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      Treatment resistant non-catatonic mutism in schizophrenia responding to a combination of continuation electroconvulsive therapy and neuroleptics

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          Abstract

          Non-catatonic mutism in schizophrenia has been described less frequently in literature. We describe the case of a young male who presented with non-catatonic mutism, secondary to first rank symptoms, which was refractory to adequate antipsychotic trials (quetiapine, risperidone, aripiprazole, ziprasidone, and trifluperazine) and responded to a combination of electroconvulsive therapy (ECT) and neuroleptics partially. However, when the ECT was continued in the continuation phase, the patient started speaking.

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          Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement.

          Worrawat Chanpattana, Harold A. Sackeim (2010)
          The clinical features of patients with schizophrenia who respond to electroconvulsive therapy (ECT) are uncertain. There is a longstanding belief that the duration of illness and/or the presence of affective symptoms associate with good prognosis. There is also little information on the nature of symptomatic improvement with this treatment. We examined the demographic and clinical history features associated with response, the symptom profile predictive of response, and the profile of symptomatic improvement. Using a standardized protocol, 253 patients with treatment-resistant schizophrenia were prospectively treated with a combination of ECT and flupenthixol. Of this group, 138 patients (54.5%) met the response criteria. Independence of sex, longer duration of current episode, and greater severity of baseline negative symptoms were predictive of poorer outcome. Duration of illness had weak relations with outcome only among females. There were marked sex differences in other clinical features and symptoms associated with response. In contrast, no sex differences were observed in the nature of symptomatic improvement. Treatment resulted in marked improvement in specific positive symptoms, with an intermediate effect on affective symptoms and no effect or worsening of specific negative symptoms. The findings challenge recommendations that long duration of illness or absence of affective symptoms portends poor response to ECT in patients with treatment-resistant schizophrenia. Sex may play a critical role in determining the features of the illness that predict outcome.
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            Combined electroconvulsive-clozapine therapy.

            M Kupchik, B Spivak, R Mester … (2000)
            We reviewed 36 reported psychiatric patients who were treated with a combination of electroconvulsive therapy (ECT) and clozapine. The indication of the ECT-clozapine treatment was resistance to classical antipsychotic agents, clozapine, or ECT alone. Sixty-seven percent of the patients benefited from the combined treatment. In most of the patients, the combined treatment was safe and well tolerated. Adverse reactions occurred in 16.6% of the patients and included prolonged ECT-induced seizures (one case), supraventricular (one case) and sinus tachycardia, and blood pressure elevation. It seems that combined ECT-clozapine treatment is effective and safe. This strategy may be a therapeutic option in treatment-resistant patients.
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              Combined use of electroconvulsive therapy and antipsychotics in schizophrenia: the Indian evidence. A review and a meta-analysis.

              Nitesh Painuly, Subho Chakrabarti (2006)
              Combined use of electroconvulsive therapy (ECT) and antipsychotics in acute phases of schizophrenia remains controversial and inadequately investigated. This study tried to examine whether the ECT-antipsychotic combination was more efficacious than antipsychotic drugs used alone in the acute phase treatment of schizophrenia, by way of an open review and an exploratory meta-analysis of the Indian studies on the subject. Eleven studies (n = 651) and 4 controlled trials (n = 113) were selected for the open review and the meta-analysis, respectively. For the meta-analysis, a standard chi analysis was undertaken to check for heterogeneity. Brief Psychiatric Rating Scale scores were used to estimate treatment effects. The open review suggested that the ECT-antipsychotic combination was more efficacious than antipsychotic drugs used alone in the first few weeks of treatment of schizophrenia. The meta-analysis, using the Inverse Weighted Variance Model, showed that the ECT-antipsychotic combination provides an advantage of approximately 5 Brief Psychiatric Rating Scale points over antipsychotic drugs, in the first 4 to 5 weeks of treatment of schizophrenia (mean treatment effect, 4.89; 95% confidence intervals, 0.50-9.38). The studies reviewed thus indicated that ECT-antipsychotic combinations might be better than antipsychotic drugs used alone in the first few weeks of treatment of schizophrenia; the main benefit seemed to be an acceleration of treatment response. Although the evidence was not conclusive because of several methodological difficulties, it does suggest that further research is required to determine the usefulness of the ECT-antipsychotic combination in the acute treatment of schizophrenia.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ind Psychiatry J
                Journal ID (iso-abbrev): Ind Psychiatry J
                Journal ID (publisher-id): IPJ
                Title: Industrial Psychiatry Journal
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-6748
                ISSN (Electronic): 0976-2795
                Publication date (Print): Jan-Jun 2012
                Volume: 21
                Issue: 1
                Pages: 69-71
                Affiliations
                [1]Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                Author notes
                Address for correspondence: Dr. Sandeep Grover, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: drsandeepg2002@ 123456yahoo.com
                Article
                Publisher ID: IPJ-21-69
                DOI: 10.4103/0972-6748.110957
                PMC ID: 3678184
                PubMed ID: 23766583
                SO-VID: a0fcd059-761d-4407-b16c-d2951b85042b
                Copyright © Copyright: © Industrial Psychiatry Journal
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: clozapine,electroconvulsive therapy,mutism
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: clozapine, electroconvulsive therapy, mutism

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