Augmentation strategies in partial responder and/or treatment-resistant schizophrenia patients treated with clozapine

Muscatello, Maria Rosaria Anna; Bruno, Antonio; Fazio, Pasquale De; Segura-Garcia, Cristina; Pandolfo, Gianluca; Zoccali, Rocco Antonio

doi:10.1517/14656566.2014.956082

Cited by 45 publications

(36 citation statements)

References 109 publications

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“…Generally, such patients should be treated with clozapine, which is the best evidence-based option for treatment-resistance schizophrenia 25 . However, a large proportion of clozapine-treated patients exhibit a partial response to therapy, while risperidone is relatively safer when compared with clozapine.…”

Section: Discussionmentioning

confidence: 99%

The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

Yang

Cheng

et al. 2016

Arq. Neuro-Psiquiatr.

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Objective:To evaluate the effect of maintenance modified electroconvulsive therapy (MECT) on schizophrenic patients. Methods: From June 2012 to June 2014, 62 patients with schizophrenia, who had recovered from a successful course of acute MECT, were recruited. Thirty-one patients received maintenance MECT and risperidone, as the experimental group. Another 31 patients were enrolled in the control group, and received risperidone only. The effects on cognitive functions, clinical symptoms and relapse rate were determined. Results: Patients in the experimental group had a lower relapse rate and longer relapse-free survival time than the controls. Relative to the baseline evaluation, patients showed statistically significant improvement in verbal memory and visual memory. At the final assessment, the scores of verbal and visual memory were remarkably lower in the experimental group than the controls but there was no significant difference in other tests. Conclusion: Maintenance MECT plus medication is superior to medication alone in preventing relapse and improving cognitive function.Keywords: schizophrenia; electroconvulsive therapy; risperidone; cognition. RESUMO Objetivo:Avaliar o efeito da manutenção de eletroconvulsoterapia modificada (ECTM) em pacientes com esquizofrenia. Métodos: Entre junho de 2012 a junho de 2014, 62 pacientes, com esquizofrenia e que apresentaram recuperação bem-sucedida após ECTM aguda, foram recrutados. Um grupo experimental de trinta e um pacientes recebeu ECTM de manutenção e risperidona. Os demais pacientes foram incluídos no grupo controle, recebendo apenas a risperidona. Determinou-se os efeitos sobre as funções cognitivas, os sintomas clínicos e a taxa de recidiva. Resultados: Os pacientes do grupo experimental tiveram menor taxa de recidiva e maior tempo de sobrevida livre de recidiva do que os do grupo controle. Em relação à avaliação inicial, os pacientes apresentaram melhora estatisticamente significativa da memória verbal e da memória visual. Na avaliação final, os escores de memória verbal e visual foram extraordinariamente menores no grupo experimental do que no grupo controle, mas não se observou diferenças significativas em outros testes. Conclusão: A ECTM de manutenção combinada à medicação é superior ao uso apenas de medicação na prevenção de recidivas e na melhora da função cognitiva.

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Section: Discussionmentioning

confidence: 99%

The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

Yang

Cheng

et al. 2016

Arq. Neuro-Psiquiatr.

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“…Before examining the effects of ECT augmentation on clozapine resistance, pseudo-resistance arising from drug noncompliance, the effects of other medications, misdiagnosis, and adverse events must be ruled out 1. However, most studies did not provide information on dosages and blood levels of clozapine, which would be necessary to confirm the effects of ECT augmentation 2324. In order to clarify the effects of ECT augmentation on clozapine-resistant schizophrenia, we conducted a case series study that included only patients whose blood clozapine levels were maintained above 350 ng/mL for a sufficient period of time,4525 and analyzed the psychopathology and symptom domains changed by ECT procedures.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia

Kim

Lee

et al. 2017

Psychiatry Investig

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ObjectiveThis retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review.MethodsClozapine-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.ResultsThe 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.ConclusionThis 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.

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“…The annual costs are 3 to 11 times greater for treatment-resistant schizophrenia patients (SCZ-TR) than for those with adequate response (SCZ) (Kennedy et al, 2014). Unfortunately, treatment options remain limited for SCZ-TR patients, apart from clozapine (Muscatello et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Emotion processing in treatment-resistant schizophrenia patients treated with clozapine: An fMRI study

Potvin

Tikàsz

Lungu

et al. 2015

Schizophrenia Research

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Augmentation strategies in partial responder and/or treatment-resistant schizophrenia patients treated with clozapine

Cited by 45 publications

References 109 publications

The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia

Emotion processing in treatment-resistant schizophrenia patients treated with clozapine: An fMRI study

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