There have been scanty reports of the clinical features of schizophrenic patients treated with electroconvulsive therapy (ECT). This prospective study examined clinical characteristics and predictive factors associated with therapeutic outcome. Two hundred and ninety-three patients with refractory schizophrenia were treated with a combination of ECT and flupenthixol. Outcome assessments included the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF), and the Mini-Mental State Examination (MMSE). One hundred and sixty patients (54.6%) met a response criterion. The responders were younger, had shorter durations of illness and current episode, more admissions, and less family history of schizophrenia. The duration of current episode (t=5.0, P<0.0001), followed by baseline GAF score (t=3.1, P=0.002), duration of illness (t=3.1, P=0.002), baseline MMSE score (t=3.0, P=0.003), duration of the previously failed neuroleptic trials (t=3.0, P=0.003), family history of schizophrenia (t=2.1, P=0.03), and paranoid type (t=2.1, P=0.04), could predict the therapeutic outcome. Treatment resulted in marked improvement in positive symptoms but had a minimal effect or led to a worsening of negative symptoms.