Department of Child and Adolescent Psychiatry and Psychology,Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain.
J Clin Psychopharmacol. 2012 Dec;32(6):756-66. doi: 10.1097/JCP.0b013e318270e2c7.
To evaluate the safety and effectiveness of the combination of electroconvulsive therapy (ECT) and clozapine compared to ECT with other antipsychotics or benzodiazepines in a sample of adolescents diagnosed with schizophrenia spectrum disorders.
Data regarding 28 adolescent subjects aged 13 to 18 with diagnoses of schizophrenia spectrum disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and treated with ECT were retrospectively collected. Twelve subjects were also treated with clozapine and 16 with other antipsychotics or benzodiazepines during ECT course and follow-up. Electroconvulsive therapy parameters and adverse effects were assessed using a systematic protocol. Positive and Negative Syndrome Scale and Clinical Global Impression scores before ECT and after acute ECT, and rate of rehospitalization during 1-year follow-up were used to assess effectiveness. Response was defined as a 20% decrease in Positive and Negative Syndrome Scale scores.
No differences were observed in the mean charge needed to induce seizure and electroencephalographic duration, but there was a slight difference in the current used. The nonclozapine group showed greater restlessness and agitation, although no differences were found in other adverse effects. The percentage of responders was similar: 66.7% in the clozapine group and 68.8% in the nonclozapine group. However, the rate of rehospitalization was lower in the patients treated with clozapine during 1-year follow-up (7.1%) compared to that of the nonclozapine group (58.3%) (P = 0.009).
The main findings of this study were that combining ECT with clozapine, compared to ECT with other antipsychotics or benzodiazepines, was safe and that both treatments were equally effective. Charges needed to induce seizure were similar in both groups. Patients treated with clozapine during 1-year follow-up had a lower rate of rehospitalization.
评估电抽搐治疗(ECT)联合氯氮平与 ECT 联合其他抗精神病药或苯二氮䓬类药物在诊断为精神分裂症谱系障碍的青少年样本中的安全性和有效性。
回顾性收集了 28 名年龄在 13 至 18 岁之间、根据《精神障碍诊断与统计手册》第四版修订版诊断为精神分裂症谱系障碍并接受 ECT 治疗的青少年患者的数据。在 ECT 治疗过程中和随访期间,12 名患者还接受氯氮平治疗,16 名患者接受其他抗精神病药或苯二氮䓬类药物治疗。采用系统方案评估 ECT 参数和不良反应。使用阳性和阴性症状量表(PANSS)和临床总体印象量表(CGI)在 ECT 前和急性 ECT 后进行评估,并在 1 年随访期间评估再住院率,以评估疗效。定义为 PANSS 评分降低 20%为有效。
两组之间需要诱导癫痫发作的电荷量和脑电图持续时间没有差异,但电流略有不同。非氯氮平组表现出更多的不安和激越,但其他不良反应无差异。两组的应答率相似:氯氮平组为 66.7%,非氯氮平组为 68.8%。然而,在 1 年随访期间,氯氮平治疗组的再住院率较低(7.1%),而非氯氮平组的再住院率较高(58.3%)(P=0.009)。
本研究的主要发现是,与 ECT 联合其他抗精神病药或苯二氮䓬类药物相比,ECT 联合氯氮平治疗是安全的,两种治疗方法同样有效。两组所需的诱导癫痫发作电荷量相似。在 1 年随访期间接受氯氮平治疗的患者再住院率较低。