., 1992)	To describe the clinical course and brain imaging findings of older adults with late age onset psychosis receiving ECT.	6 (F=6)	75 (8.2) [65–89]; Age of onset 73 (8.6) [65–89]	Late age onset psychosis.	ECT, bilateral	Case series	Clinical assessment	5/6 patients did not respond to ECT One or more structural brain changes (lateral ventricular enlargement, subcortical structural changes) present in all non-responders Higher risk for interictal ECT-induced delirium in older patients with late age onset psychosis
(Kramer, 1999)	To describe the clinical course of five older adults with schizophrenia or schizoaffective disorder receiving ECT.	5 (F=5)	65 (6.7) [58–74]	Schizophrenia, chronic undifferentiated (n=1). Schizoaffective disorder.	ECT, bilateral	Case series	Clinical assessment	Improved psychosis in all cases Four patients responded to combination ECT and antipsychotics One patient responded to ECT without antipsychotics (patient refused pharmacotherapy)
(Suzuki et al., 2003)	To evaluate the efficacy of acute ECT in treating older adults with catatonic schizophrenia.	9 (F=6)	63 (12.7) [45–77]	Schizophrenia, catatonic.	ECT, bilateral (12 sessions)	Prospective study (Participants: non-blind, Assessors: non-blind, Control conditions: none)	BPRS GAF, Guy’s five factors	Response to treatment in all participants as measured by improvement in BPRS, GAF, and Guy’s five factors One case of supraventricular premature contractions during ECT seizure Three cases of mild-moderate post-ECT delirium 6that resolved within 3 days
(Suzuki et al., 2004)	To evaluate the efficacy of acute ECT and continuation antipsychotics in treating and preventing relapse of older adults with catatonic schizophrenia.	11 (F=8)	62 (12.1) [45–77]	Schizophrenia, catatonic.	ECT, bilateral (12 sessions). Continuation antipsychotics.	Prospective study (Participants: non-blind, Assessors: non-blind, Control conditions: none).	BPRS GAF, Guy’s five factors	All participants completed phase I (acute ECT) and phase II (continuation antipsychotics) studies 7/11 participants relapsed within 6 months while receiving continuation antipsychotics
(Suzuki et al., 2005)	To evaluate the efficacy of continuation ECT and antipsychotics in preventing relapse in older adults with catatonic schizophrenia.	12 (F=7)	48 (15.9) [18–74]	Schizophrenia, catatonic (n=9), disorganized (n=1), paranoid (n=1). Schizophrenifor m disorder (n=1).	Combined continuation ECT and antipsychotics.	Prospective study (Participants: non-blind, Assessors: non-blind, Control conditions: none).	BPRS GAF, Guy’s five factors	Participants were the twelve individuals who relapsed despite use of continuation antipsychotics within 6 months after responding to two acute courses of ECT 3/12 participants relapsed Time to relapse in this phase 3 study (continuation ECT combined with antipsychotics) significantly longer than in phase 2 (continuation antipsychotics only): 153.0 (30.0) and 63.7 (55.7) days respectively, P<0.01
(Suzuki et al., 2006)	To evaluate the effect of adjusting the frequency of continuation and maintenance ECT on older adults with catatonic schizophrenia who relapsed during combined continuation ECT and antipsychotics.	3 (F=2)	61 (12.5) [49–74]	Schizophrenia, catatonic.	ECT, bilateral	Prospective study (Participants: non-blind, Assessors: non-blind, Control conditions: none).	BPRS, GAF, Guy’s five factors	All participants responded to third course of acute ECT Remission (no relapse in more than six months) achieved with increased frequency of continuation ECT and subsequent maintenance ECT No severe adverse effects reported.

Brief Psychiatric Rating Scale (BPRS), Electroconvulsive Therapy (ECT), Global Assessment of Functioning (GAF)