Out on PubMed today is this expert consensus statement about treatment of schizophrenia:

 Clozapine Combination and Augmentation Strategies in Patients With Schizophrenia -Recommendations From an International Expert Survey Among the Treatment Response and Resistance in Psychosis (TRRIP) Working Group.
Wagner E, Kane JM, Correll CU, Howes O, Siskind D, Honer WG, Lee J, Falkai P, Schneider-Axmann T, Hasan A; TRRIP Working Group.
Schizophr Bull. 2020 May 18. pii: sbaa060. doi: 10.1093/schbul/sbaa060. [Epub ahead of print]


The relevant ECT parts are (from the abstract):
 For clozapine-refractory positive symptoms, combination with a second antipsychotic (amisulpride and oral aripiprazole) and augmentation with ECT achieved consensus.
For clozapine-refractory suicidality, augmentation with antidepressants or mood-stabilizers, and ECT met consensus criteria. 

 And from the text:
Consensus was reached for clozapine augmentation with ECT (92.1% in the second round) . In the case of symptomatic improvement following an acute course of ECT, 71.1% of the survey participants suggested ECT maintenance treatment (table 3). The median number of ECT was recommended to be 12 (SA-table 4), and consensus was reached for a frequency of 3 ECT sessions per week (76.5% in the second round)

I refer you also to a soon-to-be-classic study on this subject:
Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study.
Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, Kane JM, Sanghani S, Goldberg TE, John M, Mendelowitz A.
Am J Psychiatry. 2015 Jan;172(1):52-8. doi: 10.1176/appi.ajp.2014.13060787. Epub 2014 Oct 31.
The pdf is here.

Comments

  1. ECT BloggerMay 20, 2020 at 7:41 AM

    The below comment is from Max Fink:

    Schizophrenia-Clozapine-ECT
    Studies of clozapine in schizophrenia began in 1970s. After 50 years, it is sad that discriminators are limited to "positive" and "negative" signs. Schizophrenia diagnoses are remarkably heterogeneous. Besides thought and speech disorders, motor disorders of catatonia, delusions of paranoia and world destruction, suicide thoughts, periods of mania and delirium, strengthened affective symptoms -- are identifiable variations. The failure to distinguish these signs as predictors for clozapine with or without ECT is an omission.
    In the 1980-90s, as ECT usage was being revived, many asked what was the role of "ECT in schizophrenia?" What criteria are useful to select patients for ECT? Multiple reviews highlighted catatonia, mania, suicide risk, deliria as predictors for the benefits of ECT in schizophrenia. One such review is published on this blog on May 20.

    Max Fink, MD

    ReplyDelete

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