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Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study.
Georgios Petrides1, Chitra Malur, Raphael J Braga
1From the Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, N.Y., and The Feinstein Institute for Medical Research, Manhasset, N.Y.
The American Journal of Psychiatry
|August 27, 2014
Summary
Electroconvulsive therapy (ECT) combined with clozapine effectively treats treatment-resistant schizophrenia. This augmentation strategy showed significant symptom reduction in patients who did not respond to clozapine alone.
Area of Science:
- Psychiatry
- Neuroscience
Background:
- Clozapine is a key treatment for schizophrenia, but up to 70% of patients exhibit treatment resistance.
- Pharmacological augmentation strategies for clozapine have yielded limited success in improving outcomes for these patients.
Purpose of the Study:
- To investigate the efficacy and safety of electroconvulsive therapy (ECT) as an augmentation strategy for patients with treatment-refractory schizophrenia receiving clozapine.
Main Methods:
- A randomized, single-blind, 8-week study compared clozapine alone (treatment as usual) versus clozapine plus bilateral ECT.
- Response criteria included a ≥40% reduction in Brief Psychiatric Rating Scale (BPRS) scores, Clinical Global Impressions-Severity (CGI-S) rating <3, and CGI-Improvement (CGI-I) rating ≤2.
- Patients not responding to clozapine alone underwent an open trial of ECT (crossover phase).
Main Results:
- Fifty percent of patients receiving ECT plus clozapine met the response criteria, compared to none in the clozapine-only group.
- In the crossover phase, 47% of patients who subsequently received ECT responded.
- No significant differences in global cognition were observed between groups; mild confusion led to temporary ECT postponement in two patients.
Conclusions:
- Augmenting clozapine treatment with ECT is a safe and effective option for patients with treatment-resistant schizophrenia.
- Further research is needed to assess the long-term persistence of improvement and the necessity of maintenance treatments.
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