Chanpattana W, Chakrabhand M L, Kongsakon R, Techakasem P, Buppanharun W
Department of Psychiatry, Srinakharinwirot University, Vajira Hospital, Thailand.
J ECT. 1999 Jun;15(2):129-39.
Treatment-resistant schizophrenia (TRS) is a critical public health concern. Short-term treatment with electroconvulsive therapy (ECT), combined with neuroleptics, may increase the response rate in patients with TRS, when compared with either treatment alone. We conducted an open-trial study in 59 patients with TRS with acute exacerbations, by using bilateral ECT combined with flupenthixol (dose range, 12-24 mg/day). After the first sign of clinical improvement, all patients had to pass a 3-week stabilization period during which their clinical improvement had to be sustained. The patients had to receive at least 20 ECT treatments before being considered unresponsive to ECT. Thirty-one patients were ECT responders by our criteria, 19 were non-responders, and nine were dropouts. The responder group had more male patients, paranoid type, of younger age, shorter duration of illness and duration of the current episode, less family history of schizophrenia, and higher pretreatment GAF scores. They received a lesser number of ECT treatments, a less electrical charge used, and lower doses of flupenthixol (p < 0.05). Both positive and negative symptoms improved (p < 0.05), but positive symptoms responded to a greater extent. This study supports the therapeutic efficacy of combined treatment with ECT and neuroleptic drugs. A consensus in the definition of TRS is urgently required.
难治性精神分裂症（TRS）是一个重大的公共卫生问题。与单独使用任何一种治疗方法相比，电休克治疗（ECT）联合抗精神病药物进行短期治疗，可能会提高TRS患者的缓解率。我们对59例急性加重的TRS患者进行了一项开放性试验研究，采用双侧ECT联合氟哌噻吨（剂量范围为12 - 24毫克/天）。在出现临床改善的首个迹象后，所有患者都必须经过一个为期3周的稳定期，在此期间他们的临床改善情况必须得以维持。在被认为对ECT无反应之前，患者必须接受至少20次ECT治疗。按照我们的标准，31例患者对ECT有反应，19例无反应，9例退出研究。有反应组男性患者更多，为偏执型，年龄更小，病程及当前发作的持续时间更短，精神分裂症家族史更少，且治疗前的大体功能评定量表（GAF）评分更高。他们接受的ECT治疗次数更少，使用的电量更少，氟哌噻吨剂量更低（p < 0.05）。阳性和阴性症状均有改善（p < 0.05），但阳性症状的改善程度更大。本研究支持ECT联合抗精神病药物治疗的疗效。迫切需要在TRS的定义上达成共识。
