Ahmed Saeed, Khan Ali Mahmood, Mekala Hema Madhuri, Venigalla Hema, Ahmed Rizwan, Etman Amira, Esang Michael, Qureshi Mustafa
Nassau University Medical Center, NY, USA.
Kings County Hospital Center, NY, USA.
Heliyon. 2017 Nov 3;3(11):e00429. doi: 10.1016/j.heliyon.2017.e00429. eCollection 2017 Nov.
To assess the relative efficacies of clozapine plus Electroconvulsive Therapy (ECT) compared against non-clozapine typical and atypical antipsychotics plus ECT for the treatment of "Treatment Resistant Schizophrenia" (TRS). Primarily to assess if clozapine delivers a significant improvement over other antipsychotics when combined with ECT.
Major electronic databases were searched between 1990 and March 2017 for trials measuring the effects of either clozapine augmented ECT, other antipsychotic-augmented ECT, or both. After the systematic review of the data, a random-effects meta-analysis was conducted measuring the relative effect sizes of the different treatment regimens.
1179 patients in 23 studies reporting the usage of ECT augmentation with antipsychotics. A total of 95 patients were tested with clozapine, and ECT (9 studies) and 1084 patients were tested with non-clozapine antipsychotics (14 studies) such as flupenthixol, chlorpromazine, risperidone, sulpiride, olanzapine, and loxapine with concurrent ECT treatment considered for systematic review. Of these, 13 studies reported pre and post-treatment scores were included in the meta-analysis.
The main outcome measure was the presence and degree of both positive and negative psychotic symptoms, as measured by either of two standardized clinician administered tests, the Brief Psychiatric Rating Scale (BPRS), and the Positive and Negative Symptom Scale (PANSS).
The comparison of the different antipsychotics established the supremacy of ECT-augmented clozapine treatment against other typical and atypical antipsychotics. The Forest Plot revealed that the overall standard mean difference was 0.891 for non-clozapine studies and 1.504 for clozapine studies, at a 95% interval. Furthermore, the heterogeneity plots showed that while clozapine studies showed no significant heterogeneity, non-clozapine studies showed an I2 statistic value at 42.19%, suggesting moderate heterogeneity. Lastly, publication bias showed asymmetrical plots and significant values of Kendal's tau and Egger's rank test.
ECT augmentation technique was found to be effective in the reduction of psychometric scale scores, and the resulting improvement was significant. Clozapine maintained its stance as the most effective treatment for Treatment-Resistant Schizophrenia, followed by flupenthixol.
评估氯氮平联合电休克治疗（ECT）与非氯氮平类典型及非典型抗精神病药物联合ECT治疗“难治性精神分裂症”（TRS）的相对疗效。主要评估氯氮平与ECT联合使用时是否比其他抗精神病药物有显著改善。
检索1990年至2017年3月期间的主要电子数据库，以查找测量氯氮平强化ECT、其他抗精神病药物强化ECT或两者效果的试验。在对数据进行系统评价后，进行随机效应荟萃分析，测量不同治疗方案的相对效应大小。
23项研究中的1179例患者报告了使用抗精神病药物强化ECT的情况。共有95例患者接受氯氮平与ECT联合治疗（9项研究），1084例患者接受非氯氮平类抗精神病药物治疗（14项研究），如氟哌噻吨、氯丙嗪、利培酮、舒必利、奥氮平和洛沙平，并同时接受ECT治疗以进行系统评价。其中，13项研究报告了治疗前后的评分，纳入荟萃分析。
主要观察指标是通过两种标准化的临床医生管理测试之一，即简明精神病评定量表（BPRS）和阳性与阴性症状量表（PANSS）测量的阳性和阴性精神病症状的存在情况及程度。
不同抗精神病药物的比较确立了ECT强化氯氮平治疗优于其他典型和非典型抗精神病药物。森林图显示，非氯氮平研究的总体标准平均差为0.891，氯氮平研究为1.504，置信区间为95%。此外，异质性图显示，氯氮平研究未显示出显著的异质性，而非氯氮平研究的I2统计值为42.19%，表明存在中度异质性。最后，发表偏倚显示出不对称图以及肯德尔tau检验和埃格秩检验的显著值。
发现ECT强化技术可有效降低心理测量量表评分，且改善效果显著。氯氮平仍然是治疗难治性精神分裂症最有效的药物，其次是氟哌噻吨。
