Combining ECT and Clozapine in the Treatment of Clozapine-Refractory Schizophrenia and Schizoaffective Disorder-A Pilot Study

By Koen, L.; van den Berg, C. E. et al. | South African Journal of Psychiatry, December 2008 | Go to article overview

Combining ECT and Clozapine in the Treatment of Clozapine-Refractory Schizophrenia and Schizoaffective Disorder-A Pilot Study


Koen, L., van den Berg, C. E., Niehaus, D. J. H., South African Journal of Psychiatry


Schizophrenia is considered to be among the most severe, debilitating and persistent of all psychiatric disorders. Although the adult prevalence is approximately 1%, studies have indicated that sufferers constitute close to 10% of the permanently disabled population. (1) As such, schizophrenia is a major public health problem and the negative economic consequences underscore the urgent need to develop strategies to improve treatment effectiveness. (2)

Despite great advances in the understanding and management of the disease, a significant portion of individuals with schizophrenia do not respond well to drug treatment. (3) Management of these treatment-refractory patients is particularly challenging as they often require longer periods of hospitalisation, with their care ultimately amounting to a disproportionately high share of the total cost of schizophrenia. (1) Although the advent of the second-generation antipsychotic drugs has been regarded as a breakthrough owing to improved side-effect profiles and patient satisfaction, claims of their superior efficacy in treatment-refractory patients still remain unproven. (4) To date, in terms of evidence base, clozapine remains the undisputed treatment of choice for patients with severe treatment-refractory schizophrenia. (5-7)

Unfortunately, even though clozapine remains the gold standard, recent data show that 40 - 70% of sufferers from treatment-refractory schizophrenia treated with clozapine monotherapy, of adequate dosage and duration will continue to experience cognitive deficits and disabling symptoms, i.e. positive, negative or residual symptoms. (4-6,8) Several factors have been implicated in patient failure to respond to clozapine monotherapy, including patient non-compliance and intolerable and/or serious side-effects such as agranulocytosis, seizures, sedation, hypersalivation and metabolic issues. (3,9) However, for patients in whom these can be managed and who show at least partial response to monotherapy, effective clozapine augmentation treatment strategies need to be developed. (4)

Numerous different clozapine augmentation strategies have been described in the literature, but there is currently no actual evidence supporting one strategy over another, with research consisting mostly of case reports and small open-label, unreplicated studies. (6,10-15) Strategies include adjunctive antipsychotic medications, mood stabilisers and novel anticonvulsants, antidepressants such as selective serotonin re-uptake inhibitors and others, glycinergic agents, dopamine agonists, mazindol, omega-3 fatty acids and electroconvulsive therapy (ECT).

The combined use of clozapine and ECT was first proposed in 1990 by Fink and reported on in 1991. (9,15,16) A recent literature review on ECT-clozapine bitherapy in patients with treatment-refractory schizophrenia previously treated with clozapine monotherapy revealed 72% of reported cases to have had a beneficial response on the combination treatment. (17) To date, the largest single study reported on in the literature is an open-label study evaluating ECT-clozapine bitherapy in 11 clozapine non-responders, with 8 meeting remission criteria after treatment. (18)

Safety issues could be regarded as one potential concern when considering the use of ECT-clozapine bitherapy. It is known that clozapine use may lead to an increased risk of seizures or even prolonged seizures due to the threshold-lowering effects of clozapine. (19,20) Both ECT and clozapine may also cause cardiac arrhythmias, and memory effects have been described. (21-23) However, a recent review article on somatic augmentation strategies in clozapine-refractoriness by Tranulis et al. found that only seven incidences of significant side-effects in ECT-clozapine bitherapy had been described, with no fatalities. (24) They concluded ECT to be a safe and tolerable clozapine augmentation strategy. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Combining ECT and Clozapine in the Treatment of Clozapine-Refractory Schizophrenia and Schizoaffective Disorder-A Pilot Study
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.