Anwendung der EKT bei pharmakoresistenter Schizophrenie

Zusammenfassung

Die Elektrokonvulsionstherapie (EKT) hat seit ihrer Einführung in den 30er-Jahren des vergangenen Jahrhunderts ihren Stellenwert als effektives und evidenzbasiertes somatisches Therapieverfahren in der Behandlung affektiver und schizophrener Störungen behaupten können. Im Vergleich zu den affektiven Erkrankungen wird die EKT bei Schizophrenie in den westlichen Industrienationen deutlich seltener eingesetzt. Entsprechend ist die Studienlage zur Wirksamkeit und Verträglichkeit sowie zu den Stimulationsparametern des Verfahrens unter dieser Indikation als vergleichsweise unbefriedigend anzusehen. Ergebnisse aus den hier berücksichtigten aktuellen Therapiestudien, Metaanalysen und Übersichtsarbeiten lassen bei akuten schizophrenen Episoden auf eine relativ gute Evidenz für eine höhere Wirksamkeit der kombinierten pharmakologischen und elektrokonvulsiven Behandlung gegenüber der jeweiligen Monotherapie schließen. Als klinische Einflussfaktoren für ein Ansprechen auf die EKT gelten neben Wahn und Halluzination auch affektive und katatone Begleitsymptome sowie eine kurze Episodendauer. In den gängigen Therapie-Algorithmen nationaler und internationaler Leitlinien psychiatrischer Fachgesellschaften kommt der EKT als Augmentationsstrategie in der Behandlung pharmakoresistenter Schizophrenien in der Akutphase die größte Bedeutung zu. In Anbetracht der Häufigkeit therapierefraktärer Verläufe schizophrener Psychosen besteht ein Bedarf an weiteren sorgfältig kontrollierten und randomisierten Therapiestudien, um die vielversprechende Behandlungsoption EKT bei Schizophrenie auf ein fundiertes Evidenzniveau zu bringen.

Abstract

Since its introduction in the 1930 s, electroconvulsive therapy (ECT) has maintained an important role as an efficacious and evidence-based somatic treatment option in affective or schizophrenic diseases. As opposed to major depressive disorder, ECT is commonly used to a substantially lesser extent for patients with schizophrenia in the USA, UK and most parts of Europe. Accordingly there is comparably little evidence regarding the clinical effectiveness and tolerability of ECT in schizophrenia. Recent clinical studies, meta-analyses and surveys point to the combination of ECT and antipsychotic medication as being advantageous in the treatment of schizophrenia, particularly in those patients who have shown inadequate responses to psychotropic medication alone. Clinical features considered to be predictive for ECT outcome are delusions, hallucinations, presence of affective and catatonic symptoms and absence of negative symptoms as well as a short duration of the current episode. National and international guidelines suggest ECT as an augmentation strategy in treatment-refractory schizophrenia in acute exacerbation and continuation therapy. Considering the fact that a substantial part of schizophrenic patients does not respond sufficiently to pharmacotherapy there still is a lack of well designed, controlled and randomised clinical trials to improve evidence for the promising role of ECT in schizophrenia.

Schlüsselwörter

Elektrokonvulsionstherapie - Schizophrenie - Therapieresistenz - Augmentationsstrategie

Key words

electroconvulsive therapy - schizophrenia - treatment resistance - augmentation strategy

• Literatur

• 1 Shorter E. History of Psychiatry. New York (NY): John Wiley&Sons; 1997
• 2 Sakel M, Pötzl O. Neue Behandlungsmethoden der Schizophrenie. Wien, Leipzig: Perles; 1935
• 3 Meduna L. Versuche über die biologische Beeinflussung des Ablaufes der Schizophrenie: Camphor und Cardiazolkrampfe. Z Ges Neurol Psychiatr 1935; 152: 226-235
• 4 Cerletti U, Bini L. L’Electroshock. Arch Gen Neuro Psychiatr Psychoanal 1938; 19: 266-268
• 5 Fink M. Electroconvulsive therapy resurrected: its successes and promises after 75 years. Can J Psychiatry 2011; 56: 3-4
• 6 Abrams R. Electroconvulsive therapy. New York (NY): Oxford University Press; 2002
• 7 Müller U, Klimke A, Jänner M et al. Die Elektrokrampftherapie in psychiatrischen Kliniken der Bundesrepublik Deutschland 1995. Nervenarzt 1998; 69: 15-26
• 8 Brücke H, Ginzel KH, Klupp H et al. Bis-Cholinester von Dicarbonsäuren als Muskelrelaxantien in der Narkose. Wien Klin Wochenschr 1951; 63: 464-466
• 9 Whitwam JG, Moreton T, Norman J. Clinical signs with modified electroconvulsive therapy. Br J Psychiatry 1963; 109: 399-403
• 10 Frey R, Schreinzer D, Heiden A et al. Use of electroconvulsive therapy in psychiatry. Nervenarzt 2001; 72: 661-676
• 11 Fink M, Sackeim HA. Convulsive therapy in schizophrenia?. Schizophr Bull 1996; 22: 27-39
• 12 McCall WV. Electroconvulsive therapy in the era of modern psychopharmacology. Int J Neuropsychopharmacol 2001; 4: 315-324
• 13 Taylor S. Electroconvulsive therapy: a review of history, patient selection, technique, and medication management. South Med J 2007; 100: 494-498
• 14 Geddes J. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. The UK ECT Review Group. Lancet 2003; 361: 808
• 15 Smith GE, Rasmussen Jr KG, Cullum CM et al. A randomized controlled trial comparing the memory effects of continuation electroconvulsive therapy versus continuation pharmacotherapy: results from the Consortium for Research in ECT (CORE) study. J Clin Psychiatry 2010; 71: 185-193
• 16 Krueger RB, Sackeim HA. Electroconvulsive therapy and schizophrenia. In: Hirsch R, Weinberger DR, (eds) Schizophrenia. Oxford: Blackwell; 1995: 503-545
• 17 Bundesärztekammer. Stellungnahme zur Elektrokrampftherapie (EKT) als psychiatrische Behandlungsmaßnahme. Deutsches Ärzteblatt 2003; 100: 504-506
• 18 National Institute for Health and Clinical Excellence. Schizophrenia – Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. 2009
• 19 Deutsche Gesellschaft für Psychiatrie und Nervenheilkunde. Behandlungsleitlinie Schizophrenie. S3-Praxisleitlinien in Psychiatrie und Psychotherapie. Darmstadt: Steinkopff-Verlag; 2005
• 20 Barnes TR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011; 25: 567-620
• 21 Lehman AF, Lieberman JA, Dixon LB et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004; 161: 1-56
• 22 Moore TA, Buchanan RW, Buckley PF et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2006 update. J Clin Psychiatry 2007; 68: 1751-1762
• 23 Uesugi H, Toyoda J, Iio M. Positron emission tomography and plasma biochemistry findings in schizophrenic patients before and after electroconvulsive therapy. Psychiatry Clin Neurosci 1995; 49: 131-135
• 24 Galynker II, Weiss J, Ongseng F et al. ECT treatment and cerebral perfusion in Catatonia. J Nucl Med 1997; 38: 251-254
• 25 Fujita Y, Takebayashi M, Hisaoka K et al. Asymmetric alternation of the hemodynamic response at the prefrontal cortex in patients with schizophrenia during electroconvulsive therapy: a near-infrared spectroscopy study. Brain Res 2011; 1410: 132-140
• 26 Frodl T, Meisenzahl EM, Moller HJ. Value of diagnostic imaging in evaluation of electroconvulsive therapy. Nervenarzt 2004; 75: 227-233
• 27 Devanand DP, Dwork AJ, Hutchinson ER et al. Does ECT alter brain structure?. Am J Psychiatry 1994; 151: 957-970
• 28 Nobler MS, Oquendo MA, Kegeles LS et al. Decreased regional brain metabolism after ect. Am J Psychiatry 2001; 158: 305-308
• 29 Takano H, Motohashi N, Uema T et al. Changes in regional cerebral blood flow during acute electroconvulsive therapy in patients with depression: positron emission tomographic study. Br J Psychiatry 2007; 190: 63-68
• 30 Hamani C, Mayberg H, Stone S et al. The subcallosal cingulate gyrus in the context of major depression. Biol Psychiatry 2011; 69: 301-308
• 31 Butler MO, Morinobu S, Duman RS. Chronic electroconvulsive seizures increase the expression of serotonin2 receptor mRNA in rat frontal cortex. J Neurochem 1993; 61: 1270-1276
• 32 Savitz J, Lucki I, Drevets WC. 5-HT(1A) receptor function in major depressive disorder. Prog Neurobiol 2009; 88: 17-31
• 33 Strome EM, Zis AP, Doudet DJ. Electroconvulsive shock enhances striatal dopamine D1 and D3 receptor binding and improves motor performance in 6-OHDA-lesioned rats. J Psychiatry Neurosci 2007; 32: 193-202
• 34 Landau AM, Chakravarty MM, Clark CM et al. Electroconvulsive therapy alters dopamine signaling in the striatum of non-human primates. Neuropsychopharmacology 2011; 36: 511-518
• 35 Smith SE, Sharp T. Evidence that the enhancement of dopamine function by repeated electroconvulsive shock requires concomitant activation of D1-like and D2-like dopamine receptors. Psychopharmacology 1997; 133: 77-84
• 36 Dannlowski U, Domschke K, Birosova E et al. Dopamine D3 receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression. Int J Neuropsychopharmacol 2011; 18: 1-17
• 37 Smith SE, Acton L, Sharp T. Enhancement of dopamine-mediated behaviour by the NMDA antagonists MK-801 and CPP: similarities with repeated electroconvulsive shock. Psychopharmacology 1997; 133: 85-94
• 38 Angelucci F, Brene S, Mathe AA. BDNF in schizophrenia, depression and corresponding animal models. Mol Psychiatry 2005; 10: 345-352
• 39 Altar CA, Whitehead RE, Chen R et al. Effects of electroconvulsive seizures and antidepressant drugs on brain-derived neurotrophic factor protein in rat brain. Biol Psychiatry 2003; 54: 703-709
• 40 Sartorius A, Hellweg R, Litzke J et al. Correlations and discrepancies between serum and brain tissue levels of neurotrophins after electroconvulsive treatment in rats. Pharmacopsychiatry 2009; 42: 270-276
• 41 Martinotti G, Ricci V, Di Nicola M et al. Brain-derived neurotrophic factor and electroconvulsive therapy in a schizophrenic patient with treatment-resistant paranoid-hallucinatory symptoms. J ECT 2011; 27: e44-e46
• 42 Bolwig TG. How does electroconvulsive therapy work? Theories on its mechanism. Can J Psychiatry 2011; 56: 13-18
• 43 McNally KA, Blumenfeld H. Focal network involvement in generalized seizures: new insights from electroconvulsive therapy. Epilepsy Behav 2004; 5: 3-12
• 44 Fink M, Ottosson JO. A theory of convulsive therapy in endogenous depression: significance of hypothalamic functions. Psychiatry Res 1980; 2: 49-61
• 45 American Psychiatric Association. The practice of electroconvulsive therapy – a task force report of the American Psychiatric Association. Washington (DC): 2001
• 46 Royal College of Psychiatrists. The ECT Handbook.Second Edition. The Third Report of the Royal College of Psychiatrists’ Special Committee on ECT (Council Report CR128). London: Royal College of Psychiatrists; 2005
• 47 National Institute for Clinical Excellence. The use of electroconvulsive therapy: Understanding NICE guidance – information for service users, their advocates and carers, and the public. London: National Institute for Clinical Excellence; 2010
• 48 Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev 2005; Apr 18, (2): CD000076
• 49 Greenhalgh J, Knight C, Hind D et al. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. Health Technol Assess 2005; 9: 1-iv
• 50 Scott AI. College guidelines on electroconvulsive therapy: an update for prescribers. Advances in Psychiatric Treatment 2005; 11: 150-156
• 51 Braga RJ, Petrides G. The combined use of electroconvulsive therapy and antipsychotics in patients with schizophrenia. J ECT 2005; 21: 75-83
• 52 Haskett RF, Loo C. Adjunctive psychotropic medications during electroconvulsive therapy in the treatment of depression, mania, and schizophrenia. J ECT 2010; 26: 196-201
• 53 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde DGPPN. Klinisch angewandte Stimulationsverfahren in der Psychiatrie. 2010 http://www.dgppn.de/dgppn/struktur/referate/stimulationsverfahren.html
• 54 Baghai TC, Frey R, Kasper S et al. Elektrokonvulsionstherapie – Klinische und wissenschaftliche Aspekte. Wien: Springer-Verlag; 2004
• 55 Philpot M, Treloar A, Gormley N et al. Barriers to the use of electroconvulsive therapy in the elderly: an European survey. Eur Psychiatry 2002; 17: 41-45
• 56 Thompson JW, Weiner RD, Myers CP. Use of ECT in the United States in 1975, 1980, and 1986. Am J Psychiatry 1994; 151: 1657-1661
• 57 Little JD. ECT in the Asia Pacific region: what do we know?. J ECT 2003; 19: 93-97
• 58 Eranti SV, McLoughlin DM. Electroconvulsive therapy – state of the art. Br J Psychiatry 2003; 182: 8-9
• 59 Chanpattana W, Sackeim HA. Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT 2010; 26: 289-298
• 60 Eranti SV, Thirthalli J, Pattan V et al. Comparison of electroconvulsive therapy practice between London and Bengaluru. J ECT 2011; 27: 275-280
• 61 Fink M, Kellner CH. Belling the cat: ECT practice standards in the United States. J ECT 2007; 23: 3-5
• 62 Gupta S, Hood C, Chaplin R. Use of continuation and maintenance electroconvulsive therapy: UK national trends. J ECT 2011; 27: 77-80
• 63 Evans R, Naik PC, Alikhan S. Electroconvulsive therapy – Conflicting advice confuses prescribers. British Medical Journal 2003; 327: 621
• 64 Shah A. The impact of the National Institute of Clinical Excellence guidance on the use of electroconvulsive therapy in England. Int Psychogeriatr 2010; 22: 164-166
• 65 Rose D, Wykes T, Leese M et al. Patients’ perspectives on electroconvulsion therapy: systematic review. BMJ 2003; 326: 1-5
• 66 Stromgren LS. Electroconvulsive therapy in the Nordic countries, 1977–1987. Acta Psychiatr Scand 1991; 84: 428-434
• 67 Kristensen D, Bauer J, Hageman I et al. Electroconvulsive therapy for treating schizophrenia: a chart review of patients from two catchment areas. Eur Arch Psychiatry Clin Neurosci 2011; 261: 425-432
• 68 Müller U, Geretsegger C. Die Anwendung der Elektrokonvulsionstherapie in deutschsprachigen Ländern. In: Baghai TC, Frey R, Kasper S, et al. (eds) Elektrokonvulsionstherapie – Klinische und wissenschaftlicher Aspekte. Wien: Springer-Verlag; 2004: 35-42
• 69 Nothdurfter C, Eser D, Schule C et al. The influence of concomitant neuroleptic medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry 2006; 7: 162-170
• 70 Takebayashi M. The development of electroconvulsive therapy in Japan. J ECT 2010; 26: 14-15
• 71 Chanpattana W. Maintenance ECT in treatment-resistant schizophrenia. J Med Assoc Thai 2000; 83: 657-662
• 72 Painuly N, Chakrabarti S. Combined use of electroconvulsive therapy and antipsychotics in schizophrenia: the Indian evidence. A review and a meta-analysis. J ECT 2006; 22: 59-66
• 73 Mahadevaiah M, Thirthalli J, Gangadhar BN. Discrepancy in research on ECT in schizophrenia and depression: a global perspective. World J Biol Psychiatry 2010; 11: 997-998
• 74 Dodwell D, Goldberg D. A study of factors associated with response to electroconvulsive therapy in patients with schizophrenic symptoms. Br J Psychiatry 1989; 154: 635-639
• 75 Zervas IM, Theleritis C, Soldatos CR. Using ECT in schizophrenia: A review from a clinical perspective. World J Biol Psychiatry 2012; 19 (2): 96-105
• 76 Taylor P, Fleminger JJ. ECT for schizophrenia. Lancet 1980; 1: 1380-1382
• 77 Hirose S, Ashby Jr CR, Mills MJ. Effectiveness of ECT combined with risperidone against aggression in schizophrenia. J ECT 2001; 17: 22-26
• 78 Girish K, Gill NS. Electroconvulsive therapy in Lorazepam non-responsive catatonia. Indian J Psychiatry 2003; 45: 21-25
• 79 Trollor JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry 1999; 33: 650-659
• 80 van Waarde JA, Tuerlings JH, Verwey B et al. Electroconvulsive therapy for catatonia: treatment characteristics and outcomes in 27 patients. J ECT 2010; 26: 248-252
• 81 Raveendranathan D, Narayanaswamy JC, Reddi SV. Response rate of catatonia to electroconvulsive therapy and its clinical correlates. Eur Arch Psychiatry Clin Neurosci 2011; Dec 30 [Epub ahead of print]
• 82 Hatta K, Miyakawa K, Ota T et al. Maximal response to electroconvulsive therapy for the treatment of catatonic symptoms. J ECT 2007; 23: 233-235
• 83 Kendell RE. The present status of electroconvulsive therapy. Br J Psychiatry 1981; 139: 265-283
• 84 Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP et al. Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia. Clin Neuropharmacol 2006; 29: 52-56
• 85 Masoudzadeh A, Khalilian AR. Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients. Pak J Biol Sci 2007; 10: 4287-4290
• 86 Kupchik M, Spivak B, Mester R et al. Combined electroconvulsive-clozapine therapy. Clin Neuropharmacol 2000; 23: 14-16
• 87 Fink M. Clozapine and electroconvulsive therapy. Arch Gen Psychiatry 1990; 47: 290-291
• 88 Sackeim HA, Haskett RF, Mulsant BH et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001; 285: 1299-1307
• 89 Hustig H, Onilov R. ECT rekindles pharmacological response in schizophrenia. Eur Psychiatry 2009; 24: 521-525
• 90 Suzuki T, Remington G, Mulsant BH et al. Treatment resistant schizophrenia and response to antipsychotics: a review. Schizophr Res 2011; 133: 54-62
• 91 Emsley R, Chiliza B, Asmal L et al. The concepts of remission and recovery in schizophrenia. Curr Opin Psychiatry 2011; 24: 114-121
• 92 Lambert M, Fleischhacker WW, Naber D. Pharmakotherapie der Schizophrenie: Akut-, Notfall- und Langzeitbehandlung. In: Voderholzer U, Hohagen F, (eds) Therapie psychischer Erkrankungen – State of the Art 2011/2012. München: Elsevier GmbH; 2011
• 93 Chanpattana W, Andrade C. ECT for treatment-resistant schizophrenia: a response from the far East to the UK. NICE report. J ECT 2006; 22: 4-12
• 94 Andrade C, Kurinji S. Continuation and maintenance ECT: a review of recent research. J ECT 2002; 18: 149-158
• 95 Kuhn J, Bodatsch M, Sturm V et al. Deep brain stimulation in schizophrenia. Fortschr Neurol Psychiatr 2011; 79: 632-641
• 96 Nielsen J, Damkier P, Lublin H et al. Optimizing clozapine treatment. Acta Psychiatr Scand 2011; 123: 411-422
• 97 Porcelli S, Balzarro B, Serretti A. Clozapine resistance: Augmentation strategies. Eur Neuropsychopharmacol 2011;
• 98 Trevino K, McClintock SM, Husain MM. A review of continuation electroconvulsive therapy: application, safety, and efficacy. J ECT 2010; 26: 186-195
• 99 Fink M, Abrams R, Bailine S et al. Ambulatory electroconvulsive therapy: report of a task force of the association for convulsive therapy. Association for Convulsive Therapy. Convuls Ther 1996; 12: 42-55
• 100 Chanpattana W, Chakrabhand ML, Sackeim HA et al. Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT 1999; 15: 178-192
• 101 Chanpattana W, Chakrabhand ML. Factors influencing treatment frequency of continuation ECT in schizophrenia. J ECT 2001; 17: 190-194
• 102 Levy-Rueff M, Jurgens A, Loo H et al. Maintenance electroconvulsive therapy and treatment of refractory schizophrenia. Encephale 2008; 34: 526-533
• 103 Chanpattana W, Kramer BA. Acute and maintenance ECT with flupenthixol in refractory schizophrenia: sustained improvements in psychopathology, quality of life, and social outcomes. Schizophr Res 2003; 63: 189-193
• 104 Prapotnik M, Pycha R, Nemes C et al. Adverse cognitive effects and ECT. Wien Med Wochenschr 2006; 156: 200-208
• 105 Ravanic DB, Pantovic MM, Milovanovic DR et al. Long-term efficacy of electroconvulsive therapy combined with different antipsychotic drugs in previously resistant schizophrenia. Psychiatr Danub 2009; 21: 179-186
• 106 Kho KH, Blansjaar BA, de Vries S et al. Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia – an open label study. Eur Arch Psychiatry Clin Neurosci 2004; 254: 372-379
• 107 Kellner CH, Knapp R, Husain MM et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. Br J Psychiatry 2010; 196: 226-234
• 108 Sackeim HA, Prudic J, Devanand DP et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000; 57: 425-434
• 109 Amann BL, Pogarell O, Mergl R et al. EEG abnormalities associated with antipsychotics: a comparison of quetiapine, olanzapine, haloperidol and healthy subjects. Hum Psychopharmacol 2003; 18: 641-646
• 110 Gazdag G, Barna I, Ivanyi Z et al. The impact of neuroleptic medication on seizure threshold and duration in electroconvulsive therapy. Ideggyogy Sz 2004; 57: 385-390
• 111 Casey DE. Metabolic issues and cardiovascular disease in patients with psychiatric disorders. Am J Med 2005; 118 (Suppl. 02) 15S-22S