Eren Yıldızhan, Nesrin Buket Tomruk, Özge Atay Canbek

Şizofrenide Klozapin Başlanmasından Önce ya da Sonra EKT – Nöbet Parametreleri, Tedavi Yanıtı ve Hastanede Yatış Süresinin Retrospektif Bir Karşılaştırması

Amaç: Şizofreni tanılı hastalarda klozapin ile eşzamanlı olarak uygulanan elektrokonvulziv tedavinin (EKT) daha iyi tedavi yanıtı ve hastanede yatış süresinde kısalmaya neden olma olasılığını incelemek amaçlanmıştır. Yöntemler: Kadın psikiyatri kliniğimizde 5 yıl boyunca (01.02.2014 ve 01.02.2019 arasında) yatarak tedavi gören şizofreni tanılı hastaların tıbbi kayıtları retrospektif olarak incelendi. Tedavi yanıtını değerlendirmede Klinik Global İzlem – İyileşme (KGİ-İ) ölçeği kullanılmıştı. Bulgular: EKT ile tedavi edilmiş olan 191 olgu içinde; 8 şizofreni olgusu EKT ve eşzamanlı klozapin ile tedavi edilmiş (K-EKT) ve 14 olguya ise önce EKT uygulanmış, sonrasında klozapin tedavisine başlanmıştı (EKT-Ö). İki grup arasında EKT seans sayıları ve nöbet süreleri açısından anlamlı fark yoktu (p > 0.05). EKT’ ye iyi ya da hafif yanıt oranının (KGİ-İ: 2 ya da 3), K-EKT grubunda %75 (n=6); EKT-Ö grubunda ise %85,7 (n=12) olduğu görüldü. Ortalama KGİ-İ skorları arasında gruplar arasında anlamlı fark yoktu (p > 0.05). K-EKT grubunun hastanede yatış süresi (37,7 ± 14,44 gün), EKT-Ö grubundan (56,0 ± 19,2 gün) daha kısaydı (p = 0,04). EKT seansları sırasında ya da yatışlar süresince ciddi yan etki görülmedi. Sonuç: Her iki uygulamada da tedaviye iyi yanıt yüksek orandaydı ve uygulamalar arasında anlamlı fark yoktu. EKT ile eşzamanlı klozapin uygulamasının hastanede yatış süresini anlamlı oranda kısaltırken ciddi komplikasyonlar ve yan etkilerde artışına neden olmadığı görüldü.

Electroconvulsive Therapy Before or After Initiation of Clozapine in Schizophrenia - A Retrospective Comparison for Seizure Parameters, Treatment Response and Duration of Hospitalization

Purpose: Determining whether adjunctive electroconvulsive therapy (ECT) with clozapine leads to better treatment response and decreased length of stay for patients with schizophrenia. Methods: Medical records of patients with schizophrenia who were treated with ECT-clozapine combination in our women’s mental health inpatient clinic in a period of 5 years (between 01.02.2014 and 01.02.2019) were investigated retrospectively. Clinical Global Impression of Improvement (CGI-I) scale was used for assessing treatment response. Results: Of the 191 cases treated with ECT, there were 8 cases of schizophrenia who were treated with ECT and concomitant clozapine (C-ECT) and 14 cases who were treated with ECT before the initiation of clozapine (ECT-B). Number of ECT sessions and duration of seizures were not significantly different for both groups (p > 0.05). There was good and mild response (CGI-I score of 2 and 3) in 75% of the patients (n=6) for C-ECT and 85.7% of the patients (n=12) for ECT-B. Mean CGI-I scores between the two groups were not significantly different (p > 0.05). Duration of hospitalization for the C-ECT group (37.7 ± 14.44 days) was shorter than the duration of hospitalization for the ECT-B group (56.0 ± 19.2 days) (p = 0.04). No serious adverse events were observed during the ECT sessions or during the index hospitalizations. Conclusion: Response rate was high and similar in both of the procedures and the duration of hospitalization was shorter for C-ECT group with no significant increase in serious complicatins and adverse effects.

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