Effectiveness of electroconvulsive therapy augmentation on clozapine-resistant schizophrenia

Hye Sung Kim, Se Hyun Kim, Nam Young Lee, Tak Youn, Jeoung Hyuk Lee, Seunghyun Chung, Yong Sik Kim, In Won Chung

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Objective This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review. Methods Clozapine-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. Results The 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. Conclusion This 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.

Original languageEnglish
Pages (from-to)58-62
Number of pages5
JournalPsychiatry Investigation
Volume14
Issue number1
DOIs
StatePublished - Jan 2017

Keywords

  • Augmentation
  • Clozapine-resistant schizophrenia
  • Electroconvulsive therapy

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