Maintenance Electroconvulsive Therapy in a Patient with Treatment-Resistant Paranoid Schizophrenia and Comorbid Epilepsy

The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT) and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response.

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Electroconvulsive Therapy in Treatment-Resistant Schizophrenia: a Case Report

European Psychiatry ◽

10.1016/s0924-9338(11)72840-1 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1135-1135

Author(s):

V.M. Barrau ◽

M. Salinas ◽

S. Yelmo ◽

E. Santana ◽

F. Montiano ◽

...

Keyword(s):

Electroconvulsive Therapy ◽

Hospital Admissions ◽

Paranoid Schizophrenia ◽

Chronic Schizophrenia ◽

Optimal Number ◽

Auditory Hallucinations ◽

Predictors Of Response ◽

Maintenance Ect ◽

Controversial Topic ◽

Null Response

Electroconvulsive therapy (ECT) is born as we know it in the first half of the twentieth century. Although initially introduced as a treatment for schizophrenia, soon proved more effective in affective disorders.Currently this therapy is second choice in the treatment of schizophrenia, representing only 10–20% of ECT treatments.We present a 55 years-old-woman diagnosed with Paranoid Schizophrenia in the adolescence, with several hospital admissions who was sent from sub-acute unit to receive ECT, given the null response to several pharmacological trials. The last, 1,200 mg amisulpride, 650 mg clozapine and 1,000 mg valproate per day, and Zuclopenthixol ampoule every 14 days. She verbalizes poorly structured persecutory, megalomaniac and nihilist delusional ideas, as well as auditory hallucinations which she does not clarify, and thought broadcasting phenomena. After withdrawing this medication and starting treatment with 30 mg haloperidol and 550 mg quetiapine, 14 bifrontotemporal ECT sessions were given.Given the disappearance of persecutory delusional ideas, and the decrease of auditory hallucinations, which she criticizes, the patient was discharged. After 4 months, she is still psychopathologically stable, and receiving maintenance ECT biweekly.ECT, either alone or in combination with conventional antipsychotic drugs, has been shown effective in a certain percentage of patients with acute schizophrenia, particularly in the catatonic subtype and also in schizoaffective disorder. The use and efficacy of ECT in chronic schizophrenia is a more controversial topic.Research should also focus on the determination of optimal number of ECT, the predictors of response and the efficacy of continuation and maintenance ECT.

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When it's the Time to Switch the Therapeutic Approach on Electroconvulsive Therapy for Residual Positive Symptoms in Schizophrenia?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.975 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S613-S613

Author(s):

I. Nechifor ◽

N. Nita ◽

M. Buzut

Keyword(s):

Electroconvulsive Therapy ◽

Social Life ◽

Negative Impact ◽

Paranoid Schizophrenia ◽

Anxiety And Depression ◽

Positive Symptoms ◽

Treatment Resistant ◽

The Past ◽

Competing Interest ◽

Depot Antipsychotics

IntroductionSchizophrenia is clearly one of the most debilitating diseases. Luckily, in the past 20 years, there has been a wide and good change in symptomatology due to the new atypical antipsychotics. Still, there are patients who are treatment resistant after different adjustments like switching or adding antipsychotics. Most of the clinicians consider Clozapine the “last resort”. But what if it doesn’t work so well on some patients?ObjectiveTo determine the point when it's time to try electroconvulsive therapy in schizophrenia treatment-resistant patients or remain on conventional approach.AimsThe aim of this work is to determine whether it's better for those patients who have residual positive symptoms to use oral/depot antipsychotics or to switch on electroconvulsive therapy.MethodsThis work presents the case of the patient C.D., 35 years, diagnosed with paranoid schizophrenia since 2008. Risperidone, Olanzapine, Aripiprazole were introduced during time, with some improvement on the positive symptomatology, but the patient developed several side-effects. At his last admission in our hospital, he came after a suicidal attempt caused by high anxiety and depression due to his false beliefs. Clozapine was introduced, but after one month of treatment, the patient still had the belief that his neighbours want to harm him somehow.ResultsThe patient and his mother definitively refused electroconvulsive therapy because of their personal beliefs. He affirmed that he can live with this “low-dose” of suspiciousness which, unfortunately, had a negative impact on his social life.ConclusionsWe still recommend electroconvulsive therapy in these situations, even though, there are many misconceptions regarding this approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Gene expression profiling in treatment-naive schizophrenia patients identifies abnormalities in biological pathways involving AKT1 that are corrected by antipsychotic medication

The International Journal of Neuropsychopharmacology ◽

10.1017/s1461145713000035 ◽

2013 ◽

Vol 16 (7) ◽

pp. 1483-1503 ◽

Cited By ~ 39

Author(s):

Nishantha Kumarasinghe ◽

Natalie J. Beveridge ◽

Erin Gardiner ◽

Rodney J. Scott ◽

Surangi Yasawardene ◽

...

Keyword(s):

Gene Expression ◽

Drug Treatment ◽

Antipsychotic Drug ◽

Antipsychotic Medication ◽

Expression Profiling ◽

Expression Profiles ◽

Gene Expression Profiles ◽

Canonical Pathways ◽

Treatment Naïve ◽

Antipsychotic Drug Treatment

Abstract Distinct gene expression profiles can be detected in peripheral blood mononuclear cells (PBMCs) in patients with schizophrenia; however, little is known about the effects of antipsychotic medication. This study compared gene expression profiles in PMBCs from treatment-naive patients with schizophrenia before and after antipsychotic drug treatment. PBMCs were obtained from 10 treatment-naive schizophrenia patients before and 6 wk after initiating antipsychotic drug treatment and compared to PMBCs collected from 11 healthy community volunteers. Genome-wide expression profiling was conducted using Illumina HumanHT-12 expression bead arrays and analysed using significance analysis of microarrays. This analysis identified 624 genes with altered expression (208 up-regulated, 416 down-regulated) prior to antipsychotic treatment (p < 0.05) including schizophrenia-associated genes AKT1, DISC1 and DGCR6. After 6–8 wk treatment of patients with risperidone or risperidone in combination with haloperidol, only 106 genes were altered, suggesting that the treatment corrected the expression of a large proportion of genes back to control levels. However, 67 genes continued to show the same directional change in expression after treatment. Ingenuity® pathway analysis and gene set enrichment analysis implicated dysregulation of biological functions and pathways related to inflammation and immunity in patients with schizophrenia. A number of the top canonical pathways dysregulated in treatment-naive patients signal through AKT1 that was up-regulated. After treatment, AKT1 returned to control levels and less dysregulation of these canonical pathways was observed. This study supports immune dysfunction and pathways involving AKT1 in the aetiopathophysiology of schizophrenia and their response to antipsychotic medication.

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