Electroconvulsive Therapy Before or After Initiation of Clozapine in Schizophrenia- A Retrospective Comparison for Seizure Parameters, Treatment Response and Duration of Hospitalization

Eren Yıldızhan; Nesrin Buket Tomruk; Özge Atay

doi:10.31067/acusaglik.924932

EN TR

Electroconvulsive Therapy Before or After Initiation of Clozapine in Schizophrenia- A Retrospective Comparison for Seizure Parameters, Treatment Response and Duration of Hospitalization

Abstract

Purpose: Determining whether adjunctive electroconvulsive therapy (ECT) with clozapine leads to better treatment response and fewer days in hospital for patients with schizophrenia. Methods: Medical records of patients with schizophrenia who were treated with ECT-clozapine combination in our women’s mental health clinic in a period of 5 years (between 01.02.2014 and 01.02.2019) were investigated retrospectively. Clinical Global Impression of Improvement (CGI-I) scale was used for assessing treatment response. Results: Of the 191 cases treated with ECT, there were 8 cases of schizophrenia who were treated with ECT and concomitant clozapine (C-ECT) and 14 cases who were treated with ECT before the initiation of clozapine (ECT-B). Number of ECT sessions and duration of seizures were not significantly different for both groups (p > 0.05). There was good and mild response (CGI-I score of 2 and 3) in 75% of the patients (n=6) for C-ECT and 85.7% of the patients (n=12) for ECT-B. Mean CGI-I scores between the two groups were not significantly different (p > 0.05). Duration of hospitalization for the C-ECT group (37.7  14.44 days) was shorter than the duration of hospitalization for the ECT-B group (56.0  19.2 days) (p = 0.04). No serious adverse events were observed during the ECT sessions or during the index hospitalizations Conclusion: Response rate was high and similar with both of the procedures and the duration of hospitalization was shorter for C-ECT group with no major complication and no significant increase in adverse effects.

Keywords

Klozapin Başlanmasından Önce ya da Sonra Elektrokonvülsif Tedavi - Nöbet Parametreleri, Tedavi Yanıtı ve Hastaneye Yatış Süresinin Retrospektif Bir Karşılaştırması

Öz

Amaç: Şizofreni tanılı hastalarda klozapin ile eşzamanlı olarak uygulanan elektrokonvulziv tedavinin daha iyi tedavi yanıtı ve hastanede yatış süresinde kısalmaya neden olma olasılığını incelemek amaçlanmıştır. Yöntemler: Kadın psikiyatri servisimizde 5 yıl boyunca (01.02.2014 ve 01.02.2019 arasında) yatarak tedavi gören şizofreni tanılı hastaların tıbbi kayıtları retrospektif olarak incelendi. Tedavi yanıtını değerlendirmede Klinik Global İzlem – İyileşme (KGİ-İ) ölçeği kullanılmıştı. Bulgular: EKT ile tedavi edilmiş olan 191 olgu içinde; 8 şizofreni olgusu (K-EKT) EKT ve eşzamanlı klozapin ile tedavi edilmiş ve 14 olguya ise (EKT-Ö) önce EKT uygulanmış, sonrasında klozapin tedavisine başlanmıştı. İki grup arasında EKT seans sayıları ve nöbet süreleri açısından anlamlı fark yoktu (p > 0,05). EKT’ ye yanıt oranının (KGİ-İ: 2 ya da 3), K-EKT grubunda %75 (n=6); EKT-Ö grubunda ise %85,7 (n=12) olduğu görüldü. Ortalama KGİ-İ skorları arasında gruplar arasında anlamlı fark yoktu (p > 0,05). K-EKT grubunun hastanede yatış süresi (37,7  14,44 gün), EKT-Ö grubundan (56,0  19,2 gün) daha kısaydı (p = 0,04). EKT seansları sırasında ya da yatışlar süresince ciddi yan etki görülmedi. Sonuç: Her iki uygulamada da tedaviye iyi yanıt yüksek orandaydı ve anlamlı fark yoktu. EKT ile eşzamanlı klozapin uygulamasının hastanede yatış süresini anlamlı oranda kısaltırken ciddi bir komplikasyona ve yan etki artışına neden olmadığı görüldü.

Anahtar Kelimeler

References

1. Lally J Cerletti U. L’elettroshock. Rivista Sperimentale di Freniatria, 1940;18: 209
2. Leiknes KA, Jarosh-von-Schweder L, Hoie B. Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav. 2012; 2:283-244.
3. Horneland M. The changing utilization of electroconvulsive therapy – a longitudinal study in a Norwegian catchment area, 1970-1986. Nord Psykiatr Tidsskr 1989; 43:249-254.
4. Canbek O, Menges OO, Atagun MI, Kutlar MT, Kurt E. Report on 3 years’ experience in electroconvulsive therapy in Bakirkoy Research and Training Hospital for psychiatric and neurological diseases: 2008-2010. J ECT 2013; 29:51-57.
5. Braga RJ, John M, Schooler NR, Bailine SH, Malur C, Mendelowitz A, Petrides G. Continuation Electroconvulsive Therapy for Patients With Clozapine-Resistant Schizophrenia: A Pilot Study. J ECT. 2019; 35(3):156-160.
6. 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; 29:52-56.
7. Kupchik M, Spivak B, Mester R, Reznik I, Gonen N, Weizmann A, Kotler M. Combined electroconvulsive-clozapine therapy. Clin Neuropharmacol 2000; 23:14-16.
8. Jaffe R. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A Task Force Report of the American Psychiatric Association. American Journal of Psychiatry 2002; 159(2):331.

9. NICE, 2014. Psychosis and Schizophrenia in Adults: Treatment and Management (Clinical Guideline 178). Royal College of Psychiatrists, London.
10. Pompili M, Lester D, Dominici G, Longo L, Marconi G, Forte A, Serafini G, Amore M, Girardi P. Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res 2013; 146:1–9.
11. Weiner RD, American Psychiatric Association Committ. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: a Task Force Report of the American Psychiatric Association, 2nd edn. Washington, DC: American Psychiatric Association; 2001.
12. Buckley P, Miller A, Olsen J, Garver D, Miller DD, Csernansky J. When symptoms persist: clozapine augmentation strategies. Schizophrenia Bulletin, 2001; 27:615-628.
13. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev 2005; 2:CD000076.
14. Arumugham SS, Thirthalli J, Andrade C. Efficacy and safety of combining clozapine with electrical or magnetic brain stimulation in treatment‐refractory schizophrenia. Expert Rev Clin Pharmacol 2016; 9:1245–1252.
15. Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, Kane JM, Sanghani S, Goldberg TE, John M, Mendelowitz A. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry 2015; 172:52-58.
16. Masoudzadeh A, Khalilian AR. Comparative study of clozapine, electroshock and the combination ECT with clozapine in the treatment resistant schizophrenic patients. Pak J Biol Sci 2007; 10:4287-4290.
17. Braga RJ, John M, Schooler NR, Bailine SH, Malur C, Mendelowitz A, Petrides G. Continuation electroconvulsive therapy for patients with clozapine-resistant schizophrenia: a pilot study. J ECT 2019; 35:156-610.
18. Saatcioglu O, Tomruk NB. Practice of electroconvulsive therapy at the research and training hospital in Turkey. Soc Psychiatry Psychiatr Epidemiol 2008; 43:673-677.
19. Tomruk NB, Kutlar MT, Menges OO. ECT Manual for Clinical Practice (Elektrokonvulsif Tedavi Klinik Uygulama El Kitabi). Istanbul, Turkey: Ece Press; 2007; ISBN: 978-975-590-221-0.
20. Masand P, O’Gorman C, Mandel FS. Clinical Global Impression of Improvement (CGI-I) as a valid proxy measure for remission in schizophrenia: analyses of ziprasidone clinical study data. Schizophr Res 2011; 126:174-183.
21. Özdemir A, Aksoy Poyraz C, Erten E, Çırakoğlu E, Tomruk N. Electroconvulsive therapy in women: a retrospective study from a mental health hospital in Turkey. Psychiatr Q 2016; 87:769-779.
22. Pan YJ, Kuo KH, Yeh LL. Healthcare cost, service use and mortality in major psychiatric disorders in Taiwan. J Affect Disord 2019; 246:112-20.
23. Kinchin I, Russell AMT, Tsey K, Jago J, Wintzloff T, Meurk C, Doran CM. Psychiatric inpatient cost of care before and after admission at a residential subacute step-up/step-down mental health facility. J Med Econ 2019; 22:491-8.
24. Fresán A, Robles-García R, Madrigal E, Tovilla-Zarate CA, Martínez-López N, Arango de Montis I. Demographic and clinical features related to perceived discrimination in schizophrenia. Psychiatry Res 2018; 262:427-30.
25. Holm J, Brus O, Bave U, Landen M, Lundberg J, Nordanskog P, von Knorring L, Nordenskjöld A. Improvement of cycloid psychosis following electroconvulsive therapy. Nordic Journal of Psychiatry, 2017; 71:405-410.
26. Simsek GG, Zincir S, Gulec H, Eksioglu S, Semiz UB, Kurtulmus YS. Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy? Nord J Psychiatry 2015; 69:466 –471.
27. Rostami‐Hodjegan A, Amin AM, Spencer EP, Lennard MS, Tucker GT, Flanagan RJ. Influence of dose, cigarette smoking, age, sex, and metabolic activity on plasma clozapine concentrations: a predictive model and nomograms to aid clozapine dose adjustment and to assess compliance in individual patients. J Clin Psychopharmacol 2004; 24:70–78.
28. Aytuluk HG, Simsek T, Yilmaz M, Turan AZ, Saracoglu KT. Can propofol lead to an increase in seizure treshold over the course of electroconvulsive therapy? Clin Psychopharmacol Neurosci 17(4), 523-530.
29. Sanghani SN, Petrides G, Kellner CH. Electroconvulsive therapy (ECT) in schizophrenia: a review of recent literature. Curr Opin Psychiatry 2018;31:213-222.
30. Kendell RE. The present status of electroconvulsive therapy. Br J Psychiatry 1981; 139:265–283.

Details

Primary Language

English

Subjects

Psychiatry

Journal Section

Research Article

Authors

Eren Yıldızhan ^*
0000-0002-5348-5326
Türkiye

Nesrin Buket Tomruk
0000-0002-1889-7608
Türkiye

Özge Atay
0000-0001-7681-2329
Türkiye

Publication Date

March 15, 2022

Submission Date

April 21, 2021

Acceptance Date

February 22, 2022

Published in Issue

Year 2022 Volume: 13 Number: 2

DOI

https://doi.org/10.31067/acusaglik.924932

IZ

https://izlik.org/JA94FJ79CT

Cite

RIS / Bibtex

EndNote

Yıldızhan E, Tomruk NB, Atay Ö (March 1, 2022) Electroconvulsive Therapy Before or After Initiation of Clozapine in Schizophrenia- A Retrospective Comparison for Seizure Parameters, Treatment Response and Duration of Hospitalization. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 13 2 266–273.