Abstract
Background: Electroconvulsive therapy (ECT) is a well-established intervention for severe and treatment-resistant psychiatric disorders, yet its use in adolescents remains limited, particularly in Europe. Data on its safety and effectiveness in this population are scarce. This study aimed to evaluate the clinical outcomes and tolerability of ECT in adolescents diagnosed with schizophrenia and schizoaffective disorder. Methods: We conducted a retrospective observational case series of 22 adolescents (mean age 16.7 ± 1.3 years) treated with ECT between 2017 and 2024 at a university psychiatric department. Diagnoses included paranoid schizophrenia (n = 15), catatonic schizophrenia (n = 2), and schizoaffective disorder (n = 5). Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS) before and after the ECT course. Adverse events were evaluated based on daily clinical monitoring and medical records. Results: The overall response rate, defined as ≥50% reduction in total PANSS score, was 82% (schizophrenia: 82%; schizoaffective disorder: 80%). Mean PANSS total score decreased from 158.0 ± 22.6 to 72.1 ± 20.7 (p < 0.0001). Improvements were most pronounced in the general psychopathology and positive symptom domains. No serious adverse events were observed. The most common transient side effects were headache (41%), memory complaints (27%), and somnolence (22%). Conclusions: ECT appears to be an effective and safe treatment option for adolescents with treatment-resistant schizophrenia and schizoaffective disorder. These findings add to the limited European evidence base and support considering ECT earlier in the treatment course of severe adolescent psychosis. Larger, prospective studies with long-term follow-up are warranted to confirm these results.