Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia

Abstract

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.

A Pilot Study on Daily Intensive ECT over 8 Days Improved Positive and Negative Symptoms and General Psychopathology of Patients with Treatment-Resistant Schizophrenia up to 4 Weeks after Treatment

“…For example, Kim et al [39] reported results consistent with the present study; they found that using ECT (3 times a week) reduced the PANSS index in schizophrenic patients who were resistant to clozapine treatment after 12 weeks. In a meta-analysis, Gu et al [40] described findings consistent with the present study and concluded that, for patients with schizophrenia, treatment with ECT (without concurrent use of antipsychotics), or the combination of ECT and antipsychotics, was associated with a decrease in the PANSS score.…”

“…In previous studies, the positive effects of ECT every other day have been reported for the PANSS and BPRS indices for TRS [17-20]. Furthermore, other studies have confirmed the positive effects of a combination of ECT and drugs such as clozapine and antipsychotics on schizophrenic patients’ psychiatric symptoms as measured with the BPRS and PANSS [14, 39-41]. …”

The Effects of Continuation-Maintenance Electroconvulsive Therapy on Reducing Hospital Re-Admissions in Patients with Treatment-Resistant Schizophrenia

“…Electroconvulsive therapy (ECT) is one key of various augmentation strategies for TRS patients since 1990s,5,6) and previous studies consistently demonstrated the initial effect of ECT augmentation 4). A recent systematic review and meta-analysis included data of total 192 TRS patients from previous studies, and reported the response rate of ECT-clozapine combination to be 54–66% 1).…”

Combined use of electroconvulsive therapy and antipsychotics (both clozapine and non-clozapine) in treatment resistant schizophrenia: A comparative meta-analysis

“…Many studies have shown that the augmentation of the drug responses by employing electroconvulsive therapies often rapidly improves patient’s symptoms in treatment-refractory schizophrenia [ 9 , 11 , 12 , 13 ]. Augmentation with ECT may be used with any antipsychotics, but the best results have been found in conjunction with clozapine.…”

“…Existing literature on the treatment of schizophrenia offers ample insights into the efficacy of augmentation therapies [ 11 , 14 ] but the relative analysis between the efficacies of different ECT-drug combinations have not been investigated into in much detail. While the current practice is to use clozapine unless contraindicated due to its gold standard status for psycho-active treatment alone, augmented therapy may differ in results.…”