Resolution of Auditory Hallucinations Three Years Into Maintenance ECT for Schizophrenia: Case Report From Korea

Out on PubMed, from clinicians in Korea, is this case report:

Resolution of Persistent Auditory Verbal Hallucinations after Long-term Electroconvulsive Therapy Maintenance: A Case Report of a Patient with Clozapine-resistant Schizophrenia.

Chung IW, Kim HS, Kim JH, Jang JH, Kim YS.Clin Psychopharmacol Neurosci. 2021 Feb 28;19(1):170-173. doi: 10.9758/cpn.2021.19.1.170.PMID: 3350880
The abstract is copied below:
A 32-year-old woman with schizophrenia and persistent auditory verbal hallucinations (AVHs), which caused continuous suicidal thoughts and depression, was treated with electroconvulsive therapy (ECT) of an acute course followed by maintenance ECT (M-ECT) augmented onto clozapine for 7 years. Although the general psychopathology and AVHs initially reduced slightly with ECT and clozapine, her AVHs and suicidal thoughts did not decrease subjectively. When 3 years of M-ECT, her voices declined sharply, and improvement was maintained for 2 years thereafter. A total 91 ECT sessions were performed. The daily clozapine dose was decreased from 325 to 200 mg and plasma levels remained higher than 350 ng/ml; there were no noticeable cognitive side effects. In summary, we report a case showing a sudden sharp reduction in persistent AVHs after 3 years of long-term M-ECT.
Keywords: Auditory verbal hallucinations; Clozapine; Maintenance electroconvulsive therapy; Schizophrenia.

And from the text:
Well-designed studies of the long-term M-ECT effects on persistent AVHs in patients with schizophrenia in terms of symptom resolution, persistence of any improvement, and relapse prevention are very limited [13,17,21]. Therefore, even case reports of very long-term ECT treatment could contribute to our understanding of the M-ECT effects on persistent AVHs 
This report describes a patient whose auditory hallucinations suddenly decreased 3 years into maintenance ECT. Who knows why this happened, but the authors believe it was likely due to her ongoing ECT plus clozapine. They describe good tolerability of the maintenance ECT, tapered out to approximately every 6 weeks. Many of the case details are unclear, but the main point, that therapeutic persistence sometimes reaps rewards for the patient is a good one to note. Also, as stated in the text excerpt above, there is a paucity of evidence about the effect of ongoing ECT on symptoms of schizophrenia, so any contributions are welcome. IMO, no need to read the full report, as all the important concepts are noted in the abstract (a savings of ~10 minutes).

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