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Young patient with treatment-resistant schizophrenia drastically improved by combination of clozapine and maintenance electroconvulsive therapy: a case report

Authors Ito M, Kunii Y, Horikoshi S, Miura I, Itagaki S, Shiga T, Yabe H

Received 13 December 2018

Accepted for publication 3 April 2019

Published 21 June 2019 Volume 2019:12 Pages 185—188


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Taro Kishi

Masashi Ito,1 Yasuto Kunii,1,2 Sho Horikoshi,1 Itaru Miura,1 Shuntaro Itagaki,1 Tetsuya Shiga,1 Hirooki Yabe1

1Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan; 2Department of Neuropsychiatry, Fukushima Medical University School of Aizu Medical Center, Fukushima, Japan

Objectives: Although clozapine is considered the only effective pharmacological option for patients with treatment-resistant schizophrenia (TRS), around 30–40% of patients show clozapine resistance. Modified electroconvulsive therapy augmentation is reportedly clinically effective for clozapine-resistant schizophrenia, but few case reports have described the efficacy of combining clozapine and continuous/maintenance ECT for patients with TRS.
Methods: We present the case of a young patient with TRS who was treated using combination therapy with clozapine and maintenance ECT (m-ECT).
Results: The patient achieved drastic improvement under combination therapy with clozapine and m-ECT. Total Positive and Negative Syndrome Scale (PANSS) score fell markedly by 36 (from 108 to 72) using the combination of clozapine and m-ECT. Behaviors not reflected directly by PANSS score also improved. For example, the problem of being unable to take oral drugs stably because of delusions of poisoning was resolved. Furthermore, the patient maintained improvement under m-ECT, and long-term homestays became possible.
Conclusion: Combination therapy with clozapine and m-ECT proved greatly effective in this case. Further clinical trials of this combination therapy for TRS are needed to confirm the effectiveness. Further studies are also expected to examine effective periods for this therapy.

Keywords: treatment-resistant schizophrenia (TRS), modified electroconvulsive therapy, augmentation, clozapine, maintenance ECT(m-ECT)

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