Very high-dose clozapine and electroconvulsive therapy combination treatment in a patient with schizophrenia.

We report here the case of a 19-year-old man with paranoid schizophrenia who responded only partially to treatment with daily doses of clozapine, 1800 mg; aripiprazole, 20 mg; and clonazepam, 6 mg. We reduced the clozapine to 1600 to 1700 mg, maintaining therapeutic serum levels, and added a course of electroconvulsive therapy that included 24 treatments. Therapeutic results were minimal. However, adverse effects were limited to mild cognitive disturbances. Our experience adds to other reports suggesting that clozapine and electroconvulsive therapy can be combined without causing excessive adverse effects.