Clozapine and maintenance electroconvulsive therapy in a 35-year-old patient with treatment-resistant schizophrenia and chronic imperative auditory hallucinations

Abstract

Purpose: Despite progress in the treatment of schizophrenia, treatment resistance is reported in about 30% of patients. Various forms of treatment augmentation are used, but clozapine is generally considered to be the gold standard of care. In the management of patients with clozapine resistance adjunctive electroconvulsive therapy (ECT) courses have been proposed. In recent years particular attention has been paid to augmentation of clozapine with the maintenance electroconvulsive therapy (M-ECT). Case description: The paper presents a patient with treatment-resistant schizophrenia and chronic psychotic symptoms leading to self-destructive and suicidal behaviors. After concurrent treatment with clozapine and M-ECT her clinical status and functioning have improved. Comment: Maintenance-ECT used to augment clozapine in drug-resistant schizophrenia seems to be a safe and promising management option.

Retrospective analysis of electroconvulsive therapy in treatment-resistant schizophrenia

“…They are most often not used as a single or exclusive method, but usually in combination with continued pharmacotherapy. Zakowicz et al (2019) showed that the use of ECT and clozapine in patients with drug-resistant schizophrenia (clozapine 600 mg/day, ECT every 3 weeks for more than a year) resulted in significant clinical improvement, with a reduction in perception disorders and elimination of aggressive and suicidal behaviour. A 2019 meta-analysis of 2,074 schizophrenia patients published in the Molecu lar Neuropsychiatry journal found that patients treated with ECT had a significantly reduced rate of psychiatric hospitalisation.…”