Combining ECT and Clozapine in the Treatment of Clozapine-Refractory Schizophrenia and Schizoaffective Disorder--a Pilot Study (Electroconvulsive Therapy) (Clinical Report‪)‬

Schizophrenia is considered to be among the most severe, debilitating and persistent of all psychiatric disorders. Although the adult prevalence is approximately 1%, studies have indicated that sufferers constitute close to 10% of the permanently disabled population. (1) As such, schizophrenia is a major public health problem and the negative economic consequences underscore the urgent need to develop strategies to improve treatment effectiveness. (2) Despite great advances in the understanding and management of the disease, a significant portion of individuals with schizophrenia do not respond well to drug treatment. (3) Management of these treatment-refractory patients is particularly challenging as they often require longer periods of hospitalisation, with their care ultimately amounting to a disproportionately high share of the total cost of schizophrenia. (1) Although the advent of the second-generation antipsychotic drugs has been regarded as a breakthrough owing to improved side-effect profiles and patient satisfaction, claims of their superior efficacy in treatment-refractory patients still remain unproven. (4) To date, in terms of evidence base, clozapine remains the undisputed treatment of choice for patients with severe treatment-refractory schizophrenia. (5-7)