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
