Left Anterior-Right Temporal Electroconvulsive Therapy for Catatonia After Epilepsy Surgery: A Case Report.
Left Anterior-Right Temporal Electroconvulsive Therapy for Catatonia After Epilepsy Surgery: A Case Report.
复制标题
癫痫手术后左前-右颞部电惊厥治疗紧张症：病例报告。
DOI：
10.1097/yct.0000000000000372
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Quinn,DavinK
中科院分区：
文献类型：
--
作者：
Loo,Dyani;Evans,Daniel;Abbott,ChristopherC;Quinn,DavinK
[讨论]我们描述了成功地使用超短脉冲单侧ECT治疗1例氯氮平耐药精神分裂症患者。ECT和氯氮平联合治疗氯氮平耐药精神分裂症在现有文献中得到的支持有限，尽管还需要进一步的研究。2实验研究仅限于2个随机对照试验，3个试验均不是双盲的，表明ECT联合氯氮平在减少阳性症状方面优于单独使用氯氮平，但对阴性症状的改善程度较小。此外，这些研究是基于双侧、正常脉宽的ECT，而不是单边和短暂或超短暂的脉宽刺激，后者在抑郁症患者中导致的认知不良影响要小得多，而不会失去疗效。5由于认知功能障碍日益被认为是精神分裂症的核心特征，最大限度地减少与治疗相关的认知功能障碍是任何治疗干预的强制性关注。我们的患者不仅在阳性精神病症状方面有了显着的改善，而且在基线认知缺陷方面也有了令人印象深刻和持续的改善。我们认为，这一案例说明了回顾ECT在治疗难治性和超难治性精神分裂症中的作用的重要性，以及需要就如何优化ECT对精神分裂症患者的疗效和安全性进行更多和更高质量的研究。
DISCUSSIONWe describe the successful use of ultrabrief pulse unilateral ECT to treat a patient with clozapine-resistant schizophrenia. The combination of ECT and clozapine treatment for clozapine-resistant schizophrenia finds limited support in the existing literature, although further research is needed. 2 Experimental studies are limited to 2 randomized controlled trials, 3 neither of which double-blinded, showing that combined ECT and clozapine is superior to clozapine alone in decreasing positive and, to a lesser degree, negative symptoms. Furthermore, these studies are based on bilateral, normal pulse-width ECT, rather than unilateral and brief or ultra-brief pulse-width stimulation, which, in depression, leads to much less cognitive adverse effects, without loss of efficacy. 5 Because cognitive dysfunction is increasingly recognized as a core feature of schizophrenia, minimizing treatmentrelated cognitive dysfunction is a mandatory concern for any therapeutic intervention. Our patient not only showed a marked improvement in positive psychotic symptoms but also showed an impressive and sustained amelioration of baseline cognitive deficits. We believe that this case illustrates the importance of reviewing the role of ECT in the treatment of refractory and ultrarefractory schizophrenia and the need for more and better-quality research on how to optimize the efficacy and safety of ECT for patients with schizophrenia.