Resumen
La clozapina es considerada el antipsicótico más efectivo en el manejo de la esquizofrenia resistente. A pesar de esto, hasta un tercio de los pacientes no responde a tratamiento, por lo que se han planteado múltiples estrategias terapéuticas, entre ellas la terapia electroconvulsiva, aunque aún no está claro si es efectiva y segura en estos casos. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos seis revisiones sistemáticas que en conjunto incluyen 55 estudios, entre los cuales hay seis estudios aleatorizados que evalúan esquizofrenia resistente a clozapina. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la terapia electroconvulsiva probablemente aumenta la respuesta a tratamiento en pacientes con esquizofrenia resistente que usan clozapina, sin embargo no es posible determinar si produce efectos adversos a nivel cognitivo porque la certeza de la evidencia es muy baja.
Problema
Entre 20 y 30% de las personas con esquizofrenia reciben el diagnóstico de “esquizofrenia resistente”, la que se define como la ausencia de respuesta a tratamiento con dos antipsicóticos distintos. En algunos de estos casos, la clozapina logra controlar los síntomas. Sin embargo, entre 30 y 40% no responde a este antipsicótico.
Se han intentado múltiples estrategias para potenciar el efecto terapéutico de la clozapina. Una de estas alternativas es la terapia electroconvulsiva, la cual consiste en la estimulación eléctrica del cerebro del paciente anestesiado. Si bien no se conoce completamente su mecanismo de acción, se plantean cuatro vías: aumento de la liberación de monoaminas; estimulación de la secreción pituitaria de TSH, ACTH, endorfinas y prolactina; aumento de la neurogénesis; y efecto anticonvulsivante posterior a la sesión.
El presente resumen busca evaluar si la terapia electroconvulsiva es un tratamiento efectivo y seguro en pacientes con esquizofrenia resistente, que usan clozapina.
Métodos
Utilizamos la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, para identificar revisiones sistemáticas y sus estudios primarios incluidos. Con esta información generamos un resumen estructurado, siguiendo un formato preestablecido, que incluye mensajes clave, un resumen del conjunto de evidencia (presentado como matriz de evidencia en Epistemonikos), metanálisis del total de los estudios, tablas de resumen de resultados con el método GRADE, y tabla de otras consideraciones para la toma de decisión.
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Mensajes clave
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Acerca del conjunto de evidencia para esta pregunta
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Cuál es la evidencia. |
Encontramos seis revisiones sistemáticas [1],[2],[3],[4], [5],[6] que incluyen 55 estudios primarios [7],[8],[9], [10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20], [21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31], [32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42], [43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53], [54],[55],[56],[57],[58],[59],[60],[61], de los cuales 24 corresponden a estudios controlados aleatorizados [7],[8], [9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20], [21],[22],[23],[24],[25],[26],[27],[28],[29],[30]. En seis de estos últimos [7],[8],[9],[12],[16],[17], los pacientes estaban en tratamiento con clozapina, por lo que el resumen se enfoca principalmente en estos. Sin embargo, la información sobre algunos desenlaces solo se reportó en estudios observacionales, por lo que estos casos se incluyeron en nuestro análisis. |
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Qué tipo de pacientes incluyeron los estudios |
Cuatro de los seis estudios aleatorizados realizaron el diagnóstico de esquizofrenia con criterios CCMD-3 [8],[9], [12],[17] y solo uno con criterios DSM-IV [16]. Un estudio no reportó el método diagnóstico [7]. Dos estudios aleatorizados [9],[16] definieron resistencia como falla del tratamiento con dos o más antipsicóticos, mientras que tres lo definieron como falla con tres o más [8],[12],[17] y un estudio no reportó como definió la resistencia [7]. Los estudios observacionales [38],[55],[62] no describieron los criterios diagnósticos de esquizofrenia ni cómo fue definida la resistencia al tratamiento. |
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Qué tipo de intervenciones incluyeron los estudios |
Un estudio aleatorizado [17] no reportó la dosis de clozapina utilizada, tres utilizaron más de 600 mg/día en equivalentes de clorpromazina [8],[9],[16], uno usó más de 250 mg/día [7] y uno más de 1000 mg/día [12]. Respecto al régimen de terapia electroconvulsiva, los estudios aleatorizados emplearon entre 6 a 20 sesiones, aunque un estudio [7] no reportó este dato. Los estudios observacionales no describieron el número de sesiones empleadas. Cuatro estudios aleatorizados realizaron las sesiones 2-3 veces por semana [8],[9],[16],[17] y dos estudios no reportaron la frecuencia [7],[12]. Los estudios observacionales [38],[55],[62] no describieron las dosis utilizadas, ni la frecuencia de la terapia electroconvulsiva. Todos los estudios aleatorizados compararon contra placebo o tratamiento estándar |
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Qué tipo de desenlaces midieron |
Las revisiones evaluaron mejoría sintomática mediante cualquier definición utilizada en los estudios. Los estudios primarios definieron mejoría sintomática como un cambio en la escala Positive and Negative Syndrome Scale (PANSS) ≥20% [17], ≥25% [9] o ≥40% [16], o como un cambio en la escala Brief Psychiatric Rating Scale (BPRS) ≥20% [7] o ≥25% [8],[12]. Sólo una revisión sistemática evaluó el desempeño neurocognitivo posterior a la realización de la terapia electroconvulsiva [6]. |
Resumen de los resultados
La información sobre los efectos de la terapia electroconvulsiva está basada en seis estudios aleatorizados que incluyen 368 pacientes, y en tres estudios observacionales para los desenlaces en los cuales no se encontró información proveniente de estudios aleatorizados. Todos los estudios aleatorizados midieron la respuesta a tratamiento. La información sobre el desempeño en pruebas neurocognitivas se reportó en una revisión sistemática [6], que incorporó cuatro estudios primarios para la medición del desenlace. La presencia de convulsiones prolongadas fue evaluada en sólo un estudio observacional [55] y la influencia sobre los días de hospitalización fue reportada por dos estudios observacionales [38],[62].
- La terapia electroconvulsiva probablemente aumenta la respuesta a tratamiento en pacientes con esquizofrenia resistente que usan clozapina. La certeza de la evidencia es moderada.
- No está claro si la terapia electroconvulsiva disminuye la necesidad de hospitalizarse en pacientes con esquizofrenia resistente que usan clozapina porque la certeza de la evidencia es muy baja.
- No está claro si la terapia electroconvulsiva produce efectos adversos a nivel cognitivo en pacientes con esquizofrenia resistente que usan clozapina porque la certeza de la evidencia es muy baja.
- No está claro si la terapia electroconvulsiva aumenta el riesgo de convulsiones en pacientes con esquizofrenia resistente que usan clozapina porque la certeza de la evidencia es muy baja.
Otras consideraciones para la toma de decisión
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A quién se aplica y a quién no se aplica esta evidencia |
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| Sobre los desenlaces incluidos en este resumen |
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| Balance riesgo/beneficio y certeza de la evidencia |
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| Qué piensan los pacientes y sus tratantes |
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| Consideraciones de recursos |
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| Diferencias entre este resumen y otras fuentes |
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| ¿Puede que cambie esta información en el futuro? |
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Cómo realizamos este resumen
Mediante métodos automatizados y colaborativos recopilamos toda la evidencia relevante para la pregunta de interés y la presentamos en una matriz de evidencia.
Siga el enlace para acceder a la versión interactiva: Terapia electroconvulsiva para el tratamiento de la esquizofrenia resistente
Notas
Si con posterioridad a la publicación de este resumen se publican nuevas revisiones sistemáticas sobre este tema, en la parte superior de la matriz se mostrará un aviso de “nueva evidencia”. Si bien el proyecto contempla la actualización periódica de estos resúmenes, los usuarios están invitados a comentar en Medwave o contactar a los autores mediante correo electrónico si creen que hay evidencia que motive una actualización más rápida.
Luego de crear una cuenta en Epistemonikos, al guardar las matrices recibirá notificaciones automáticas cada vez que exista nueva evidencia que potencialmente responda a esta pregunta. El detalle de los métodos para elaborar este resumen están descritos aquí: http://dx.doi.org/10.5867/medwave.2014.06.5997.
La Fundación Epistemonikos es una organización que busca acercar la información a quienes toman decisiones en salud, mediante el uso de tecnologías. Su principal desarrollo es la base de datos Epistemonikos (www.epistemonikos.org).
Los resúmenes de evidencia siguen un riguroso proceso de revisión por pares interno.
Declaración de conflictos de intereses
Los autores declaran no tener conflictos de intereses con la materia de este artículo.
Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.
La clozapina es considerada el antipsicótico más efectivo en el manejo de la esquizofrenia resistente. A pesar de esto, hasta un tercio de los pacientes no responde a tratamiento, por lo que se han planteado múltiples estrategias terapéuticas, entre ellas la terapia electroconvulsiva, aunque aún no está claro si es efectiva y segura en estos casos. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos seis revisiones sistemáticas que en conjunto incluyen 55 estudios, entre los cuales hay seis estudios aleatorizados que evalúan esquizofrenia resistente a clozapina. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la terapia electroconvulsiva probablemente aumenta la respuesta a tratamiento en pacientes con esquizofrenia resistente que usan clozapina, sin embargo no es posible determinar si produce efectos adversos a nivel cognitivo porque la certeza de la evidencia es muy baja.
Authors:
Lucas Kittsteiner Manubens [1,2 ], Diego Lobos Urbina [1,2 ], David Aceituno [2,3 ]
Affiliation:
[1] Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[2] Proyecto Epistemonikos, Santiago, Chile
[3] Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
E-mail: daceituno@med.puc.cl
Author address:
[1] Facultad de Medicina
Pontificia Universidad Católica de Chile
Diagonal Paraguay 362
5º piso
Santiago Centro
Chile
Citation: Kittsteiner Manubens L , Lobos Urbina D , Aceituno D . Is electroconvulsive therapy effective as augmentation in clozapine-resistant schizophrenia?. Medwave 2016;16(Suppl5):e6577 doi: 10.5867/medwave.2016.6577
Publication date: 14/10/2016
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- Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Paplos KG, Soldatos CR. Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia. Clin Neuropharmacol. 2006 Jan-Feb;29(1):52-6. | PubMed |
- Lally J, Tully J, Robertson D, Stubbs B, Gaughran F, MacCabe JH. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis. Schizophr Res. 2016 Mar;171(1-3):215-24. | CrossRef | PubMed |
- Lima NN, Nascimento VB, Peixoto JA, Moreira MM, Neto ML, Almeida JC, et al. Electroconvulsive Therapy Use in Adolescents: A Systematic Review. Ann Gen Psychiatry. 2013 May 30;12(1):17. | CrossRef | PubMed |
- Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, et al. Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res. 2013 May;146(1-3):1-9. | CrossRef | PubMed |
- Porcelli S, Balzarro B, Serretti A. Clozapine resistance: augmentation strategies. Eur Neuropsychopharmacol. 2012 Mar;22(3):165-82. | CrossRef | PubMed |
- Wang W, Pu C, Jiang J, Cao X, Wang J, Zhao M, Li C. Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis. Shanghai Arch Psychiatry. 2015 Aug 25;27(4):206-19. | CrossRef | PubMed |
- Braga RJ, Mendelowitz AJ, Fink M, Schooler NR, Bailine SH, Malur C. A randomized controlled trial of ECT in clozapine-refractory schizophrenia. Biological Psychiatry. 2009;s8:212S–213S. | Link |
- Cai Xiong, LinLiang,SU Ying, Zheng Youmin, Luo Xiu Fang,Yang Feng. A Comparison Study of MECT Combining Clozapine in the Treatment of Treatment- Resistant Schizophrenia. Chinese People ’s Health. 2008;(13):1423-1424. | Link |
- Chen Derong. Comparative Analysis of MECT Treatment on Refractory Schizophrenia. Xinjiang Medical Journal. 2012; 42(09):57-60. | CrossRef |
- Chen Qu Liang, Weng KH, XU Zhenqiang, Wang Xinglong. A Control Study of Antipsychotic Combined with MECT in Treatment-Resistant Schizophrenia. Journal of Clinical Psychosomatic Diseases. 2013;19(3): 204–206. | CrossRef |
- Ding Ling, YanJuan Ma. Clinical Study of MECT on 100 Patients with Refractory Schizophrenia. Chinese Community Doctors. 2011;13(31): 82–83. | CrossRef |
- Du Zhihua, FengMei Li, SuPing Liu. Analysis of Efficacy and Safety of Clozapine Combined with MECT Treatment on Refractory Schizophrenia. Medical Journal of Chinese People’s Health 2011;23(24):3056,3115. | CrossRef |
- Jian, Shen Hui, Sheng Jiang Huang, Liqun Wei. Clinical Analysis of MECT on 46 Patients with Refractory Schizophrenia. Chinese Community Doctors. 2011 13(17):57. | CrossRef |
- Masoudzadeh A, Khalilian AR. Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients. Pak J Biol Sci. 2007 Dec 1;10(23):4287-90. | PubMed |
- Liu Fajiang, Gaoqin Gong. Effect of Schizophrenia MECT. China Modern Doctor. 2010 48(01):29. | CrossRef |
- Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry. 2015 Jan;172(1):52-8. | CrossRef | PubMed |
- Yang Jun Kong, Gao Huan, WU, Dong-hui, Feng Zheng, Wu Huaian. A Comparative Study of Combination Therapy with Excitement MECT Aggressive Behavior of Refractory Schizophrenia. Chinese People ’s Health. 2005;(9): 485-486. | CrossRef |
- Zhang Shang Rong, Zhang Jinling, Xiu Zhen, Yang Ye Peng, Lang Sen. Observational Study of the Efficacy of MECT Combined Olanzapine on the Treatment of Refractory Schizophrenia. People’s Military Surgeon. 2012; 55(2):141-143. | Link |
- Wang Youbing. Comparative Study of Quetiapine Combined MECT on the Treatment of Female Refractory Schizophrenia. Contemporary Medicine. 2012 18(22):133-134. | CrossRef |
- Chanpattana W, Chakrabhand ML, Sackeim HA, Kitaroonchai W, Kongsakon R, Techakasem P, et al. Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT. 1999 Sep;15(3):178-92. | PubMed |
- Ding Yuan Fu, Shi whole Zheng, Changhai Song. The comparison study of curative effect of risperidone and modified electroconvulsive shock therapy in refractory schizophrenia. Journal of Psychiatry. 2007;20(06):397-398. | CrossRef |
- Wang, Fei, Dingwang Guo. Efficacy Study of Olanzapine Combined with MECT on the Treatment of Refractory Schizophrenia. Chinese Journal of Clinical Rational Drug Use. 2013; 6(24):99. | CrossRef |
- Duo J. Intractable Mental Disease Clinical Classification Analysis. Medical Information. 2011;24(05):2003-2004.
- Yang Kai Ren, Jian Xiaoqin, Mao Furong, Jiang Zheng. Modified electroconvulsive therapy combined with risperidone in treatment of negative symptoms in treatment-resistant schizophrenia. Zhejiang Medical Journal. 2011; 33(11):1602-1605. | CrossRef |
- Liu Guanjun, Guangsheng Liu, Xiaobin Zhang. A control study of risperidone combined with mect in refractory schizophrenia. Journal of Clinical Psychosomatic Diseases. 2010;16(1):57-60. | CrossRef |
- Jiang Xiaoqin, Yang Kairen, Kim Pang, Zheng Lifeng, Chin Miranda. Clinical study of risperidone combining mect treatment of refractory schizophrenia. Chinese Journal of Nervous and Mental Diseases. 2009;35(02):79-83. | CrossRef |
- Zhou Huijing, Mao Zhengrong, Chen YJ, Song BF, Shi DQ. A comparative study of modified electroconvulsive therapy combined with olanzapine in the treatment of treatment-refractory schizophrenia. Journal Of Nevroscience And Mental Health. 2009;9(4):328-331. | CrossRef |
- Jiang Zhengwei. Clinical analysis on mect combined with ziprasidone in treatment of patients with refractory schizophrenia. Journal of Clinical and Experimental Medicine. 2013;12(17):1394-1395. | CrossRef |
- Small JG, Milstein V, Klapper M, Kellams JJ, Small IF. ECT Combined with neuroleptics in the treatment of schizophrenia.” Psychopharmacol Bull. 1982;18(1):34-35. | Link |
- Goswami U, Kumar U, Singh B. Efficacy of Electroconvulsive Therapy in Treatment Resistant Schizophreinia: A double-blind study. Indian J Psychiatry. 2003 Jan;45(1):26-9. | PubMed |
- Safferman AZ, Munne R. Combining Clozapine with ECT. Convuls Ther. 1992;8(2):141-143. | PubMed |
- Cardwell BA, Nakai B. Seizure activity in combined clozapine and ECT: a retrospective view. Convuls Ther. 1995 Jun;11(2):110-3. | PubMed |
- Bannour S, Bouhlel S, Krir MW, Amamou B, Ben Nasr S, El Kissi Y, et al. Combination of maintenance electroconvulsive therapy and clozapine in treating a patient with refractory schizophrenia. J ECT. 2014 Sep;30(3):e29-30. | CrossRef | PubMed |
- Benatov R, Sirota P, Megged S. Neuroleptic-resistant schizophrenia treated with clozapine and ECT. Convuls Ther. 1996 Jun;12(2):117-21. | PubMed |
- Biedermann F, Pfaffenberger N, Baumgartner S, Kemmler G, Fleischhacker WW, Hofer A. Combined clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia: clinical and cognitive outcomes. J ECT. 2011 Dec;27(4):e61-2. | CrossRef | PubMed |
- Ravanić DB, Pantović MM, Milovanović DR, Dukić-Dejanović S, Janjić V, Ignjatović DR, et al. Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia. Psychiatr Danub. 2009 Jun;21(2):179-86. | PubMed |
- Vowels EC, Hittur Lingappa S, Bastiampillai T. Combination clozapine and electroconvulsive therapy in a patient with schizophrenia and comorbid intellectual disability. Aust N Z J Psychiatry. 2014 Jul;48(7):689-90. | CrossRef | PubMed |
- Flamarique I, Castro-Fornieles J, Garrido JM, de la Serna E, Pons A, Bernardo M, Baeza I. Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination? J Clin Psychopharmacol. 2012 Dec;32(6):756-66. | CrossRef | PubMed |
- Frankenburg FR, Suppes T, McLean PE. Combined Clozapine and Electroconvulsive Therapy. Convuls Ther. 1993;9(3):176-180. | PubMed |
- Garg R, Chavan BS, Arun P. Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia. Indian J Med Res. 2011 Jun;133:641-4. | PubMed |
- Garg Rohit, S Chavan Bir, Priti Arun. Short-Term Efficacy of Electroconvulsive Therapy in Treatment-Resistant Schizophrenia. German Journal of Psychiatry. 2012;15(2):44-49. | Link |
- Gazdag G, Kocsis-Ficzere N, Tolna J. The augmentation of clozapine treatment with electroconvulsive therapy. Ideggyogy Sz. 2006 Jul 20;59(7-8):261-7. | PubMed |
- Gerretsen P, Diaz P, Mamo D, Kavanagh D, Menon M, Pollock BG, et al. Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review. J ECT. 2011 Sep;27(3):247-50. | CrossRef | PubMed |
- Grover S, Hazari N, Chakrabarti S, Avasthi A. Augmentation of Clozapine With ECT: Observations From India. Am J Psychiatry. 2015 May;172(5):487. | CrossRef | PubMed |
- Kales HC, Dequardo JR, Tandon R. Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 1999 Apr;23(3):547-56. | PubMed |
- Husni M, Haggarty J, Peat C. Clozapine does not increase ECT-seizure duration. Can J Psychiatry. 1999 Mar;44(2):190-1. | PubMed |
- Hustig H, Onilov R. ECT rekindles pharmacological response in schizophrenia. Eur Psychiatry. 2009 Dec;24(8):521-5. | CrossRef | PubMed |
- Keller S, Drexler H, Lichtenberg P. Very high-dose clozapine and electroconvulsive therapy combination treatment in a patient with schizophrenia. J ECT. 2009 Dec;25(4):280-1. | CrossRef | PubMed |
- Kho KH, Blansjaar BA, de Vries S, Babuskova D, Zwinderman AH, Linszen DH.Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia--an open label study. Eur Arch Psychiatry Clin Neurosci. 2004 Dec;254(6):372-9. | PubMed |
- Abraham KR, Kulhara P. The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study. Br J Psychiatry. 1987 Aug;151:152-5. | PubMed |
- Kristensen D, Bauer J, Hageman I, Jørgensen MB. Electroconvulsive therapy for treating schizophrenia: a chart review of patients from two catchment areas. Eur Arch Psychiatry Clin Neurosci. 2011 Sep;261(6):425-32. | CrossRef | PubMed |
- Kurian S, Tharyan P, Jacob KS. Combination of ECT and clozapine in drug-resistant schizophrenia. Indian J Psychiatry. 2005 Oct;47(4):245. | CrossRef | PubMed |
- Manjunatha N, Ram Kumar GS, Vidyendaran R, Muralidharan K, John JP. Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy. Indian J Psychol Med. 2011 Jan;33(1):80-2. | CrossRef | PubMed |
- Klapheke MM. Clozapine, ECT, and Schizoaffective Disorder, Bipolar Type. Convuls Ther. 1991;7(1):36-39. | PubMed |
- Pawełczyk T, Kołodziej-Kowalska E, Pawełczyk A, Rabe-Jabłońska J. Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms. Psychiatry Res. 2014 Dec 15;220(1-2):175-80. | CrossRef | PubMed |
- Bhatia SC, Bhatia SK, Gupta S. Concurrent administration of clozapine and ECT: a successful therapeutic strategy for a patient with treatment-resistant schizophrenia. J ECT. 1998 Dec;14(4):280-3. | PubMed |
- Sienaert P, Bouckaert F, Fernandez I, Hagon A, Hagon B, Peuskens J. Propofol in the management of postictal delirium with clozapine-electroconvulsive therapy combination. J ECT. 2004 Dec;20(4):254-7. | PubMed |
- Sinha, Deoraj. Fatal pulmonary embolism in a patient treated with clozapine and electroconvulsive therapy. Int J Med Phar Scienc. 2013;4(4):9-11. | Link |
- Lee WK, Shiah IS, Chen CY, Lin TL, Shen LJ. Electroconvulsive therapy-associated Pisa syndrome in clozapine treatment. Psychiatry Clin Neurosci. 2008 Dec;62(6):753. | CrossRef | PubMed |
- Tang WK, Ungvari GS. Efficacy of electroconvulsive therapy combined with antipsychotic medication in treatment-resistant schizophrenia: a prospective, open trial. J ECT. 2002 Jun;18(2):90-4. | PubMed |
- Yoshino Y, Ozaki Y, Kawasoe K, Ochi S, Niiya T, Sonobe N, et al. Combined clozapine and electroconvulsive therapy in a Japanese schizophrenia patient: a case report. Clin Psychopharmacol Neurosci. 2014 Aug;12(2):160-2. | CrossRef | PubMed |
- Ghaziuddin N, Kutcher SP, Knapp P, Bernet W, Arnold V, Beitchman J, et al. Practice parameter for use of electroconvulsive therapy with adolescents. J Am Acad Child Adolesc Psychiatry. 2004 Dec;43(12):1521-39. | PubMed |
- Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010 Sep 15;68(6):568-77. | CrossRef | PubMed |
- Rajkumar AP, Saravanan B, Jacob KS. Perspectives of patients and relatives about electroconvulsive therapy: a qualitative study from Vellore, India. J ECT. 2006 Dec;22(4):253-8. | PubMed |
- Rose D, Fleischmann P, Wykes T, Leese M, Bindman J. Patients' perspectives on electroconvulsive therapy: systematic review. BMJ. 2003 Jun 21;326(7403):1363. | PubMed |
- Greenhalgh J, Knight C, Hind D, Beverley C, Walters S. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. Health Technol Assess. 2005 Mar;9(9):1-156, iii-iv. | PubMed |
- Lehman AF. Treatment of Patients With Schizophrenia. American Psychiatric Association; 2010. | Link |
- Kazmierski,Jakub; Kloszewska, Iwona. Comparison of the Efficacy and Safety of the Bifrontal Electroconvulsive Therapy (ECT) and the Standard Bitemporal ECT in the Treatment of Patients With Schizophrenia. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). 2000. | Link |
Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Paplos KG, Soldatos CR. Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia. Clin Neuropharmacol. 2006 Jan-Feb;29(1):52-6. | PubMed |Lally J, Tully J, Robertson D, Stubbs B, Gaughran F, MacCabe JH. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: A systematic review and meta-analysis. Schizophr Res. 2016 Mar;171(1-3):215-24. | CrossRef | PubMed |Lima NN, Nascimento VB, Peixoto JA, Moreira MM, Neto ML, Almeida JC, et al. Electroconvulsive Therapy Use in Adolescents: A Systematic Review. Ann Gen Psychiatry. 2013 May 30;12(1):17. | CrossRef | PubMed |Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, et al. Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res. 2013 May;146(1-3):1-9. | CrossRef | PubMed |Porcelli S, Balzarro B, Serretti A. Clozapine resistance: augmentation strategies. Eur Neuropsychopharmacol. 2012 Mar;22(3):165-82. | CrossRef | PubMed |Wang W, Pu C, Jiang J, Cao X, Wang J, Zhao M, Li C. Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis. Shanghai Arch Psychiatry. 2015 Aug 25;27(4):206-19. | CrossRef | PubMed |Braga RJ, Mendelowitz AJ, Fink M, Schooler NR, Bailine SH, Malur C. A randomized controlled trial of ECT in clozapine-refractory schizophrenia. Biological Psychiatry. 2009;s8:212S–213S. | Link |Cai Xiong, LinLiang,SU Ying, Zheng Youmin, Luo Xiu Fang,Yang Feng. A Comparison Study of MECT Combining Clozapine in the Treatment of Treatment- Resistant Schizophrenia. Chinese People ’s Health. 2008;(13):1423-1424. | Link |Chen Derong. Comparative Analysis of MECT Treatment on Refractory Schizophrenia. Xinjiang Medical Journal. 2012; 42(09):57-60. | CrossRef |Chen Qu Liang, Weng KH, XU Zhenqiang, Wang Xinglong. A Control Study of Antipsychotic Combined with MECT in Treatment-Resistant Schizophrenia. Journal of Clinical Psychosomatic Diseases. 2013;19(3): 204–206. | CrossRef |Ding Ling, YanJuan Ma. Clinical Study of MECT on 100 Patients with Refractory Schizophrenia. Chinese Community Doctors. 2011;13(31): 82–83. | CrossRef |Du Zhihua, FengMei Li, SuPing Liu. Analysis of Efficacy and Safety of Clozapine Combined with MECT Treatment on Refractory Schizophrenia. Medical Journal of Chinese People’s Health 2011;23(24):3056,3115. | CrossRef |Jian, Shen Hui, Sheng Jiang Huang, Liqun Wei. Clinical Analysis of MECT on 46 Patients with Refractory Schizophrenia. Chinese Community Doctors. 2011 13(17):57. | CrossRef |Masoudzadeh A, Khalilian AR. Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients. Pak J Biol Sci. 2007 Dec 1;10(23):4287-90. | PubMed |Liu Fajiang, Gaoqin Gong. Effect of Schizophrenia MECT. China Modern Doctor. 2010 48(01):29. | CrossRef |Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry. 2015 Jan;172(1):52-8. | CrossRef | PubMed |Yang Jun Kong, Gao Huan, WU, Dong-hui, Feng Zheng, Wu Huaian. A Comparative Study of Combination Therapy with Excitement MECT Aggressive Behavior of Refractory Schizophrenia. Chinese People ’s Health. 2005;(9): 485-486. | CrossRef |Zhang Shang Rong, Zhang Jinling, Xiu Zhen, Yang Ye Peng, Lang Sen. Observational Study of the Efficacy of MECT Combined Olanzapine on the Treatment of Refractory Schizophrenia. People’s Military Surgeon. 2012; 55(2):141-143. | Link |Wang Youbing. Comparative Study of Quetiapine Combined MECT on the Treatment of Female Refractory Schizophrenia. Contemporary Medicine. 2012 18(22):133-134. | CrossRef |Chanpattana W, Chakrabhand ML, Sackeim HA, Kitaroonchai W, Kongsakon R, Techakasem P, et al. Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT. 1999 Sep;15(3):178-92. | PubMed |Ding Yuan Fu, Shi whole Zheng, Changhai Song. The comparison study of curative effect of risperidone and modified electroconvulsive shock therapy in refractory schizophrenia. Journal of Psychiatry. 2007;20(06):397-398. | CrossRef |Wang, Fei, Dingwang Guo. Efficacy Study of Olanzapine Combined with MECT on the Treatment of Refractory Schizophrenia. Chinese Journal of Clinical Rational Drug Use. 2013; 6(24):99. | CrossRef |Duo J. Intractable Mental Disease Clinical Classification Analysis. Medical Information. 2011;24(05):2003-2004. Yang Kai Ren, Jian Xiaoqin, Mao Furong, Jiang Zheng. Modified electroconvulsive therapy combined with risperidone in treatment of negative symptoms in treatment-resistant schizophrenia. Zhejiang Medical Journal. 2011; 33(11):1602-1605. | CrossRef |Liu Guanjun, Guangsheng Liu, Xiaobin Zhang. A control study of risperidone combined with mect in refractory schizophrenia. Journal of Clinical Psychosomatic Diseases. 2010;16(1):57-60. | CrossRef |Jiang Xiaoqin, Yang Kairen, Kim Pang, Zheng Lifeng, Chin Miranda. Clinical study of risperidone combining mect treatment of refractory schizophrenia. Chinese Journal of Nervous and Mental Diseases. 2009;35(02):79-83. | CrossRef |Zhou Huijing, Mao Zhengrong, Chen YJ, Song BF, Shi DQ. A comparative study of modified electroconvulsive therapy combined with olanzapine in the treatment of treatment-refractory schizophrenia. Journal Of Nevroscience And Mental Health. 2009;9(4):328-331. | CrossRef |Jiang Zhengwei. Clinical analysis on mect combined with ziprasidone in treatment of patients with refractory schizophrenia. Journal of Clinical and Experimental Medicine. 2013;12(17):1394-1395. | CrossRef |Small JG, Milstein V, Klapper M, Kellams JJ, Small IF. ECT Combined with neuroleptics in the treatment of schizophrenia.” Psychopharmacol Bull. 1982;18(1):34-35. | Link |Goswami U, Kumar U, Singh B. Efficacy of Electroconvulsive Therapy in Treatment Resistant Schizophreinia: A double-blind study. Indian J Psychiatry. 2003 Jan;45(1):26-9. | PubMed |Cardwell BA, Nakai B. Seizure activity in combined clozapine and ECT: a retrospective view. Convuls Ther. 1995 Jun;11(2):110-3. | PubMed |Bannour S, Bouhlel S, Krir MW, Amamou B, Ben Nasr S, El Kissi Y, et al. Combination of maintenance electroconvulsive therapy and clozapine in treating a patient with refractory schizophrenia. J ECT. 2014 Sep;30(3):e29-30. | CrossRef | PubMed |Benatov R, Sirota P, Megged S. Neuroleptic-resistant schizophrenia treated with clozapine and ECT. Convuls Ther. 1996 Jun;12(2):117-21. | PubMed |Biedermann F, Pfaffenberger N, Baumgartner S, Kemmler G, Fleischhacker WW, Hofer A. Combined clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia: clinical and cognitive outcomes. J ECT. 2011 Dec;27(4):e61-2. | CrossRef | PubMed |Ravanić DB, Pantović MM, Milovanović DR, Dukić-Dejanović S, Janjić V, Ignjatović DR, et al. Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia. Psychiatr Danub. 2009 Jun;21(2):179-86. | PubMed |Vowels EC, Hittur Lingappa S, Bastiampillai T. Combination clozapine and electroconvulsive therapy in a patient with schizophrenia and comorbid intellectual disability. Aust N Z J Psychiatry. 2014 Jul;48(7):689-90. | CrossRef | PubMed |Flamarique I, Castro-Fornieles J, Garrido JM, de la Serna E, Pons A, Bernardo M, Baeza I. Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination? J Clin Psychopharmacol. 2012 Dec;32(6):756-66. | CrossRef | PubMed |Frankenburg FR, Suppes T, McLean PE. Combined Clozapine and Electroconvulsive Therapy. Convuls Ther. 1993;9(3):176-180. | PubMed |Garg R, Chavan BS, Arun P. Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia. Indian J Med Res. 2011 Jun;133:641-4. | PubMed |Garg Rohit, S Chavan Bir, Priti Arun. Short-Term Efficacy of Electroconvulsive Therapy in Treatment-Resistant Schizophrenia. German Journal of Psychiatry. 2012;15(2):44-49. | Link |Gazdag G, Kocsis-Ficzere N, Tolna J. The augmentation of clozapine treatment with electroconvulsive therapy. Ideggyogy Sz. 2006 Jul 20;59(7-8):261-7. | PubMed |Gerretsen P, Diaz P, Mamo D, Kavanagh D, Menon M, Pollock BG, et al. Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review. J ECT. 2011 Sep;27(3):247-50. | CrossRef | PubMed |Grover S, Hazari N, Chakrabarti S, Avasthi A. Augmentation of Clozapine With ECT: Observations From India. Am J Psychiatry. 2015 May;172(5):487. | CrossRef | PubMed |Kales HC, Dequardo JR, Tandon R. Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 1999 Apr;23(3):547-56. | PubMed |Husni M, Haggarty J, Peat C. Clozapine does not increase ECT-seizure duration. Can J Psychiatry. 1999 Mar;44(2):190-1. | PubMed |Hustig H, Onilov R. ECT rekindles pharmacological response in schizophrenia. Eur Psychiatry. 2009 Dec;24(8):521-5. | CrossRef | PubMed |Keller S, Drexler H, Lichtenberg P. Very high-dose clozapine and electroconvulsive therapy combination treatment in a patient with schizophrenia. J ECT. 2009 Dec;25(4):280-1. | CrossRef | PubMed |Kho KH, Blansjaar BA, de Vries S, Babuskova D, Zwinderman AH, Linszen DH.Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia--an open label study. Eur Arch Psychiatry Clin Neurosci. 2004 Dec;254(6):372-9. | PubMed |Abraham KR, Kulhara P. The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study. Br J Psychiatry. 1987 Aug;151:152-5. | PubMed |Kristensen D, Bauer J, Hageman I, Jørgensen MB. Electroconvulsive therapy for treating schizophrenia: a chart review of patients from two catchment areas. Eur Arch Psychiatry Clin Neurosci. 2011 Sep;261(6):425-32. | CrossRef | PubMed |Kurian S, Tharyan P, Jacob KS. Combination of ECT and clozapine in drug-resistant schizophrenia. Indian J Psychiatry. 2005 Oct;47(4):245. | CrossRef | PubMed |Manjunatha N, Ram Kumar GS, Vidyendaran R, Muralidharan K, John JP. Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy. Indian J Psychol Med. 2011 Jan;33(1):80-2. | CrossRef | PubMed |Klapheke MM. Clozapine, ECT, and Schizoaffective Disorder, Bipolar Type. Convuls Ther. 1991;7(1):36-39. | PubMed |Pawełczyk T, Kołodziej-Kowalska E, Pawełczyk A, Rabe-Jabłońska J. Effectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms. Psychiatry Res. 2014 Dec 15;220(1-2):175-80. | CrossRef | PubMed |Bhatia SC, Bhatia SK, Gupta S. Concurrent administration of clozapine and ECT: a successful therapeutic strategy for a patient with treatment-resistant schizophrenia. J ECT. 1998 Dec;14(4):280-3. | PubMed |Sienaert P, Bouckaert F, Fernandez I, Hagon A, Hagon B, Peuskens J. Propofol in the management of postictal delirium with clozapine-electroconvulsive therapy combination. J ECT. 2004 Dec;20(4):254-7. | PubMed |Sinha, Deoraj. Fatal pulmonary embolism in a patient treated with clozapine and electroconvulsive therapy. Int J Med Phar Scienc. 2013;4(4):9-11. | Link |Lee WK, Shiah IS, Chen CY, Lin TL, Shen LJ. Electroconvulsive therapy-associated Pisa syndrome in clozapine treatment. Psychiatry Clin Neurosci. 2008 Dec;62(6):753. | CrossRef | PubMed |Tang WK, Ungvari GS. Efficacy of electroconvulsive therapy combined with antipsychotic medication in treatment-resistant schizophrenia: a prospective, open trial. J ECT. 2002 Jun;18(2):90-4. | PubMed |Yoshino Y, Ozaki Y, Kawasoe K, Ochi S, Niiya T, Sonobe N, et al. Combined clozapine and electroconvulsive therapy in a Japanese schizophrenia patient: a case report. Clin Psychopharmacol Neurosci. 2014 Aug;12(2):160-2. | CrossRef | PubMed |Ghaziuddin N, Kutcher SP, Knapp P, Bernet W, Arnold V, Beitchman J, et al. Practice parameter for use of electroconvulsive therapy with adolescents. J Am Acad Child Adolesc Psychiatry. 2004 Dec;43(12):1521-39. | PubMed |Semkovska M, McLoughlin DM. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol Psychiatry. 2010 Sep 15;68(6):568-77. | CrossRef | PubMed |Rajkumar AP, Saravanan B, Jacob KS. Perspectives of patients and relatives about electroconvulsive therapy: a qualitative study from Vellore, India. J ECT. 2006 Dec;22(4):253-8. | PubMed |Rose D, Fleischmann P, Wykes T, Leese M, Bindman J. Patients' perspectives on electroconvulsive therapy: systematic review. BMJ. 2003 Jun 21;326(7403):1363. | PubMed |Greenhalgh J, Knight C, Hind D, Beverley C, Walters S. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. Health Technol Assess. 2005 Mar;9(9):1-156, iii-iv. | PubMed |Lehman AF. Treatment of Patients With Schizophrenia. American Psychiatric Association; 2010. | Link |Kazmierski,Jakub; Kloszewska, Iwona. Comparison of the Efficacy and Safety of the Bifrontal Electroconvulsive Therapy (ECT) and the Standard Bitemporal ECT in the Treatment of Patients With Schizophrenia. In: ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). 2000. | Link |
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