Grover Sandeep, Hazari Nandita, Kate Natasha
1Department of Psychiatry,Post Graduate Institute of Medical Education and Research,Chandigarh,India.
2Department of Psychiatry,KEM Hospital,Mumbai,India.
Acta Neuropsychiatr. 2015 Jun;27(3):131-42. doi: 10.1017/neu.2015.8. Epub 2015 Feb 20.
This paper aims to review the available evidence for the use of clozapine and electroconvulsive therapy (ECT) in combination.
Electronic searches were carried out to identify reports describing the combined use of clozapine and ECT.
Forty reports including 208 patients were identified. The majority of reports were in the form of case reports and case series, with few retrospective and open-label studies. The majority of patients were aged between 18 and 65 years and diagnosed with schizophrenia or schizoaffective disorder. Most of the patients refractory to clozapine were started on ECT as an augmentation therapy; however, in some reports, both ECT and clozapine were started concurrently, and in few cases clozapine was started after ECT. In terms of effectiveness, 37.5-100% patients improved in short-term, and sustained long-term improvement (3 weeks to 24 months) was described in few studies. In terms of the side-effect profile, five patients each had delirium and tachycardia and only four patients were described to have prolonged seizures. Overall, the combination was considered effective and safe.
There is evidence for the effectiveness and safety of the clozapine-ECT combination and it should be used in patients with treatment-resistant schizophrenia who do not respond to clozapine.
本文旨在综述氯氮平与电休克治疗（ECT）联合使用的现有证据。
进行电子检索以识别描述氯氮平与ECT联合使用的报告。
共识别出40篇报告，涉及208例患者。大多数报告为病例报告和病例系列形式，回顾性研究和开放标签研究较少。大多数患者年龄在18至65岁之间，诊断为精神分裂症或分裂情感性障碍。大多数对氯氮平难治的患者开始接受ECT作为强化治疗；然而，在一些报告中，ECT和氯氮平同时开始使用，少数情况下在ECT后开始使用氯氮平。在有效性方面，37.5%至100%的患者在短期内有所改善，少数研究描述了持续的长期改善（3周至24个月）。在副作用方面，各有5例患者出现谵妄和心动过速，只有4例患者被描述为癫痫发作延长。总体而言，这种联合治疗被认为是有效和安全的。
有证据表明氯氮平与ECT联合使用有效且安全，应在对氯氮平无反应的难治性精神分裂症患者中使用。
