title: Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia.
abstract: OBJECTIVE
  This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review.
  
  
  METHODS
  Clozapine-resistance was defined as persistent psychotic symptoms despite at least 12 weeks of clozapine administration with blood levels over 350 ng/mL in order to rule out pseudo-resistance. Seven in-patients who were taking clozapine and treated with ECT were selected. We analyzed the psychopathology and subscales changed by ECT.
  
  
  RESULTS
  The average number of ECT sessions was 13.4 (±4.6). Total Positive and Negative Syndrome Scale (PANSS) score was significantly reduced by 17.9 (±12.8) points (p=0.0384) on average, which represented a reduction of 25.5% (±14.3). 71.4% (5/7) of patients were identified as clinical remission, with at least a 20% reduction in PANSS score. PANSS reduction was associated with number of ECT sessions, stimulus level in the final session, and blood clozapine levels before ECT. However, the negative subscale on the PANSS were not reduced by ECT in any patient. We did not observe any persistent adverse cognitive effects.
  
  
  CONCLUSIONS
  This study supports that ECT augmentation on clozapine-resistant schizophrenia reveals clinically effective and safe. Further research should be done involving a larger number of patients to investigate the effectiveness of clozapine/ECT combination therapy.
authors.affiliation: Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.
authors.forename: Hye Sung
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
authors.forename: Nam Young
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
authors.forename: Tak
authors.initials: T
authors.lastname: Youn
authors.affiliation: Department of Anesthesia & Pain Medicine, Dongguk University International Hospital, Goyang, Republic of Korea.
authors.forename: Jeoung Hyuk
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Anesthesia & Pain Medicine, Dongguk University International Hospital, Goyang, Republic of Korea.
authors.forename: Seunghyun
authors.initials: S
authors.lastname: Chung
authors.affiliation: Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
authors.forename: In Won
authors.initials: IW
authors.lastname: Chung
keywords: Augmentation; Clozapine-resistant schizophrenia; Electroconvulsive therapy