СLINICAL PREDICTORS OF THE EFFECTIVENESS OF ELECTROCONVULSIVE THERAPY IN THERAPEUTICALLY RESISTANT SCHIZOPHRENIA

Abstract

The issue of clinical prediction of the effectiveness of electroconvulsive therapy (ECT) in cases of therapeutic resistance, which occurs in almost a third of patients with schizophrenia, is particularly relevant due to the lack of absolute contraindications to use of it, its good tolerability, and the possible presence of other mechanisms of influence on resistance, in addition to the effect directly on dopaminergic neurotransmitter systems. Materials and methods. The study involved 38 patients with therapeutically resistant schizophrenia who, in accordance with the Protocol, underwent a course of ECT (6514 sessions) against the background of drug treatment with atypical antipsychotics (clozapine and olanzapine) in constant dosages (clozapine 300-800 mg/day, olanzapine 15-30 mg/day). TRS meant a slight decrease in the severity of productive disorders or a complete absence of positive dynamics after previous treatment with two neuroleptics of different pharmacological groups for 6-8 weeks in medium5therapeutic or maximum permissible doses. Correlation and regression statistical analyses were performed to identify features that are predictive of the ECT effect. Results. The positive effect of ECT was significantly correlated with the basic values of such items on the PANSS scale as arousal, dullness of affect, emotional isolation, communication difficulties, mannerism, depression, and inhibition. The following significant variables were obtained in the reverse step5by5step multiple regression: emotional detachment, mannerism, and arousal. Besides, there was a statistically significant relationship a negative correlation between disease duration and the reduction in symptoms on PANSS in excess of 50 %, and a positive correlation between disease duration and value of the item “suspicion” of the scale of PANSS. Conclusions. negative clinical predictors of ECT use in therapeutically resistant schizophrenia may be a significant duration of the disease and a large proportion of paranoid symptoms in the structure of the pathological condition. Positive prognostic factors are the relative short duration of the disease with the presence of depressive, catatonic and negative symptoms in the clinical picture.