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Psychiatry Investig. 2017 Jan;14(1):58-62. doi: 10.4306/pi.2017.14.1.58. Epub 2016 Dec 29.

Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia.

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Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.
Department of Psychiatry, Dongguk University International Hospital, Goyang, Republic of Korea.; Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Republic of Korea.
Department of Anesthesia & Pain Medicine, Dongguk University International Hospital, Goyang, Republic of Korea.



This retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review.


Clozapine-resistance was defined as persistent psychotic symptoms despite at least 12 weeks of clozapine administration with blood levels over 350 ng/mL in order to rule out pseudo-resistance. Seven in-patients who were taking clozapine and treated with ECT were selected. We analyzed the psychopathology and subscales changed by ECT.


The average number of ECT sessions was 13.4 (±4.6). Total Positive and Negative Syndrome Scale (PANSS) score was significantly reduced by 17.9 (±12.8) points (p=0.0384) on average, which represented a reduction of 25.5% (±14.3). 71.4% (5/7) of patients were identified as clinical remission, with at least a 20% reduction in PANSS score. PANSS reduction was associated with number of ECT sessions, stimulus level in the final session, and blood clozapine levels before ECT. However, the negative subscale on the PANSS were not reduced by ECT in any patient. We did not observe any persistent adverse cognitive effects.


This study supports that ECT augmentation on clozapine-resistant schizophrenia reveals clinically effective and safe. Further research should be done involving a larger number of patients to investigate the effectiveness of clozapine/ECT combination therapy.


Augmentation; Clozapine-resistant schizophrenia; Electroconvulsive therapy

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