Combined Antipsychotics and Electroconvulsive Therapy in an Acutely Psychotic Patient with Treatment-Resistant Schizophrenia

Treatment of patients with Treatment-resistant Schizophrenia (TRS), who fail to respond to multiple antipsychotic trials, including clozapine (CLZ), is challenging. Several alternative strategies are reported in studies, one of which includes augmenting antipsychotics (AP) with Electroconvulsive therapy (ECT). We discuss a case of an acutely psychotic patient with TRS who responded effectively and sustained remission to this strategy which was ECT combined with two AP, CLZ and aripiprazole. Notable improvement in clinical and cognitive outcomes was seen with just five right unilateral ECT sessions, CLZ titrated up to 62.5 mg/d and aripiprazole 20 mg/d with no adverse effects. Nine days into the psychiatric hospitalization, patient had decreased total scores on the Positive and Negative Syndrome Scale by 44% and an improved score on the St. Louis University Mental Status Exam by increasing from 3 to 22. This case report suggests that a subgroup of patients with TRS could benefit from a trial of adjunct ECT combined with AP to achieve a rapid alleviation of positive and negative symptoms which allows patients to have greater functional stability.