The role of electroconvulsive therapy (ECT) in treating patients with schizophrenia remains unclear. This paper aims to determine whether ECT results in clinically meaningful benefit with regard to psychopathology, behavior and functioning for patients with schizophrenia, and whether variations in the practical administration of ECT influences outcome. Existing research in the field and the new information of research in patients with treatment-resistant schizophrenia (TRS) from Thailand are summarized. Independent of gender, duration of the current episode and severity of baseline negative symptoms predict outcome. Treatment results in marked improvement in positive symptoms, with an intermediate effect on affective symptoms, and no effect or worsening of negative symptoms. The combination of ECT and conventional antipsychotic drug is associated with better outcome than either ECT alone or antipsychotic drug alone during both acute and maintenance phases of treatment. This improvement is not only in psychopathology but also in quality of life and social functioning. Electrical stimulus doses 2-4 times the seizure threshold are likely to increase the speed of recovery with bilateral ECT. Thrice-weekly ECT elicits response faster than does twice-weekly ECT. Although this preliminary evidence supports the use of ECT in patients with TRS, the research base for its use is still inadequate and deserves better investigation.