ECT and Clozapine combination producing delirium : A Case Report

Although successfully used, caution has been advised with the combined use of clozapine and electroconvulsive therapy (ECT).The combination has been associated with delirium, in this report, which successfully resolves on discontinuation of ECT

ECT and Clozapine combination producing delirium: A Case Report

Although successfully used, caution has been advised with the combined use of clozapine and electroconvulsive therapy (ECT).The combination has been associated with delirium, in this report, which successfully resolves on discontinuation of ECT. Key words: ECT Clozapine, Schizophrenia Simultaneous use of electroconvulsive therapy (ECT) and clozapine has always been controversial. Fink (1990) strongly advocates the use of ECT along with a neuroleptic in drug-resistant schizophrenia instead of subjecting the patients to prolonged neuroleptic trial. However, Meltzer (1990) points out that the combination might be effective only in the less chronic schizophrenic patients, especially those with marked depressive features. He also suggests that the effects are modest and usually transient. Frankenburg et al, (1993), Benatov et al, (1996) have reviewed the use of ECT and clozapine in treatment-resistant schizophrenics and found it to be safe and effective although short lived. Efficacy of this combination without any adverse effects has also been reported in mania (Lurie, 1996, Chanpattna, 2000) However, the combined use has been shown to cause serious adverse effects like prolonged seizure (Bloch et al, 1996), supraventricular tachycardia and blood pressure elevation (kupchik et al, 2000) and thus contraindicated. We are reporting the case of a schizophrenic patient who developed delirium when clozapine was added to ECT. CASE A 56 year old male schizophrenic patient having family history of schizophrenia in elder brother presented widi an illness characterized by persecutory delusions and hostility accompanied by prominent euphoric symptoms for the last 5 years, with alcohol intake amounting to dependence for the last 3 years. When he showed no response to 6 weeks treatment with 20mg/day olanzapine, haloperidol was started and titrated to a dose of 20 mg/d. Thriceweekly modified ECTs were also added in die third week of haloperidol use. At the end of 4 weeks, haloperidol was discontinued as there was no clinical response and clozapine initiated at 50 mg/d in divided doses. By then, the patient had already received 7 modified ECTs with haloperidol without any cognitive impairment on Min