Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia
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초록
Objective: This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review. Methods: 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. Results: 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. Conclusion: 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.
Abstract
Objective: This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review. Methods: 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. Results: 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. Conclusion: 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.
참고문헌 (35)
- Dold M, "Pharmacotherapy of treatment-resistant schizophrenia : a clinical perspective", Evid Based Ment Health, 17, pp.33~37 (2014)
- Juarez-Reyes MG, "Effects of stringent criteria on eligibility for clozapine among public mental health clients", Psychiatr Serv, 46, pp.801~806 (1995)
- Meltzer HY, "Treatment-resistant schizophrenia--the role of clozapine", Curr Med Res Opin, 14, pp.1~20 (1997)
- Petrides G, "Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study", Am J Psychiatry, 172, pp.52~58 (2015)
- Remington G, "Augmentation strategies in clozapine-resistant schizophrenia", CNS Drugs, 19, pp.843~872 (2005)
- Miyamoto S, "New therapeutic approaches for treatment-resistant schizophrenia : a look to the future", J Psychiatr Res, 58, pp.1~6 (2014)
- Kerwin RW, "Management of clozapine-resistant schizophrenia", Adv Psychiatr Treat, 11, pp.101~106 (2005)
- Shiloh R, "Sulpiride augmentation in people with schizophrenia partially responsive to clozapine. A double-blind, placebo-controlled study", Br J Psychiatry, 171, pp.569~573 (1997)
- Kerwin R, "From pharmacological profiles to clinical outcomes", Int Clin Psychopharmacol, 15(Suppl 4), pp.S1~S4 (2000)
- Fink M, "Clozapine and electroconvulsive therapy", Arch Gen Psychiatry, 47, pp.290~291 (1990)
- Masoudzadeh A, "Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients", Pakistan Journal of Biological Sciences, 10, pp.4287~4290 (2007)
- Williams L, "Clozapine-resistant schizophrenia : a positive approach", Br J Psychiatry, 181, pp.184~187 (2002)
- Friedel RO, "The combined use of neuroleptics and ECT in drug resistant schizophrenic patients", Psychopharmacol Bull, 22, pp.928~930 (1986)
- Safferman AZ, "Combining Clozapine with ECT", Convuls Ther, 8, pp.141~143 (1992)
- Benatov R, "Neuroleptic-resistant schizophrenia treated with clozapine and ECT", Convuls Ther, 12, pp.117~121 (1996)
- Bhatia SC, "Concurrent administration of clozapine and ECT : a successful therapeutic strategy for a patient with treatment-resistant schizophrenia", J ECT, 14, pp.280~283 (1998)
- Kales HC, "Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia", Prog Neuropsychopharmacol Biol Psychiatry, 23, pp.547~556 (1999)
- Kho KH, "Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia--an open label study", Eur Arch Psychiatry Clin Neurosci, 254, pp.372~379 (2004)
- Grover S, "Combined use of clozapine and ECT : a review", Acta Neuropsychiatr, 27, pp.131~142 (2015)
- Havaki-Kontaxaki BJ, "Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia", Clin Neuropharmacol, 29, pp.52~56 (2006)
- Kupchik M, "Combined electroconvulsive-clozapine therapy", Clin Neuropharmacol, 23, pp.14~16 (2000)
- Lally J, "Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia : a systematic review and meta-analysis", Schizoph Res, 171, pp.215~224 (2016)
- Porcelli S, "Clozapine resistance : augmentation strategies", Eur Neuropsychopharmacol, 22, pp.165~182 (2012)
- Muscatello MR, "Augmentation strategies in partial responder and", or treatment-resistant schizophrenia patients treated with clozapine, 2014, pp.15, 2329~2345
- Buchanan RW, "The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements", Schizophr Bull, 36, pp.71~93 (2010)
- Leucht S, "The PANSS should be rescaled", Schizophr Bull, 36, pp.461~462 (2010)
- Hwang SS, "Causal model of insight and psychopathology based on the PANSS factors : 1-year cross-sectional and longitudinal revalidation", Int Clin Psychopharmacol, 24, pp.189~198 (2009)
- Lee JH, "Development of the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet(CERAD-K) : clinical and neuropsychological assessment batteries", J Gerontol B Psychol Sci Soc Sci, 57, pp.47~53 (2002)
- Coffey CE, "Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold", Biol Psychiatry, 37, pp.713~720 (1995)
- Kay SR, "The Positive and Negative Syndrome Scale(PANSS)for schizophrenia", Schizophr Bull, 13, pp.261~276 (1987)
- Chanpattana W, "Short-term effect of combined ECT and neuroleptic therapy in treatment-resistant schizophrenia", J ECT, 15, pp.129~139 (1999)
- Chanpattana W, "Combined ECT and neuroleptic therapy in treatment : prediction of outcome", Psychiatry Res, 105, pp.107~115 (2001)
- Payne NA, "Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT", J Psychiatr Pract, 15, pp.346~368 (2009)
- Pawelczyk T, "Augmentation of antipsychotics with electroconvulsive therapy in treatment-resistant schizophrenia patients with dominant negative symptoms : a pilot study of effectiveness", Neuropsychobiology, 70, pp.158~164 (2014)
- Schooler NR, "Defining therapeutic benefit for people with schizophrenia : focus on negative symptoms", Schizophr Res, 162, pp.169~174 (2015)