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Electroconvulsive therapy in a patient with resistant paranoid schizophrenia treated with clozapine

Published online by Cambridge University Press:  13 August 2021

S. Castelao-Almodóvar*
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
A. Pérez-Balaguer
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
T. Ponte
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
B. Estevez Peña
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
Y.D. Corres Fuentes
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
E. Gil-Benito
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
E.M. Suárez Del Río
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
L. Gayubo-Moreo
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
B. Sanz-Aranguez
Affiliation:
Psychiatry, Hospital Universitario Puerta de Hierro de Majadahonda, Madrid, Spain
*
*Corresponding author.

Abstract

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Introduction

One of the usual indications for Electroconvulsive Therapy (ECT) is Paranoid Schizophrenia (PS), being performed usually in cases resistant to antipsychotics.

Objectives

To present a clinical case of a patient with antipsychotic-resistant PS, including Clozapine, who received ECT.

Methods

We present the case of a 47-year-old patient with an 8-years diagnosis of PS. He presented visual, auditory, and kinesthetic hallucinations, delusions, and thought insertion and diffusion phenomena that impeded concentration. He had received treatment with different antipsychotics (including Clozapine), without achieving remission of symptoms. He also presented significant adverse effects such as hypersalivation and extrapyramidal symptoms. Due to the poor response and the adverse effects that limited the dose increase, it was decided to start ECT.

Results

The patient received a total of 9 sessions, presenting a significant reduction in symptoms since the 5th session (disappearance of the sensory-perceptual alterations and thought disturbances). As side effects, the patient presented amnesia of the moments prior to applying the therapy, which subsequently resolved. The patient continued to present concentration difficulties, although after ECT he denied the presence of thought insertion or diffusion phenomena to which he previously attributed the cause of these difficulties.

Conclusions

Although less responsive than in other indications, ECT combined with antipsychotic drugs has been proven to be more effective than monotherapy (regardless of whether it’s Clozapine or another). This lower response could be due to the use of ECT in the most resistant cases, since it has been demostrated that in more acute cases a faster improvement occurs when the two treatments are combined.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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