Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia
Clozapine is considered the gold standard for patients with treatment-resistant schizophrenia (TRS) who have previously tried other antipsychotics at adequate doses (two or more, with at least one being atypical). However, despite optimal treatment, a subgroup of TRS patients with what is known as u...
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MDPI AG
2023-04-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/11/4/1072 |
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| author | Vjekoslav Peitl Antonia Puljić Mislav Škrobo Sergej Nadalin Lidija Fumić Dunkić Dalibor Karlović |
| author_facet | Vjekoslav Peitl Antonia Puljić Mislav Škrobo Sergej Nadalin Lidija Fumić Dunkić Dalibor Karlović |
| author_sort | Vjekoslav Peitl |
| collection | DOAJ |
| description | Clozapine is considered the gold standard for patients with treatment-resistant schizophrenia (TRS) who have previously tried other antipsychotics at adequate doses (two or more, with at least one being atypical). However, despite optimal treatment, a subgroup of TRS patients with what is known as ultra-treatment-resistant schizophrenia (UTRS) fails to respond to clozapine, which occurs in 40–70% of cases. The most common approach to manage UTRS involves augmenting clozapine with pharmacological or non-pharmacological interventions, with a growing body of evidence that supports the use of electroconvulsive therapy (ECT) as an augmenter. This prospective non-randomized 8-week study, which followed the TRIPP Working Group guidelines and is one of few that separate TRS from UTRS, aimed to evaluate the effectiveness of clozapine in TRS patients and the efficacy of ECT augmentation of clozapine in UTRS patients. Patients with TRS were assigned to receive clozapine alone (clozapine group), whereas UTRS patients received bilateral ECT in addition to their current medication regimen (ECT plus clozapine group). The severity of symptoms was evaluated using the Clinical Global Impression Scale (CGI) and Positive and Negative Syndrome Scale (PANSS) at baseline and at the end of the 8-week trial. Both treatment approaches resulted in improved CGI and PANSS scores. The results suggest that both clozapine and ECT are effective treatment options for patients with TRS and UTRS, respectively, and that adherence to guidelines should provide a better frame for future clinical studies. |
| first_indexed | 2024-03-11T05:13:22Z |
| format | Article |
| id | doaj.art-beebf520a43c47ca8a4347d3d9552e1c |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-11T05:13:22Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-beebf520a43c47ca8a4347d3d9552e1c2023-11-17T18:26:10ZengMDPI AGBiomedicines2227-90592023-04-01114107210.3390/biomedicines11041072Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant SchizophreniaVjekoslav Peitl0Antonia Puljić1Mislav Škrobo2Sergej Nadalin3Lidija Fumić Dunkić4Dalibor Karlović5Department of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, CroatiaDepartment of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, CroatiaDepartment of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, CroatiaDepartment of Psychiatry, General Hospital “Dr. Josip Benčević”, 35000 Slavonski Brod, CroatiaSchool of Medicine, Catholic University of Croatia, 10000 Zagreb, CroatiaDepartment of Psychiatry, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, CroatiaClozapine is considered the gold standard for patients with treatment-resistant schizophrenia (TRS) who have previously tried other antipsychotics at adequate doses (two or more, with at least one being atypical). However, despite optimal treatment, a subgroup of TRS patients with what is known as ultra-treatment-resistant schizophrenia (UTRS) fails to respond to clozapine, which occurs in 40–70% of cases. The most common approach to manage UTRS involves augmenting clozapine with pharmacological or non-pharmacological interventions, with a growing body of evidence that supports the use of electroconvulsive therapy (ECT) as an augmenter. This prospective non-randomized 8-week study, which followed the TRIPP Working Group guidelines and is one of few that separate TRS from UTRS, aimed to evaluate the effectiveness of clozapine in TRS patients and the efficacy of ECT augmentation of clozapine in UTRS patients. Patients with TRS were assigned to receive clozapine alone (clozapine group), whereas UTRS patients received bilateral ECT in addition to their current medication regimen (ECT plus clozapine group). The severity of symptoms was evaluated using the Clinical Global Impression Scale (CGI) and Positive and Negative Syndrome Scale (PANSS) at baseline and at the end of the 8-week trial. Both treatment approaches resulted in improved CGI and PANSS scores. The results suggest that both clozapine and ECT are effective treatment options for patients with TRS and UTRS, respectively, and that adherence to guidelines should provide a better frame for future clinical studies.https://www.mdpi.com/2227-9059/11/4/1072clozapineECTTRSUTRS |
| spellingShingle | Vjekoslav Peitl Antonia Puljić Mislav Škrobo Sergej Nadalin Lidija Fumić Dunkić Dalibor Karlović Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia Biomedicines clozapine ECT TRS UTRS |
| title | Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia |
| title_full | Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia |
| title_fullStr | Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia |
| title_full_unstemmed | Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia |
| title_short | Clozapine in Treatment-Resistant Schizophrenia and Its Augmentation with Electroconvulsive Therapy in Ultra-Treatment-Resistant Schizophrenia |
| title_sort | clozapine in treatment resistant schizophrenia and its augmentation with electroconvulsive therapy in ultra treatment resistant schizophrenia |
| topic | clozapine ECT TRS UTRS |
| url | https://www.mdpi.com/2227-9059/11/4/1072 |
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