Effect of psychological nursing interventions on effectiveness and quality of life in schizophrenia patients receiving modified electroconvulsive therapy

BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances,hallucinations,delusions,and emotional instability.For some patients,conventional treatment methods may not effectively alleviate symptoms,necessitating the use of alternative therapeutic approaches.Modified electroconvulsive therapy(MECT)is an effective treatment modality for schizophrenia,inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity.AIM To explore the impact of psychological nursing intervention(PNI)before and after MECT on the efficacy and quality of life of patients with schizophrenia.METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups:The intervention group(n=40)and the control group(n=40).The intervention group received PNI before and after MECT,while the control group received routine nursing care.The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale(PANSS)and the Clinical Global Impression Scale(CGI)before and after the treatment.The quality of life was assessed by the Short Form 36 Health Survey(SF-36)after the treatment.RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment(P<0.05).The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning(P<0.05).CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia.It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.

Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder

BACKGROUND Electroconvulsive therapy(ECT)is both an effective treatment for patients with major depressive disorder(MDD)and a noxious stimulus.Although some studies have explored the effect of sedation depth on seizure parameters in ECT,there is little research on the noxious stimulation response to ECT.In this study,we used two electroencephalography(EEG)-derived indices,the quantitative consci-ousness(qCON)index and quantitative nociceptive(qNOX)index,to monitor sedation,hypnosis,and noxious stimulation response in patients with MDD undergoing acute ECT.METHODS Patients with MDD(n=24)underwent acute bilateral temporal ECT under propofol anesthesia.Before ECT,the patients were randomly divided into three groups according to qCON scores(qCON60-70,qCON50-60,and qCON40-50).Continuous qCON monitoring was performed 3 minutes before and during ECT,and the qCON,qNOX,vital signs,EEG seizure parameters,and complications during the recovery period were recorded.The 24-item Hamilton Rating Scale for Depression,Zung’s Self-rating Depression Scale,and Montreal Cognitive Asse-ssment scores were evaluated before the first ECT session,after the fourth ECT session,and after the full course of ECT.RESULTS A total of 193 ECT sessions were performed on 24 participants.The qCON index significantly affected the EEG seizure duration,peak mid-ictal amplitude,and maximum heart rate during ECT(P<0.05).The qNOX index significantly affected the post-ictal suppression index(P<0.05).Age,number of ECT sessions,and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters(P<0.05).However,there were no significant differences in complications,24-item Hamilton Rating Scale for Depression scores,Zung’s Self-rating Depression Scale scores,or Montreal Cognitive Assessment scores among the three groups(P>0.05).CONCLUSION Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.

Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression

BACKGROUND Traditional treatments for major depressive disorder(MDD),including medication and therapy,often fail and have undesirable side effects.Electroconvulsive therapy(ECT)uses electrical currents to induce brief seizures in the brain,resulting in rapid and potent antidepressant effects.However,owing to misconceptions and controversies,ECT is not as widely used as it could and often faces stigmatization.AIM To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.METHODS This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups.The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions.The non-ECT group received medication and/or therapy according to clinical guidelines for MDD.The primary outcome was the variation in the hamilton depression rating scale(HDRS)score from treatment/ECT initiation to week 12.In addition,patients’quality of life,cognitive abilities,and biomarkers were measured throughout the study.RESULTS Although both groups showed significant improvements in their HDRS scores over time,the improvement was more pronounced in the ECT group than in the non-ECT group.Additionally,the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group.Compared with the non-ECT group,the ECT group exhibited evidently lower variations in the brain-derived neurotrophic factor(BDNF)and cytokine interleukin-6(IL-6)levels.The side effects were generally mild and comparable between the two groups.ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms,enhancing wellbeing,and bolstering cognitive capabilities in individuals with severe MDD.ECT may also affect the levels of BDNF and IL-6,which are indicators of neuroplasticity and inflammation,respectively.CONCLUSION ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.

Electroconvulsive therapy:80 years old and still going strong

Electroconvulsive therapy(ECT),which is among the oldest and most controversial treatments in the field of psychiatry,has its 80th birthday this year.In this brief historical overview,the discovery of the therapeutic effects of convulsive therapy by LaszlóMeduna,and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described.Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT.The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications,including catatonia,and preand postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving.Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed.The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys.This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT,which constitutes a violation of psychiatric patients’right to an effective treatment.

Current progress in neuroimaging research for the treatment of major depression with electroconvulsive therapy

Electroconvulsive therapy(ECT)uses a certain amount of electric current to pass through the head of the patient,causing convulsions throughout the body,to relieve the symptoms of the disease and achieve the purpose of treatment.ECT can effectively improve the clinical symptoms of patients with major depression,but its therapeutic mechanism is still unclear.With the rapid development of neuroimaging technology,it is necessary to explore the neurobiological mechanism of major depression from the aspects of brain structure,brain function and brain metabolism,and to find that ECT can improve the brain function,metabolism and even brain structure of patients to a certain extent.Currently,an increasing number of neuroimaging studies adopt various neuroimaging techniques including functional magnetic resonance imaging(MRI),positron emission tomography,magnetic resonance spectroscopy,structural MRI,and diffusion tensor imaging to reveal the neural effects of ECT.This article reviews the recent progress in neuroimaging research on ECT for major depression.The results suggest that the neurobiological mechanism of ECT may be to modulate the functional activity and connectivity or neural structural plasticity in specific brain regions to the normal level,to achieve the therapeutic effect.

Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy A randomized controlled trial

BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the patients were i.v. injected with 1 mg of butorphanol tartrate parenteral solution （Jiangsu Hengrui Medicine Co., Ltd., No.05100732） 5 minutes prior to anesthesia; the remaining treatments were the same as in the control group. （2） Evaluations： myalgia conditions were assessed 6 hours after the patients opened their eyes. The patients were evaluated by a visual analogue scale and Ramsay sedation scale immediately, and at 3 minutes and 6 hours after they opened their eyes. MAIN OUTCOME MEASURES： （1） Conditions of myalgia. （2） Scores of visual analogue scale and Ramsay sedation scale. RESULTS： All 120 psychiatric patients were involved in the final analysis. （1） Conditions of myalgia： 6 hours after modified electroconvulsive therapy, 22 patients in the control group and 1 patient in the treatment group complained of myalgia, which resulted in a significant difference between the two groups （P 〈 0.05）. （2） Scores of visual analogue scale and Ramsay sedation scale： the scores of visual analogue scale at 30 minutes and 6 hours after opening eyes were significantly lower in the treatment group than the control group （P 〈 0.05）, and the scores of Ramsay sedation scale were not significantly different between the two groups （P 〉 0.05）. CONCLUSION： Preemptive analgesia by butorphanol can effectively alleviate modified electroconvulsive therapy-induced myalgia, without adverse reactions.

Efficacy of propofol versus ketamine in modified electroconvulsive therapy: A prospective randomized control trial

Objective:To investigate the effects of propofol and ketamine on seizure duration,hemodynamics,and recovery of electroconvulsive therapy(ECT).Methods:This prospective randomized trial included patients who had undergone ECT under anesthesia.Patients received injection of propofol 1.5 mg/kg i.v.(the propofol group)or ketamine 0.8-1.2 mg/kg i.v.(the ketamine group)during ECT.Seizure duration,hemodynamics,and recovery were recorded and compared between the two groups.Results:This trial included 44 patinets with 22 patients receiving propofol and 22 patients receiving ketamine.The total dose of propofol and ketamine was(105.68±25.27)mg and(81.36±24.55)mg,respectively.The motor seizure and electroencephalogram seizure duration were prolonged in the ketamine group(P<0.001).The hemodynamics at the admission of the two groups were comparable(P>0.05);however,the mean systolic blood pressure during the procedure was significantly higher in the ketamine group(P=0.04).Besides,spontaneous eye-opening in the ketamine group took longer than that of the propofol group(P=0.001).Conclusion:Both propofol and ketamine are safe as anesthetic agents for modified ECT,and ketamine provides a longer seizure duration without hemodynamic instability or any significant complication.

Electroconvulsive therapy plays an irreplaceable role in treatment of major depressive disorder

Major depressive disorder is a serious and common neuropsychiatric disorder that affects more than 350 million people worldwide.Electroconvulsive therapy is the oldest and most effective treatment available for the treatment of severe major depressive disorder.Electroconvulsive therapy modifies structural network changes in patients with major depressive disorder and schizophrenia.And it can also affect neuroinflammatory responses and may have neuroprotective effects.Electroconvulsive therapy plays an irreplaceable role in the treatment of major depressive disorder.

Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy:A retrospective cohort study

BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.METHODS We analyzed the relationships between relapse,the diagnostic change from MDD to bipolar disorder(BP),and treatment after the initial ECT.We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital.The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP.A receiver operating characteristic(ROC)curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study.Compared with the MDD participants,more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission(65.6%vs 15.1%,P<0.001;relative risk=4.35,95%CI:2.19-8.63,P<0.001).Twenty-nine patients experienced relapses during the three-year follow-up.In 21(72.4%,21/29)patients with relapse,the diagnosis was changed from MDD to BP.The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients(9.63±10.4 mo vs 3.38±3.77 mo,P=0.022);for most patients,the interval was less than one month.The relative risk of depressive symptoms based on diagnostic changes was 4.35(95%confidence interval:2.19–8.63,P<0.001),and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756(95%CI:0.562-0.895,P=0.007).CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.

Changes in the amplitude of low-frequency fluctuations in specific frequency bands in major depressive disorder after electroconvulsive therapy

BACKGROUND Major depressive disorder(MDD)tends to have a high incidence and high suicide risk.Electroconvulsive therapy(ECT)is currently a relatively effective treatment for MDD.However,the mechanism of efficacy of ECT is still unclear.AIM To investigate the changes in the amplitude of low-frequency fluctuations in specific frequency bands in patients with MDD after ECT.METHODS Twenty-two MDD patients and fifteen healthy controls(HCs)were recruited to this study.MDD patients received 8 ECT sessions with bitemporal placement.Resting-state functional magnetic resonance imaging was adopted to examine regional cerebellar blood flow in both the MDD patients and HCs.The MDD patients were scanned twice(before the first ECT session and after the eighth ECT session)to acquire data.Then,the amplitude of low-frequency fluctuations(ALFF)was computed to characterize the intrinsic neural oscillations in different bands(typical frequency,slow-5,and slow-4 bands).RESULTS Compared to before ECT(pre-ECT),we found that MDD patients after the eighth ECT(post-ECT)session had a higher ALFF in the typical band in the right middle frontal gyrus,posterior cingulate,right supramarginal gyrus,left superior frontal gyrus,and left angular gyrus.There was a lower ALFF in the right superior temporal gyrus.Compared to pre-ECT values,the ALFF in the slow-5 band was significantly increased in the right limbic lobe,cerebellum posterior lobe,right middle orbitofrontal gyrus,and frontal lobe in post-ECT patients,whereas the ALFF in the slow-5 band in the left sublobar region,right angular gyrus,and right frontal lobe was lower.In contrast,significantly higher ALFF in the slow-4 band was observed in the frontal lobe,superior frontal gyrus,parietal lobe,right inferior parietal lobule,and left angular gyrus.CONCLUSION Our results suggest that the abnormal ALFF in pre-and post-ECT MDD patients may be associated with specific frequency bands.

A Prospective Study of Maintenance Electroconvulsive Therapy in an Elderly Depressed Population

Objective: This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depression. Methodology: Twenty-nine (N = 29) individuals over the age of 65 years of age and older were assigned to a control or treatment group on the basis of their decision to receive M-ECT (treatment group) or to refrain from receiving the treatment (control group). A battery of psychometric tests designed to measure severity of depression, quality of life, and cognition were administered at baseline as well as at 6-month and 1-year intervals. Results: Statistical analysis of the data indicated no significant differences in the efficacy of M-ECT between the control and treatment groups in any of the tests administered during the participation of the study. Conclusion: The results of the study suggest that there is no added benefit for patients administered M-ECT. However, study sample size and availability of alternative treatment regimens for the control group limit generalizability of these findings and warrant further investigation.

Antidepressant Effects of Electroconvulsive Therapy Unrelated to the Brain＇s Functional Network Connectivity alterations at an Individual Level

Background： Electroconvulsive therapy （ECT） can alleviate the symptoms of treatment-resistant depression （TRD）. Functional network connectivity （FNC） is a newly developed method to investigate the brain＇s functional connectivity patterns. The first aim of this study was to investigate FNC alterations between TRD patients and healthy controls. The second aim was to explore the relationship between the ECT treatment response and pre-ECT treatment FNC alterations in individual TRD patients. Methods： This study included 82 TRD patients and 41 controls. Patients were screened at baseline and after 2 weeks of treatment with a combination of ECT and antidepressants. Group information guided-independent component analysis （G1G-ICA） was used to compute subject-specific functional networks （FNs）. Grassmann maniibld and step-wise forward component selection using support vector machines were adopted to perform the FNC measure and extract the functional networks＇ connectivity patterns （FCP）. Pearson＇s correlation analysis was used to calculate the correlations between the FCP and ECT response. Results： A total of 82 TRD patients in the ECT group were successfully treated. On an average, 8.50 ~ 2.00 ECT sessions were conducted. After ECT treatment, only 42 TRD patients had an improved response to ECT （the Hamilton scores reduction rate was more than 50%）, response rate 51%. 8 FNs （anterior and posterior default mode network, bilateral frontoparietal network, audio network, visual network, dorsal attention network, and sensorimotor network） were obtained using GIG-ICA. We did not found that FCPs were significantly different between TRD patients and healthy controls. Moreover, the baseline FCP was unrelated to the ECT treatment response. Conclusions： The FNC was not significantly different between the TRD patients and healthy controls, and the baseline FCP was unrelated to the ECT treatment response. These findings will necessitate that we modify the experimental scheme to explore the mechanisms underlying ECT＇s effects on depression and explore the specific predictors of the effects of ECT based on the pre-ECT treatment magnetic resonance imaging.

Potential Mechanisms Underlying the Therapeutic Effects of Electroconvulsive Therapy

In spite of the extensive application of electroconvulsive therapy（ECT）, how it works remains unclear.So far, researchers have made great efforts in figuring out the mechanisms underlying the effect of ECT treatment via determining the levels of neurotransmitters and cytokines and using genetic and epigenetic tools, as well as structural and functional neuroimaging. To help address this question and provide implications for future research, relevant clinical trials and animal experiments are reviewed.

Catatonia:A deep dive into its unfathomable depths

This editorial addresses catatonia,a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances.The editorial seeks to clarify the ambiguous aspects of catatonia,integrating recent research findings,including global studies and diagnostic advancements.It discusses catatonia’s clinical manifestations,prevalence,and associated psychiatric and medical conditions,with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders.The prevalence of catatonia,which varies across psychiatric populations,is illustrated by a significant study conducted in Nelson Mandela Bay,South Africa.This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia.The editorial evaluates treatment approaches,primarily focusing on benzodiazepines and electroconvulsive therapy,and discusses emerging therapeutic strategies.It underscores the importance of robust diagnostic frameworks and early intervention in managing catatonia,as recommended by the latest evidence-based consensus guideline.Furthermore,it suggests future research directions,particularly in exploring the neurobiological and genetic factors of catatonia,to enhance our understanding and improve treatment outcomes.This editorial succinctly aims to demystify catatonia and provide valuable insights for clinicians and researchers in mental health care.

Multiple therapies relieve long-term tardive dyskinesia in a patient with chronic schizophrenia:A case report

BACKGROUND Tardive dyskinesia(TD)is a serious and disabling movement disorder;it impairs social function and quality of life and increases the mortality rate.TD is usually induced by the use of antipsychotic drugs;however,the underlying mechanism remains unclear.Pharmacotherapy of TD includes cholinergic drugs,benzodiazepines,ginkgo biloba extract(GBE),antioxidants,amantadine,propanolol,botulinum toxin,valbenazine,and deutetrabenazine,whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy(MECT)and deep brain stimulation.We successfully treated a chronic schizophrenia patient with comorbid long-term severe TD using deutetrabenazine,clozapine,and MECT.CASE SUMMARY A 69-year-old woman who was diagnosed as having schizophrenia 16 years ago developed severe TD after 6-mo prescription of risperidone oral solution.Her TD symptoms did not resolve despite various treatments,such as GBE,vitamin E,trihexyphenidyl,promethazine,benzodiazepines,and switching to quetiapine and olanzapine.After admission,she was given deutetrabenazine 6 mg bid.Her buccal tremor was slightly resolved 3 d later;however,her tongue remained protruded and could not be retracted.Quetiapine was switched to clozapine on day 4,and the buccal tremor remarkably resolved,and the tongue could be retracted into the mouth from day 6 onward.After three sessions of MECT,the buccal tremor resolved further.Since then,she has been able to take a semifluid diet,and her quality of life improved remarkably during 6 mo of follow-up.CONCLUSION TD is a serious condition which could be caused by antipsychotic medications;however,the best strategy against TD is prevention and monitoring during using antipsychotics.For patients with TD caused by antipsychotic medication use,multiple measures should be considered like switching to clozapine,adjunction with deutetrabenazine,or even MECT.

Clozapine resistant schizophrenia:Newer avenues of management

About 40%-70%of the patients with treatment-resistant schizophrenia have a poor response to adequate treatment with clozapine.The impact of clozapineresistant schizophrenia(CRS)is even greater than that of treatment resistance in terms of severe and persistent symptoms,relapses and hospitalizations,poorer quality of life,and healthcare costs.Such serious consequences often compel clinicians to try different augmentation strategies to enhance the inadequate clozapine response in CRS.Unfortunately,a large body of evidence has shown that antipsychotics,antidepressants,mood stabilizers,electroconvulsive therapy,and cognitive-behavioural therapy are mostly ineffective in augmenting clozapine response.When beneficial effects of augmentation have been found,they are usually small and of doubtful clinical significance or based on low-quality evidence.Therefore,newer treatment approaches that go beyond the evidence are needed.The options proposed include developing a clinical consensus about the augmentation strategies that are most likely to be effective and using them sequentially in patients with CRS.Secondly,newer approaches such as augmentation with long-acting antipsychotic injections or multi-component psychosocial interventions could be considered.Lastly,perhaps the most effective way to deal with CRS would be to optimize clozapine treatment,which might prevent clozapine resistance from developing.Personalized dosing,adequate treatment durations,management of side effects and non-adherence,collaboration with patients and caregivers,and addressing clinician barriers to clozapine use are the principal ways of ensuring optimal clozapine treatment.At present,these three options could the best way to manage CRS until research provides more firm directions about the effective options for augmenting clozapine response.

Major depressive disorder:Validated treatments and future challenges

Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning.Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning.Pharmacotherapy,especially selective serotonin reuptake inhibitors antidepressants,remains the most frequent option for treating depression during the acute phase,while other promising pharmacological options are still competing for the attention of practitioners.Depressionfocused psychotherapy is the second most common option for helping patients overcome the acute phase,maintain remission,and prevent relapses.Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations;meanwhile,other methods have limits,and their specific indications are still being studied.Combining medications,psychotherapy,and somatic therapies remains the most effective way to manage resistant forms of depression.

Low-dose clozapine-related seizure: A case report and literature review

BACKGROUND Treatment-resistant schizophrenia is a severe form of schizophrenia characterized by poor response to at least two antipsychotic drugs and is typically treated with clozapine.However,clozapine lowers the epileptic threshold,leading to seizures,which are severe side effects of antipsychotics that result in multiple complications.Clozapine-related seizures are generally considered to be dose-dependent and especially rare in the low-dose(150-300 mg/d)clozapine treated population.Due to clinical rarity,little is known about its clinical characteristics and treatment.CASE SUMMARY A 62-year-old Chinese man with a 40-year history of treatment-resistant schizophrenia presented to the Emergency Department with symptoms of myoclonus,consciousness disturbance and vomiting after taking 125 mg clozapine.Upon admission,the patient had a suddenly generalized tonic-clonic seizure lasting for about half a minute with persistent disturbance of consciousness,fever,cough and bloody sputum,which was considered to be low-dose clozapine-related seizure.After antiepileptic and multiple anti-infection treatments,the patient was discharged without epileptic or psychotic symptoms.CONCLUSION Our aim is to highlight the early prevention and optimal treatment of clozapine related seizure through case analysis and literature review.