Kim Hye Sung, Kim Se Hyun, Lee Nam Young, Youn Tak, Lee Jeoung Hyuk, Chung Seunghyun, Kim Yong Sik, Chung In Won
Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.
Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
Psychiatry Investig. 2017 Jan;14(1):58-62. doi: 10.4306/pi.2017.14.1.58. Epub 2016 Dec 29.
This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review.
Clozapine-resistance was defined as persistent psychotic symptoms despite at least 12 weeks of clozapine administration with blood levels over 350 ng/mL in order to rule out pseudo-resistance. Seven in-patients who were taking clozapine and treated with ECT were selected. We analyzed the psychopathology and subscales changed by ECT.
The average number of ECT sessions was 13.4 (±4.6). Total Positive and Negative Syndrome Scale (PANSS) score was significantly reduced by 17.9 (±12.8) points (p=0.0384) on average, which represented a reduction of 25.5% (±14.3). 71.4% (5/7) of patients were identified as clinical remission, with at least a 20% reduction in PANSS score. PANSS reduction was associated with number of ECT sessions, stimulus level in the final session, and blood clozapine levels before ECT. However, the negative subscale on the PANSS were not reduced by ECT in any patient. We did not observe any persistent adverse cognitive effects.
This study supports that ECT augmentation on clozapine-resistant schizophrenia reveals clinically effective and safe. Further research should be done involving a larger number of patients to investigate the effectiveness of clozapine/ECT combination therapy.
本回顾性病例系列研究通过电子病历回顾，探讨电休克治疗（ECT）强化治疗对氯氮平抵抗性精神分裂症的有效性。
氯氮平抵抗定义为尽管服用氯氮平至少12周且血药浓度超过350 ng/mL，但仍存在持续性精神病性症状，以排除假性抵抗。选取7例正在服用氯氮平并接受ECT治疗的住院患者。我们分析了ECT引起的精神病理学和分量表变化。
ECT平均治疗次数为13.4（±4.6）次。阳性和阴性症状量表（PANSS）总分平均显著降低17.9（±12.8）分（p = 0.0384），相当于降低了25.5%（±14.3）。71.4%（5/7）的患者达到临床缓解，PANSS评分至少降低20%。PANSS评分降低与ECT治疗次数、最后一次治疗的刺激水平以及ECT治疗前的氯氮平血药浓度有关。然而，ECT并未使任何患者的PANSS阴性分量表得分降低。我们未观察到任何持续性不良认知效应。
本研究支持ECT强化治疗氯氮平抵抗性精神分裂症具有临床有效性和安全性。应开展涉及更多患者的进一步研究，以探讨氯氮平/ECT联合治疗的有效性。
