OBJETIVO: Hasta 70% de los pacientes con esquizofrenia resistente al tratamiento no responden a la clozapina. El aumento farmacológica a la clozapina se ha estudiado con resultados mediocres. Los autores examinaron el uso de la TEC como un aumento de la clozapina para la esquizofrenia resistente al tratamiento.
MÉTODO: En un estudio doble ciego aleatorizado estudio de 8 semanas, los pacientes con esquizofrenia resistente a la clozapina fueron asignados a tratamiento habitual (grupo clozapina) o un curso de TEC bilateral más clozapina (más el grupo de clozapina TEC). No respondedores del grupo de clozapina recibieron un ensayo abierto de 8 semanas de la TEC (fase de transición). TEC se realizó tres veces por semana durante las primeras 4 semanas y dos veces por semana durante las últimas 4 semanas. Las dosis de clozapina se mantuvieron constantes. La respuesta se definió como una reducción ≥40% en los síntomas basados en la subescala de síntomas psicóticos de la Brief Psychiatric Rating Scale, una calificación global -severity Impresiones (CGI) Clínica <3, y una calificación de CGI-mejora ≤2.
RESULTADOS: La muestra de intención de tratar incluyeron 39 participantes (grupo de TEC más clozapina, N = 20; grupo clozapina, N = 19). Los 19 pacientes del grupo de clozapina recibieron TEC en la fase de cruce. El cincuenta por ciento de los pacientes con TEC y clozapina se reunió con el criterio de respuesta. Ninguno de los pacientes en el grupo de clozapina cumple el criterio. En la fase de cruce, la respuesta fue del 47%. No se encontraron diferencias discernibles entre los grupos en la cognición global. Dos pacientes requirieron el aplazamiento de una sesión de TEC debido a la confusión leve.
CONCLUSIONES: El aumento de la clozapina con TEC es una opción de tratamiento segura y efectiva. Se necesitan investigaciones adicionales para determinar la persistencia de la mejora y la necesidad potencial de los tratamientos de mantenimiento.
Clozapine is well-known for successful use in schizophrenic patients treatment resistant to other antipsychotics. However, even with clozapine, 25% of schizophrenic patients are not in remission. Recently, as adjunctive treatment with clozapine, electroconvulsive therapy has been reported to be an effective and safe adjunctive treatment. We report a Japanese schizophrenic woman who was not in remission with clozapine alone but with both clozapine and electroconvulsive therapy.
The effectiveness and predictors of response to electroconvulsive therapy (ECT) combined with antipsychotics (AP) in treatment-resistant schizophrenia patients with the dominance of negative symptoms (TRS-NS) have not been studied systematically so far. 29 patients aged 21-55 years diagnosed with TRS-NS underwent ECT combined with antipsychotics (ECT+AP). Prior to the ECT, the symptom profile and severity were evaluated using Positive and Negative Syndrome Scale (PANSS). Demographic and medical data was collected; ECT parameters and pharmacotherapy results were evaluated. After the combined ECT+AP therapy a significant decrease in symptom severity was found. A response to treatment was achieved by 60% of patients. The greatest reductions were obtained in general and positive PANSS subscale (median change: 11 and 7 pts.) and the smallest, but still significant, ones in negative symptoms subscale (median: 3.5 pts.). Patients who responded to ECT+AP demonstrated a significantly shorter duration of the current episode in comparison with patients who did not experience at least a 25% reduction in symptom severity (median: 4 vs. 8 months). A combination of ECT and antipsychotic therapy can provide a useful treatment option for patients with TRS-NS. The only significant predictor of response to treatment was a shorter duration of the current episode.
Combination of Electroconvulsive therapy (ECT) and clozapine is used in resistant schizophrenia. Fatal pulmonary embolism is a rare complication of clozapine and ECT each, when combined it almost doubles the risk of mortality. The ECT and clozapine combination should be used judiciously in patients of schizophrenia. During the coure of treatment one should always suspect pulmonary embolism if there is any complains of breathlessness.
BACKGROUND: About one third of patients with schizophrenia are treatment-resistant. The treatment options for these patients are limited. OBJECTIVES: To study the short-term efficacy of electroconvulsive therapy in treatment-resistant schizophrenia. METHODS: 30 patients with treatment-resistant schizophrenia were included. Patients were assessed at baseline, after 4, and after 6 sessions of electroconvulsive therapy using the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). Global Assessment of Functioning (GAS) and Clinical Global Impression (CGI) scales were applied at baseline and at the end of ECT course. RESULTS: As compared to baseline, the score on the BPRS changed significantly from 57.4 to 40.9 after 4 sessions (P<0.001) and further to 65.6 at the end of 6 sessions (P<0.001). The significant change in score on the GAS and the CGI further shows that electroconvulsive therapy is effective in treatment-resistant Schizophrenia. CONCLUSIONS: A short course of electroconvulsive therapy leads to significant benefit in treatment-resistant schizophrenia
For treatment-refractory schizophrenia, electroconvulsive therapy (ECT) remains controversial because of its cognitive adverse effects. We report here on clinical and cognitive outcomes of a treatment-resistant schizophrenia patient treated with clozapine and right unilateral ECT.The patient was administered 300 mg of clozapine and 12 right unilateral ECT sessions. Psychopathology was rated by means of the Positive and Negative Syndrome Scale. The neurocognitive test battery included the Wisconsin Card Sorting Test, the Münchner Gedächtnis Test, an attentional performance test, the Trail Making Test, and the Hamburger-Wechsler Intelligence Test.The Positive and Negative Syndrome Scale total score decreased, and all cognitive measures improved.Electroconvulsive therapy would seem to be a safe treatment option for treatment-refractory schizophrenia patients.
To examine disease and treatment characteristics of patients with schizophrenia treated with electroconvulsive therapy (ECT). We examined charts from 79 patients diagnosed with schizophrenia (n = 55), persistent delusional disorders (n = 7), and schizoaffective disorders (n = 17) between 2003 and 2008. We recorded age, sex, indication for ECT, number of ECT sessions, ECT series, outcome, maintenance ECT, use of antipsychotics, duration of illness, and duration of the current exacerbation. All patients were taking antipsychotics at the time of enrolment in the study. Acute ECT included 2-26 sessions; maintenance ECT (M-ECT) was given to 18 patients for up to 12 years. Initial indications for ECT included psychosis (n = 28), pronounced affective symptoms (n = 28), delirious states (n = 20), and M-ECT (n = 3). Most patients experienced excellent/good outcomes (n = 66), but others experienced moderate (n = 8) or poor (n = 5) outcomes. No factors were identified that predicted treatment responses in individual patients. ECT proved to be effective in a population of patients that were severely ill with treatment-refractory schizophrenia. This does not imply that the patients were cured from schizophrenia. Rather, it reflects the degree of relief from psychosis and disruptive behaviour, as described in the patient charts. The treatment was often offered to patients after considerable disease durations.
