Psychiatry Investig.  2017 Jan;14(1):58-62. 10.4306/pi.2017.14.1.58.

Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia

• Kim HS
• Kim SH
• Lee NY
• Youn T
• Lee JH
• Chung S
• Kim YS
• Chung IW

• KMID: 2365013
• DOI: http://doi.org/10.4306/pi.2017.14.1.58

Abstract

OBJECTIVE
This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review.
METHODS
Clozapine-resistance was defined as persistent psychotic symptoms despite at least 12 weeks of clozapine administration with blood levels over 350 ng/mL in order to rule out pseudo-resistance. Seven in-patients who were taking clozapine and treated with ECT were selected. We analyzed the psychopathology and subscales changed by ECT.
RESULTS
The average number of ECT sessions was 13.4 (±4.6). Total Positive and Negative Syndrome Scale (PANSS) score was significantly reduced by 17.9 (±12.8) points (p=0.0384) on average, which represented a reduction of 25.5% (±14.3). 71.4% (5/7) of patients were identified as clinical remission, with at least a 20% reduction in PANSS score. PANSS reduction was associated with number of ECT sessions, stimulus level in the final session, and blood clozapine levels before ECT. However, the negative subscale on the PANSS were not reduced by ECT in any patient. We did not observe any persistent adverse cognitive effects.
CONCLUSION
This study supports that ECT augmentation on clozapine-resistant schizophrenia reveals clinically effective and safe. Further research should be done involving a larger number of patients to investigate the effectiveness of clozapine/ECT combination therapy.

Keyword

Clozapine-resistant schizophrenia; Electroconvulsive therapy; Augmentation

MeSH Terms

Clozapine
Electroconvulsive Therapy*
Humans
Psychopathology
Retrospective Studies
Schizophrenia*
Clozapine