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Augmentation of clozapine with ECT: a retrospective case analysis

Published online by Cambridge University Press:  24 September 2020

John Lally Open the ORCID record for John Lally [Opens in a new window] ,
Emily Breese ,
Mugtaba Osman ,
Cai Hua Sim ,
Hitesh Shetty ,
Amir Krivoy  and
James H. MacCabe
John Lally*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Psychiatry, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland Department of Psychiatry, St Vincent’s Hospital Fairview, Dublin, Ireland
Emily Breese
Affiliation:
School of Life, Health and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, UK
Mugtaba Osman
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
Cai Hua Sim
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
Hitesh Shetty
Affiliation:
BRC Case Register, South London and Maudsley NHS Foundation Trust, London, UK
Amir Krivoy
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
James H. MacCabe
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
*
Author for correspondence: John Lally, Email: [email protected]
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Abstract

Objective:

We sought to assess the effectiveness of clozapine augmentation with Electroconvulsive therapy (ECT) (C+ECT) in patients with clozapine-resistant schizophrenia.

Methods:

We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT.

Results:

Forty-two patients were treated with C+ECT over a 10-year period. The mean age of the patients at initiation of ECT was 46.3 (SD = 8.2) years (range 27–62 years). The mean number of ECTs given was 10.6 (SD = 5.3) (range 3–25) with the majority receiving twice weekly ECT. Seventy-six per cent of patients (n = 32) showed a Clinical Global Impression-Improvement (CGI-I) score of ≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3–25) with the majority receiving twice weekly ECT. Sixty-four per cent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness or duration of clozapine treatment. Seventy-five per cent of responders remained out of hospital over the course of 1-year follow-up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised.

Conclusion:

This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine-resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended.

Keywords

schizophreniatreatment-resistantelectroconvulsive therapypsychosisclozapine
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 33 , Issue 1 , February 2021 , pp. 31 - 36
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Copyright
© Scandinavian College of Neuropsychopharmacology 2020

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Footnotes

*

Both are first named authors and should be acknowledged as such.

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