ECT IN CLOZAPINE REFRACTORY SCHIZOPHRENIA

描述(申请人摘要)：多达30%的精神分裂症患者 对标准的抗精神病药物有抵抗力。氯氮平代表一种 我们医院对精神分裂症的独特治疗，因为它有助于 治疗30%-50%的难治性患者。然而，其中50%-70%的人 不幸的是，患者对氯氮平没有足够的反应，被留下来 没有任何可行的治疗方案。他们继续无情地忍受着痛苦， 给他们的家庭和社会带来了相当大的负担。本研究 将研究电休克治疗(ECT)作为增强策略 适用于对氯氮平反应不充分的患者。选择 ECT基于三条趋同的证据：在抗精神病药物前 在药物时代，ECT通常是精神分裂症的有效治疗方法； ECT和抗精神病药物的结合提供了更好的临床 回应；几个病例系列表明，将ECT添加到 氯氮平。持续的氯氮平单药治疗和ECT增强氯氮平 在氯氮平难治性精神分裂症患者中， 前瞻性随机分配研究。我们将治疗曾患过AT的患者 至少12周的适当氯氮平试验。六十四科(32 随机服用氯氮平，32名随机服用氯氮平加ECT) 治疗长达8周；ECT+氯氮平组的受试者将 接受最多16至20次双边治疗。自然主义的后续行动将 比较接受继续电疗和未接受电疗的受试者 另外6个月。研究结果将指导临床医生面对 如何治疗没有得到标准帮助的患者的问题 抗精神病药物，对氯氮平没有足够的反应。

DESCRIPTION (Applicant's abstract): As many as 30% of schizophrenic patients are resistant to standard antipsychotic medications. Clozapine represents a unique treatment in our armamentarium for schizophrenia as it is helpful in treating 30-50% of the treatment-refractory patients. However, 50-70% of these unfortunate patients do not respond adequately to clozapine, and are left without any viable treatment options. They continue to suffer unrelentingly, and represent a considerable burden to their families and society. This study will investigate electroconvulsive therapy (ECT) as an augmentation strategy for patients who have failed to adequately respond to clozapine. The choice of ECT is based on three converging lines of evidence: in the pre-antipsychotic medication era, ECT was often an effective treatment for schizophrenia; the combination of ECT and antipsychotic medications provides enhanced clinical response; and several case series suggest a benefit when ECT is added to clozapine. Continued clozapine monotherapy and clozapine augmentation with ECT in clozapine refractory schizophrenic patients will be compared in a prospective, random assignment study. We will treat patients who have had at least 12 weeks of an adequate clozapine trial. Sixty-four subjects (32 randomized to clozapine and 32 randomized to clozapine plus ECT) will be treated for up to eight weeks; subjects in the ECT plus clozapine arm will receive up to 16 to 20 bilateral treatments. A naturalistic follow-up will compare subjects who receive continuation ECT with those who do not for an additional 6 months. The results of the study will guide clinicians faced with the problem of how to treat patients who have not been helped by standard antipsychotic medications and do not show an adequate response to clozapine.