Journal of ECT • Volume 30, Number 3, September 2014
Letters to the Editor
Alexander Z. Tzabazis, MD Department of Anesthesia Stanford University Stanford, CA [email protected]
Hubert J. Schmitt, MD Tino Muenster, MD Department of Anesthesia University Hospital Erlangen, Germany
The authors have no conflicts of interest or financial disclosures to report. REFERENCES 1. Augoustides JG, Greenblatt E, Abbas MA, et al. Clinical approach to agitation after electroconvulsive therapy: a case report and literature review. J ECT. 2002;18:213–217. 2. Cristancho MA, Alici Y, Augoustides JG, et al. Uncommon but serious complications associated with electroconvulsive therapy: recognition and management for the clinician. Curr Psychiatry Rep. 2008;10:474–480. 3. Tzabazis A, Schmitt HJ, Ihmsen H, et al. Postictal agitation after electroconvulsive therapy: incidence, severity, and propofol as a treatment option. J ECT. 2013;29:189–195. 4. Warnell RL, Swartz CM, Thomson A. Propofol interruption of ECT seizure to reduce side-effects: a pilot-study. Psychiatry Res. 2010;175:184–185. 5. Hill GE, Wong KC, Hodges MR. Lithium carbonate and neuromuscular blocking agents. Anesthesiology. 1977;46:122–126.
Geriatric ECT at a Turkish Teaching Hospital A 5-Year Experience To the Editor: e present here our 5-year experience with the practice of electroconvulsive therapy (ECT) at the Bakirkoy Hospital in Istanbul, Turkey, in patients older than 65 years. The data were obtained by retrospective chart review of inpatients treated with ECT while hospitalized at the Bakirkoy Hospital between March 2006 and May 2010. Sociodemographic characteristics, general medical conditions, mean number of patients who received ECT, the diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, mean number of ECT sessions, response rates, adverse reactions, and duration of hospital stay were determined. For purposes of statistical analysis, every treatment course was recorded as a separate patient. Descriptive analysis was performed using SPSS 17 Software (SPSS, Inc, Chicago, Ill) and the results are presented as mean (SD).
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The characteristics of the hospital, catchment area, patients, ECT unit, and practice of ECT administration were described in detail elsewhere.1 A total of 41,295 (25,299 [61.26%] men and 15,996 [38.73%] women) acute psychiatric patients were hospitalized between March 2006 and May 2010, and 1118 (643 [57.51%] men and 475 [42.48%] women) of these patients were older than 65 years. Electroconvulsive therapy was administered to 5977 (3511 [58.74%] men and 2466 [41.25%] women) of all acute patients (14.47%). A total of 96 patients (56 [58.33%] women and 40 [41.66%] men) older than 65 years were treated with ECT, who constituted 1.6% of all patients treated with ECT. The psychiatric diagnoses of the patients were as follows: 74 (77.08%) patients had affective disorders and 22 (22.92%) patients had psychotic disorders. A total of 803 sessions of ECT were administered in 96 courses of ECT. The mean number of ECT sessions per patient was 8.36 (2.51) (range, 1–16). Ten (10.41%) patients had a history of hypothyroidism; 5 (5.2%) central nervous system malignancy; 2 (2.08%) breast cancer; 1 (1.04%) hematologic malignancy; and 1 (1.04%) skin cancer. Three (3.12%) patients had a history of hepatitis C or D. The clinical responses on discharge were classified as “total improvement,” “partial improvement,” and “non-responsiveness”, according to discharge summary, medical chart, and computer data. Total improvement was observed in 52 (54.2%) patients, and partial improvement was observed in 39 (40.6%) patients. Global clinical response rate was 94.8%, whereas 5 (5.2%) patients were discharged without any apparent change in their clinical features. There were no life-threatening complications and/or deaths. The types of acute adverse events that were reported in 8.3% of the 96 patients treated with ECT were confusion (n = 3), headache (n = 1), prolonged seizure (n = 2), and prolonged recovery (n = 2). A second or third restimulation was required in 37 sessions. Although controversy continues about psychiatric treatment algorithms for elderly patients, various studies have shown successful results with ECT. Results suggesting that elderly patients respond well to ECT were reviewed by Mitchell and Subramaniam.2 Advanced age is not by itself a contraindication to this treatment.3 We found ECT to be effective and safe, too, in the elderly patient subgroup in this study: the rate of response to treatment was 94.8%, which is similar to results of other studies.4,5 In our study, there were more female elderly patients treated with ECT. The
sex distribution is similar to studies from Western countries and differs from the findings of our other recent report.1 The distribution of diagnoses is also different. Affective disorders (77.08%) and depression (58.33%) are the leading diagnoses in the subgroup of ECT patients older than 65 years. The most frequently diagnosed disorders were depression (58.33%), followed by mania (16.70%). Although depression is a leading diagnosis, the presence of manic and psychotic (nonaffective psychosis) patients shows that ECT is not used solely for depressed patients. The mean number of ECT treatments was 8.36 (2.51) in our study, similar to many studies.4 The rate of medical comorbidities was 60% in the present study, compared with 33.66% in an Indian study and 20% in another Turkish study.4,5 The slightly younger mean age in those studies may explain the lower rate of comorbidities. Absence of any life-threatening adverse effects or death, and the occurence of relatively few adverse effects of any kind, suggest that ECT is a safe treatment modality in this patient population. It is also an indication of conformity with current practice guidelines. The most important limitation of the present study is its retrospective design. Response to treatment, adverse effects (especially cognitive effects), and complications were determined by relying on clinical records and patient charts, rather than the use of standardized measures. Also, only the short-term response to ECT was evaluated, which makes it harder to reach conclusions about long-term efficacy. Several studies have reported on the efficacy of ECT in the elderly. Its adverse effect profile may compare favorably to pharmacological treatments in this age group. We hope that clinicians will become more comfortable prescribing ECT to geriatric patients, as more experience with ECT in the elderly is documented in the medical literature. Ozge Canbek, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases ECT Center Istanbul, Turkey [email protected] Goksen Yuksel, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases Istanbul, Turkey Murat Ilhan Atagun, MD Department of Psychiatry Yildirim Beyazit University Medical School Ankara, Turkey © 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Journal of ECT • Volume 30, Number 3, September 2014
Derya Ipekcıoglu, MD Erhan Kurt, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases Istanbul, Turkey Okan Oktay Menges, MD Mehmet Tarik Kutlar, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases ECT Center Istanbul, Turkey
ACKNOWLEDGMENTS The authors would like to thank all the devoted staff of ECT Center, Evin Kantemir for reviewing the text and references, and Charles Kellner for helpful comments and edits on early draft. The authors declare no conflict of interest. REFERENCES 1. Canbek O, Menges O, Atagun MI, et al. Report on three years' experience in electroconvulsive therapy in Bakirkoy research and teaching hospital for psychiatric and neurological diseases 2008–2010. J ECT. 2013;29:51–57. 2. Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. Am J Psychiatry. 2005;162:1588–1601. 3. O'Reardon JP, Cristancho MA, Ryley B, et al. Electroconvulsive therapy for treatment of major depression in a 100-year-old patient with severe aortic stenosis: a 5-year follow-up report. J ECT. 2011;27:227–230. 4. Jain G, Kumar V, Subho Chakrabarti S, et al. The use of electroconvulsive therapy in the elderly: a study from the psychiatric unit of a North Indian teaching hospital. J ECT. 2008;24:122–127. 5. Tamam L, Zeren T, Evlice YE. Yaþli psikiyatrik hastalarda elektrokonvülsif tedavinin kullanim etkinliði (Effective use of electroconvulsive therapy in elderly psychiatric patients). Klinik Psikofarmakoloji Bülteni (Bull Clin Psychopharmacol). 2003; 13:6–12.
Combination of Maintenance Electroconvulsive Therapy and Clozapine in Treating a Patient With Refractory Schizophrenia To the Editor: lozapine is the most effective antipsychotic in the treatment of resistant
C
© 2014 Lippincott Williams & Wilkins
Letters to the Editor
forms of schizophrenia, however, many resistant patients do not respond to it. Several therapeutic strategies have been proposed to potentiate its effectiveness such as electroconvulsive therapy (ECT). Studies on this combination are still limited to isolated case reports or series of small numbers. Treatment is not yet standardized particularly regarding the maintenance ECT (M-ECT). Indeed, the use of this technique in schizophrenia is much less documented than in mood disorders and practice varies from one psychiatrist to another. Through this case report, we try to illustrate the value of combining clozapine and M-ECT in refractory schizophrenia.
CASE REPORT Miss H is now 32 years old. She attended high school until the seventh year and dropped out of studies due to her psychiatric disorder. She worked for a short time as a laborer in a garment factory and stopped working due to the aggravation of her illness. She is single and lives with her parents. Her first psychiatric hospitalization dates back to the age of 21 years. Diagnosed as having a major depressive episode with psychotic features, the patient had anafranil and chlorpromazine with good improvement. Stopping her treatment after 6 months, she presented 4 months later with a mixed episode with delusional and hallucinatory syndromes and was hospitalized. She had initially valproate and haloperidol but the latter was replaced by chlorpromazine due to great sedation. Evolution was favorable but partially, as delusions persisted. One year later, a month after stopping treatment, she was hospitalized again, delusional and dissociative syndromes were objectified and the diagnosis of undifferentiated schizophrenia was considered. The patient had pipothiazine, orally then as a long-acting dose of 150 mg every 3 weeks, associated to chlorpromazine and valproate. Clinical improvement was slow and partial as some dissociative symptoms and ideas of reference persisted. The next relapses occurred despite good adherence to treatment: the first one 11 months later, pipothiazine was replaced by 10 mg/d of olanzapine, which allowed partial stabilization but induced diabetes 5 months later; the second one 18 months later, olanzapine and valproate were stopped and clozapine was prescribed at the dose of 400 mg/d (BPRS-18 score decreased from 77 to 20); the third one 6 months later, clozapine was increased to 500 mg/d (BPRS-18 score decreased from 72 to 24); the fourth one 12 months later, clozapine was increased to 700 mg daily and associated to
10 mg of haloperidol (BPRS-18 score decreased from 66 to 43); and the fifth one 20 months later, in combination with clozapine maintained at the same dose, the patient had 16 sessions of bilateral ECT at the rate of 3 sessions per week (BPRS-18 score decreased from 95 to 29). The patient had sessions of consolidation for 8 weeks (BPRS-18 score decreased to 20) and sessions continued at the rate of 1 session per month. After 24 sessions now, the patient is still well stabilized, she has no sign of intolerance and she returned to work as a laborer in a garment factory with good socio-family insertion.
DISCUSSION In this observation, the patient presented during the first years of its disorder delusional and hallucinatory syndromes with mood symptoms which disappeared thereafter. The clinical course was in favor of an undifferentiated schizophrenia marked by multiple relapses, indicating many hospitalizations and preventing social and professional integration despite the prescription of 3 antipsychotics at effective doses and for periods exceeding 6 weeks. Antipsychotics have allowed clinical improvement but a treatment failure occurred each time. Schizophrenia was considered as resistant and clozapine was indicated. This molecule has shown efficacy in early treatment, but once again there were relapses despite higher doses and potentiating with haloperidol, leading to a refractory schizophrenia diagnosis. ECT combined with clozapine allowed a good clinical improvement which was consolidated by the M-ECT with no adverse effects. For some authors, refractory schizophrenia is not a good indication for ECT. However, several recent studies and reviews have shown that such therapy can give good results in patients with ultraresistant schizophrenia. Kristensen et al1 in a retrospective review evaluated the efficacy of ECT in 79 patients diagnosed with schizophrenia (n = 55), persistent delusional disorders (n = 7), and schizoaffective disorders (n = 17). They found that 66 patients had a good or excellent response after 9 to 10 sessions. Eighteen patients were treated with M-ECT while maintaining antipsychotic treatment for periods ranging from 3 months to 12 years with an average of 2.2 years. The interval between sessions was 1 to 3 weeks. This combination has shown good efficacy with a reduction in the duration of hospitalization. Suzuki et al2 treated with ECT 7 patients older than 45 years and experiencing catatonic schizophrenia. The authors found that all patients have relapsed after the first cure despite maintaining antipsychotic treatment, www.ectjournal.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Letters to the Editor
Alexander Z. Tzabazis, MD Department of Anesthesia Stanford University Stanford, CA [email protected]
Hubert J. Schmitt, MD Tino Muenster, MD Department of Anesthesia University Hospital Erlangen, Germany
The authors have no conflicts of interest or financial disclosures to report. REFERENCES 1. Augoustides JG, Greenblatt E, Abbas MA, et al. Clinical approach to agitation after electroconvulsive therapy: a case report and literature review. J ECT. 2002;18:213–217. 2. Cristancho MA, Alici Y, Augoustides JG, et al. Uncommon but serious complications associated with electroconvulsive therapy: recognition and management for the clinician. Curr Psychiatry Rep. 2008;10:474–480. 3. Tzabazis A, Schmitt HJ, Ihmsen H, et al. Postictal agitation after electroconvulsive therapy: incidence, severity, and propofol as a treatment option. J ECT. 2013;29:189–195. 4. Warnell RL, Swartz CM, Thomson A. Propofol interruption of ECT seizure to reduce side-effects: a pilot-study. Psychiatry Res. 2010;175:184–185. 5. Hill GE, Wong KC, Hodges MR. Lithium carbonate and neuromuscular blocking agents. Anesthesiology. 1977;46:122–126.
Geriatric ECT at a Turkish Teaching Hospital A 5-Year Experience To the Editor: e present here our 5-year experience with the practice of electroconvulsive therapy (ECT) at the Bakirkoy Hospital in Istanbul, Turkey, in patients older than 65 years. The data were obtained by retrospective chart review of inpatients treated with ECT while hospitalized at the Bakirkoy Hospital between March 2006 and May 2010. Sociodemographic characteristics, general medical conditions, mean number of patients who received ECT, the diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, mean number of ECT sessions, response rates, adverse reactions, and duration of hospital stay were determined. For purposes of statistical analysis, every treatment course was recorded as a separate patient. Descriptive analysis was performed using SPSS 17 Software (SPSS, Inc, Chicago, Ill) and the results are presented as mean (SD).
W
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www.ectjournal.com
The characteristics of the hospital, catchment area, patients, ECT unit, and practice of ECT administration were described in detail elsewhere.1 A total of 41,295 (25,299 [61.26%] men and 15,996 [38.73%] women) acute psychiatric patients were hospitalized between March 2006 and May 2010, and 1118 (643 [57.51%] men and 475 [42.48%] women) of these patients were older than 65 years. Electroconvulsive therapy was administered to 5977 (3511 [58.74%] men and 2466 [41.25%] women) of all acute patients (14.47%). A total of 96 patients (56 [58.33%] women and 40 [41.66%] men) older than 65 years were treated with ECT, who constituted 1.6% of all patients treated with ECT. The psychiatric diagnoses of the patients were as follows: 74 (77.08%) patients had affective disorders and 22 (22.92%) patients had psychotic disorders. A total of 803 sessions of ECT were administered in 96 courses of ECT. The mean number of ECT sessions per patient was 8.36 (2.51) (range, 1–16). Ten (10.41%) patients had a history of hypothyroidism; 5 (5.2%) central nervous system malignancy; 2 (2.08%) breast cancer; 1 (1.04%) hematologic malignancy; and 1 (1.04%) skin cancer. Three (3.12%) patients had a history of hepatitis C or D. The clinical responses on discharge were classified as “total improvement,” “partial improvement,” and “non-responsiveness”, according to discharge summary, medical chart, and computer data. Total improvement was observed in 52 (54.2%) patients, and partial improvement was observed in 39 (40.6%) patients. Global clinical response rate was 94.8%, whereas 5 (5.2%) patients were discharged without any apparent change in their clinical features. There were no life-threatening complications and/or deaths. The types of acute adverse events that were reported in 8.3% of the 96 patients treated with ECT were confusion (n = 3), headache (n = 1), prolonged seizure (n = 2), and prolonged recovery (n = 2). A second or third restimulation was required in 37 sessions. Although controversy continues about psychiatric treatment algorithms for elderly patients, various studies have shown successful results with ECT. Results suggesting that elderly patients respond well to ECT were reviewed by Mitchell and Subramaniam.2 Advanced age is not by itself a contraindication to this treatment.3 We found ECT to be effective and safe, too, in the elderly patient subgroup in this study: the rate of response to treatment was 94.8%, which is similar to results of other studies.4,5 In our study, there were more female elderly patients treated with ECT. The
sex distribution is similar to studies from Western countries and differs from the findings of our other recent report.1 The distribution of diagnoses is also different. Affective disorders (77.08%) and depression (58.33%) are the leading diagnoses in the subgroup of ECT patients older than 65 years. The most frequently diagnosed disorders were depression (58.33%), followed by mania (16.70%). Although depression is a leading diagnosis, the presence of manic and psychotic (nonaffective psychosis) patients shows that ECT is not used solely for depressed patients. The mean number of ECT treatments was 8.36 (2.51) in our study, similar to many studies.4 The rate of medical comorbidities was 60% in the present study, compared with 33.66% in an Indian study and 20% in another Turkish study.4,5 The slightly younger mean age in those studies may explain the lower rate of comorbidities. Absence of any life-threatening adverse effects or death, and the occurence of relatively few adverse effects of any kind, suggest that ECT is a safe treatment modality in this patient population. It is also an indication of conformity with current practice guidelines. The most important limitation of the present study is its retrospective design. Response to treatment, adverse effects (especially cognitive effects), and complications were determined by relying on clinical records and patient charts, rather than the use of standardized measures. Also, only the short-term response to ECT was evaluated, which makes it harder to reach conclusions about long-term efficacy. Several studies have reported on the efficacy of ECT in the elderly. Its adverse effect profile may compare favorably to pharmacological treatments in this age group. We hope that clinicians will become more comfortable prescribing ECT to geriatric patients, as more experience with ECT in the elderly is documented in the medical literature. Ozge Canbek, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases ECT Center Istanbul, Turkey [email protected] Goksen Yuksel, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases Istanbul, Turkey Murat Ilhan Atagun, MD Department of Psychiatry Yildirim Beyazit University Medical School Ankara, Turkey © 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Journal of ECT • Volume 30, Number 3, September 2014
Derya Ipekcıoglu, MD Erhan Kurt, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases Istanbul, Turkey Okan Oktay Menges, MD Mehmet Tarik Kutlar, MD Bakirkoy Teaching Hospital for Psychiatric and Neurological Diseases ECT Center Istanbul, Turkey
ACKNOWLEDGMENTS The authors would like to thank all the devoted staff of ECT Center, Evin Kantemir for reviewing the text and references, and Charles Kellner for helpful comments and edits on early draft. The authors declare no conflict of interest. REFERENCES 1. Canbek O, Menges O, Atagun MI, et al. Report on three years' experience in electroconvulsive therapy in Bakirkoy research and teaching hospital for psychiatric and neurological diseases 2008–2010. J ECT. 2013;29:51–57. 2. Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. Am J Psychiatry. 2005;162:1588–1601. 3. O'Reardon JP, Cristancho MA, Ryley B, et al. Electroconvulsive therapy for treatment of major depression in a 100-year-old patient with severe aortic stenosis: a 5-year follow-up report. J ECT. 2011;27:227–230. 4. Jain G, Kumar V, Subho Chakrabarti S, et al. The use of electroconvulsive therapy in the elderly: a study from the psychiatric unit of a North Indian teaching hospital. J ECT. 2008;24:122–127. 5. Tamam L, Zeren T, Evlice YE. Yaþli psikiyatrik hastalarda elektrokonvülsif tedavinin kullanim etkinliði (Effective use of electroconvulsive therapy in elderly psychiatric patients). Klinik Psikofarmakoloji Bülteni (Bull Clin Psychopharmacol). 2003; 13:6–12.
Combination of Maintenance Electroconvulsive Therapy and Clozapine in Treating a Patient With Refractory Schizophrenia To the Editor: lozapine is the most effective antipsychotic in the treatment of resistant
C
© 2014 Lippincott Williams & Wilkins
Letters to the Editor
forms of schizophrenia, however, many resistant patients do not respond to it. Several therapeutic strategies have been proposed to potentiate its effectiveness such as electroconvulsive therapy (ECT). Studies on this combination are still limited to isolated case reports or series of small numbers. Treatment is not yet standardized particularly regarding the maintenance ECT (M-ECT). Indeed, the use of this technique in schizophrenia is much less documented than in mood disorders and practice varies from one psychiatrist to another. Through this case report, we try to illustrate the value of combining clozapine and M-ECT in refractory schizophrenia.
CASE REPORT Miss H is now 32 years old. She attended high school until the seventh year and dropped out of studies due to her psychiatric disorder. She worked for a short time as a laborer in a garment factory and stopped working due to the aggravation of her illness. She is single and lives with her parents. Her first psychiatric hospitalization dates back to the age of 21 years. Diagnosed as having a major depressive episode with psychotic features, the patient had anafranil and chlorpromazine with good improvement. Stopping her treatment after 6 months, she presented 4 months later with a mixed episode with delusional and hallucinatory syndromes and was hospitalized. She had initially valproate and haloperidol but the latter was replaced by chlorpromazine due to great sedation. Evolution was favorable but partially, as delusions persisted. One year later, a month after stopping treatment, she was hospitalized again, delusional and dissociative syndromes were objectified and the diagnosis of undifferentiated schizophrenia was considered. The patient had pipothiazine, orally then as a long-acting dose of 150 mg every 3 weeks, associated to chlorpromazine and valproate. Clinical improvement was slow and partial as some dissociative symptoms and ideas of reference persisted. The next relapses occurred despite good adherence to treatment: the first one 11 months later, pipothiazine was replaced by 10 mg/d of olanzapine, which allowed partial stabilization but induced diabetes 5 months later; the second one 18 months later, olanzapine and valproate were stopped and clozapine was prescribed at the dose of 400 mg/d (BPRS-18 score decreased from 77 to 20); the third one 6 months later, clozapine was increased to 500 mg/d (BPRS-18 score decreased from 72 to 24); the fourth one 12 months later, clozapine was increased to 700 mg daily and associated to
10 mg of haloperidol (BPRS-18 score decreased from 66 to 43); and the fifth one 20 months later, in combination with clozapine maintained at the same dose, the patient had 16 sessions of bilateral ECT at the rate of 3 sessions per week (BPRS-18 score decreased from 95 to 29). The patient had sessions of consolidation for 8 weeks (BPRS-18 score decreased to 20) and sessions continued at the rate of 1 session per month. After 24 sessions now, the patient is still well stabilized, she has no sign of intolerance and she returned to work as a laborer in a garment factory with good socio-family insertion.
DISCUSSION In this observation, the patient presented during the first years of its disorder delusional and hallucinatory syndromes with mood symptoms which disappeared thereafter. The clinical course was in favor of an undifferentiated schizophrenia marked by multiple relapses, indicating many hospitalizations and preventing social and professional integration despite the prescription of 3 antipsychotics at effective doses and for periods exceeding 6 weeks. Antipsychotics have allowed clinical improvement but a treatment failure occurred each time. Schizophrenia was considered as resistant and clozapine was indicated. This molecule has shown efficacy in early treatment, but once again there were relapses despite higher doses and potentiating with haloperidol, leading to a refractory schizophrenia diagnosis. ECT combined with clozapine allowed a good clinical improvement which was consolidated by the M-ECT with no adverse effects. For some authors, refractory schizophrenia is not a good indication for ECT. However, several recent studies and reviews have shown that such therapy can give good results in patients with ultraresistant schizophrenia. Kristensen et al1 in a retrospective review evaluated the efficacy of ECT in 79 patients diagnosed with schizophrenia (n = 55), persistent delusional disorders (n = 7), and schizoaffective disorders (n = 17). They found that 66 patients had a good or excellent response after 9 to 10 sessions. Eighteen patients were treated with M-ECT while maintaining antipsychotic treatment for periods ranging from 3 months to 12 years with an average of 2.2 years. The interval between sessions was 1 to 3 weeks. This combination has shown good efficacy with a reduction in the duration of hospitalization. Suzuki et al2 treated with ECT 7 patients older than 45 years and experiencing catatonic schizophrenia. The authors found that all patients have relapsed after the first cure despite maintaining antipsychotic treatment, www.ectjournal.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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