title: Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination?
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of the combination of electroconvulsive therapy (ECT) and clozapine compared to ECT with other antipsychotics or benzodiazepines in a sample of adolescents diagnosed with schizophrenia spectrum disorders.
  
  
  METHODS
  Data regarding 28 adolescent subjects aged 13 to 18 with diagnoses of schizophrenia spectrum disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and treated with ECT were retrospectively collected. Twelve subjects were also treated with clozapine and 16 with other antipsychotics or benzodiazepines during ECT course and follow-up. Electroconvulsive therapy parameters and adverse effects were assessed using a systematic protocol. Positive and Negative Syndrome Scale and Clinical Global Impression scores before ECT and after acute ECT, and rate of rehospitalization during 1-year follow-up were used to assess effectiveness. Response was defined as a 20% decrease in Positive and Negative Syndrome Scale scores.
  
  
  RESULTS
  No differences were observed in the mean charge needed to induce seizure and electroencephalographic duration, but there was a slight difference in the current used. The nonclozapine group showed greater restlessness and agitation, although no differences were found in other adverse effects. The percentage of responders was similar: 66.7% in the clozapine group and 68.8% in the nonclozapine group. However, the rate of rehospitalization was lower in the patients treated with clozapine during 1-year follow-up (7.1%) compared to that of the nonclozapine group (58.3%) (P = 0.009).
  
  
  CONCLUSIONS
  The main findings of this study were that combining ECT with clozapine, compared to ECT with other antipsychotics or benzodiazepines, was safe and that both treatments were equally effective. Charges needed to induce seizure were similar in both groups. Patients treated with clozapine during 1-year follow-up had a lower rate of rehospitalization.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychology,Institut Clinic de Neurociències, Hospital Clínic Universitari, Barcelona, Spain. iflamari@clinic.ub.es
authors.forename: Itziar
authors.initials: I
authors.lastname: Flamarique
authors.forename: Josefina
authors.initials: J
authors.lastname: Castro-Fornieles
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Garrido
authors.forename: Elena
authors.initials: E
authors.lastname: de la Serna
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pons
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardo
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Baeza
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003024:Clozapine / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D004562:Electrocardiography / Q000187:drug effects / Q000379:methods; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D012640:Seizures / Q000139:chemically induced / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine