Electroconvulsive Therapy Before or After Initiation of Clozapine in Schizophrenia- A Retrospective Comparison for Seizure Parameters, Treatment Response and Duration of Hospitalization

Abstract

Purpose: Determining whether adjunctive electroconvulsive therapy (ECT) with clozapine leads to better treatment response and decreased length of stay for patients with schizophrenia.Methods: Medical records of patients with schizophrenia who were treated with ECT-clozapine combination in our women's mental health inpatient clinic in a period of 5 years (between 01.02.2014 and 01.02.2019) were investigated retrospectively. Clinical Global Impression of Improvement (CGI-I) scale was used for assessing treatment response.Results: Of the 191 cases treated with ECT, there were 8 cases of schizophrenia who were treated with ECT and concomitant clozapine (C-ECT) and 14 cases who were treated with ECT before the initiation of clozapine (ECT-B). Number of ECT sessions and duration of seizures were not significantly different for both groups (p > 0.05). There was good and mild response (CGI-I score of 2 and 3) in 75% of the patients (n=6) for C-ECT and 85.7% of the patients (n=12) for ECT-B. Mean CGI-I scores between the two groups were not significantly different (p > 0.05). Duration of hospitalization for the C-ECT group (37.7 ± 14.44 days) was shorter than the duration of hospitalization for the ECT-B group (56.0 ± 19.2 days) (p = 0.04). No serious adverse events were observed during the ECT sessions or during the index hospitalizations. Conclusion:Response rate was high and similar in both of the procedures and the duration of hospitalization was shorter for C-ECT group with no significant increase in serious complicatins and adverse effects.