Rayikanti Ruth, Lentowicz Iga, Birur Badari, Li Li
Drs. Rayikanti, MD, Lentowicz, MD, Birur, MD, Li, MD, PhD, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, AL, USA.
Psychopharmacol Bull. 2017 May 15;47(2):57-62.
Treatment of patients with Treatment-resistant Schizophrenia (TRS), who fail to respond to multiple antipsychotic trials, including clozapine (CLZ), is challenging. Several alternative strategies are reported in studies, one of which includes augmenting antipsychotics (AP) with Electroconvulsive therapy (ECT). We discuss a case of an acutely psychotic patient with TRS who responded effectively and sustained remission to this strategy which was ECT combined with two AP, CLZ and aripiprazole. Notable improvement in clinical and cognitive outcomes was seen with just five right unilateral ECT sessions, CLZ titrated up to 62.5 mg/d and aripiprazole 20 mg/d with no adverse effects. Nine days into the psychiatric hospitalization, patient had decreased total scores on the Positive and Negative Syndrome Scale by 44% and an improved score on the St. Louis University Mental Status Exam by increasing from 3 to 22. This case report suggests that a subgroup of patients with TRS could benefit from a trial of adjunct ECT combined with AP to achieve a rapid alleviation of positive and negative symptoms which allows patients to have greater functional stability.
治疗难治性精神分裂症（TRS）患者具有挑战性，这类患者对包括氯氮平（CLZ）在内的多种抗精神病药物试验均无反应。研究报道了几种替代策略，其中之一是用电休克疗法（ECT）增强抗精神病药物（AP）的疗效。我们讨论了一例患有TRS的急性精神病患者，该患者对ECT联合两种抗精神病药物（CLZ和阿立哌唑）的治疗策略产生了有效且持续的缓解反应。仅进行了5次右侧单侧ECT治疗、将CLZ滴定至62.5mg/d以及阿立哌唑20mg/d，临床和认知结果就有显著改善，且无不良反应。在精神科住院第9天时，患者的阳性和阴性症状量表总分下降了44%，圣路易斯大学精神状态检查得分从3分提高到22分。本病例报告表明，一部分TRS患者可能受益于ECT联合AP的试验，以快速缓解阳性和阴性症状，使患者具有更高的功能稳定性。
