The Effectiveness of Non-clozapine Antipsychotics Combined with Electroconvulsive Therapy versus Clozapine Combined with Electroconvulsive Therapy for Treatment-resistant Schizophrenia
Antipsychotic Plus ECT in Schizophrenia
Abstract
The study aimed to compare the effectiveness and safety of other atypical antipsychotics (non-clozapine) plus electroconvulsive therapy (ECT) (NC+ECT) versus clozapine plus ECT (C+ECT) for treating treatment-resistant schizophrenia (TRS). Data of 32 patients with TRS who was receiving ECT were analysed. We compared clinical characteristics, response to treatment [defined as an improvement of 40% in the Brief Psychotic Rating Scale (BPRS) psychotic symptom subscale from pretreatment scores], change of Mini-mental Status Exam (MMSE) scores, and other adverse effects between the NC+ECT group (N= 16) and C+ECT group (N =16). We found that the overall response rate was 65.6% (75.8% for the NC+ECT group and 56.3% for the C+ECT group, p=0.26). The overall BPRS score in both groups decreased significantly. The mean difference in total BPRS psychotic subscale score between pre-ECT and after last ECT was 10.4 + 5.8 (p<0.001) for the NC+ECT group and 6.6 + 7.3 (p = 0.002) for the C+ECT group. When comparing the NC+ECT group to the C+ECT group, the mean difference in total BPRS psychotic subscale score was not significant. (p = 0.104). The mean difference in MMSE score between pre-ECT and after the last ECT was -1.1 + 5.1 (p =0.45) for the NC+ECT group and 0.2 + 4.3 (p=0.855) for the C+ECT group. The change of MMSE score in the NC+ECT group was not significant different compare to the C+ECT group (p = 0.461). We concluded the combination of antipsychotics and ECT is an effective and safe treatment option for patients with TRS. Other NC+ECT groups’ efficacy may be comparable to that of clozapine plus ECT.
Keywords :
brain stimulation,cognitive impairment,pharmacotherapy,psychotic disorders,
Abstrak
Objektif kajian ini ialah untuk membandingkan keberkesanan dan keselamatan ubat antipsikotik atipikal lain jenis bukan clozapine yang dikombinasikan dengan terapi elektrokonvulsif (ECT) (NC+ECT) melawan clozapine bersama rawatan ECT (C+ECT) untuk merawat skizofrenia yang resistan terhadap rawatan (TRS). Kami mengkaji data 32 pesakit yang mengalami TRS yang menerima ECT. Kami membandingkan ciri klinikal, tindak balas terhadap rawatan [ditakrifkan sebagai peningkatan≥40% dalam skala kecil gejala psikotik mengikut Skala Penarafan (BPRS) dari skor pra-rawatan], perubahan skor ujian status mini mental (MMSE), dan kesan buruk yang lain antara kumpulan NC+ECT (N = 16) dan kumpulan C+ECT (N = 16). Hasil kajian menunjukkan kadar respons keseluruhan adalah 65.6% (75.8% untuk kumpulan NC+ECT dan 56.3% untuk kumpulan C+ECT, p = 0.26). Skor BPRS keseluruhan di kedua-dua kumpulan menurun dengan ketara, perbezaan min dalam jumlah skor subskala psikotik BPRS antara pra-ECT dan selepas ECT terakhir adalah 10.4 + 5.8 (p<0.001) untuk kumpulan NC+ECT dan 6.6 + 7.3 (p = 0.002) untuk kumpulan C+ECT masing-masing. Semasa membandingkan kumpulan NC+ECT dengan kumpulan C+ECT, perbezaan min dalam jumlah skor subskala psikotik BPRS didapati tidak signifikan (p = 0.104). Perbezaan min skor MMSE antara pra-ECT dan selepas ECT terakhir adalah -1.1 + 5.1 (p = 0.45) untuk kumpulan NC+ECT dan 0.2 + 4.3 (p = 0.855) untuk kumpulan C+ECT. Perubahan skor MMSE dalam kumpulan NC+ECT tidak berbeza berbeza dengan kumpulan C+ECT (p = 0.461). Kesimpulannya, gabungan antipsikotik dan ECT adalah pilihan rawatan yang berkesan dan selamat bagi pesakit dengan TRS. Keberkesanan antipsikotik atipikal lain serta keberkesanan kumpulan ECT mungkin setanding dengan clozapine bersama-sama rawatan ECT.
Kata Kunci :
farmakoterapi, gangguan psikotik, kecacatan kognitif, rangsangan otak,
Correspondance Address
Pichai Ittasakul. Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Tel: +662-2011478 Email: pichai118@gmail.com
Correspondance Address
