Electroconvulsive Therapy (ECT) in Patients With Super Refractory Schizophrenia

NCT ID: NCT02049021

Last Updated: 2014-01-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Introduction: In spite of recent advances in schizophrenia treatment, 30% of patients still do not respond properly to antipsychotic therapy. These patients are considered treatment-resistant or refractory, and the best choice for them is clozapine. However, even supported by the literature as the best known antipsychotic in terms of efficacy and rates of response, a considerable number of patients will still not respond to this treatment, remaining symptomatic and dysfunctional. These patients are classified as super-refractory (clozapine-resistent). In these cases, augmenting strategies are necessary, and some have been in use: typical and atypical antipsychotics, mood stabilizers, antidepressants and electroconvulsive therapy (ECT). Some studies have favored ECT, but no definitive conclusion has been drawn.

Objective: Test the electroconvulsive therapy efficacy and safety as augmenting strategy to clozapine-resistant patients, as compared to placebo (sham ECT).

Methods: This is a pilot double blind, placebo controlled and randomized study to assess electroconvulsive therapy efficacy as augmenting strategy to clozapine in super-refractory schizophrenia. The ECT treatment will be delivered with either a MECTA SPECTRUM 5000Q or 4000Q device, and the procedure is under general anesthesia and monitorization, after informed consent. The Hospital will follow national protocols and regulations on ECT. Sham ECT consists in habitual patient preparation and sedation, without stimulation. Patients that fit inclusion criteria will have their clozapine blood levels dosed and undergo structured assessments at baseline, after 6 treatments and at the end of the cycle of 12 ECT sessions (thrice a week protocol). The assessments will be based on CGI (Clinical Global Impression) and PANSS (Positive and Negative Syndrome Scale) scales. All medication will be maintained, except lithium carbonate.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Refractory Schizophrenia Super Refractory Schizophrenia

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Electroconvulsive Therapy

Patients in use of clozapine randomized to receive ECT treatment

Group Type EXPERIMENTAL

MECTA SPECTRUM 5000Q ECT

Intervention Type DEVICE

SHAM ECT

Patients receiving clozapine randomized to sham ECT (placebo)

Group Type SHAM_COMPARATOR

Sham ECT

Intervention Type PROCEDURE

Sedation using propofol or etomidate and usual ECT preparation (no stimulation)

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

MECTA SPECTRUM 5000Q ECT

Intervention Type DEVICE

Sham ECT

Sedation using propofol or etomidate and usual ECT preparation (no stimulation)

Intervention Type PROCEDURE

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

ECT Electrochock electroconvulsive therapy device

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Clinical diagnosis of schizophrenia or schizoaffective disorder (DSM-IV-TR);
* Ages between 18 and 55 years old, both genders;
* Must be using adequate contraception if a fertile woman;
* Must be on clozapine treatment for at least 6 months, with or without augmenting strategies;
* Must be clozapine-resistent (super-refractory patient), defined by a CGI-severity ≥ 4, PANSS total score ≥ 60 and at least 4 items of the positive subscale ≥ 4 at baseline.

Exclusion Criteria

* Clinical somatic disease not stabilized in the three months preceding the study;
* Other Axis I disorders (DSM-IV-TR);
* Laboratory tests with significantly abnormal values that persist for more than two weeks;
* Lack of permanent residence during the study period;
* History of poor treatment adherence.
* History of ECT use in the past six months that precede the start of the study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of Sao Paulo

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Helio Elkis

MD, PhD ; Associated Professor of the Departament of Psychiatric

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Hélio Elkis, MD PhD

Role: PRINCIPAL_INVESTIGATOR

University of Sao Paulo

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Institute of Psychiatry - Clinics Hospital - University of Sao Paulo

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Brazil

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Helio Elkis, MD,PhD

Role: CONTACT

+55-1126617581

Debora L Melzer-Ribeiro, MD

Role: CONTACT

+55-11999415282

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Helio Elkis, Md PhD

Role: primary

+55-11-2661-7322

Debora Melzer, MD

Role: backup

+551126616525

References

Explore related publications, articles, or registry entries linked to this study.

Elkis H. Treatment-resistant schizophrenia. Psychiatr Clin North Am. 2007 Sep;30(3):511-33. doi: 10.1016/j.psc.2007.04.001.

Reference Type BACKGROUND
PMID: 17720034 (View on PubMed)

Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Paplos KG, Soldatos CR. Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia. Clin Neuropharmacol. 2006 Jan-Feb;29(1):52-6. doi: 10.1097/00002826-200601000-00012.

Reference Type BACKGROUND
PMID: 16518135 (View on PubMed)

Kho KH, Blansjaar BA, de Vries S, Babuskova D, Zwinderman AH, Linszen DH. Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia--an open label study. Eur Arch Psychiatry Clin Neurosci. 2004 Dec;254(6):372-9. doi: 10.1007/s00406-004-0517-y. Epub 2004 Nov 12.

Reference Type BACKGROUND
PMID: 15538604 (View on PubMed)

Lehman AF, Lieberman JA, Dixon LB, McGlashan TH, Miller AL, Perkins DO, Kreyenbuhl J; American Psychiatric Association; Steering Committee on Practice Guidelines. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004 Feb;161(2 Suppl):1-56. No abstract available.

Reference Type BACKGROUND
PMID: 15000267 (View on PubMed)

Miller A, Hall CS, Buchanan RW, Buckley PF, Chiles JA, Conley RR, Crismon ML, Ereshefsky L, Essock SM, Finnerty M, Marder SR, Miller DD, McEvoy JP, Rush AJ, Saeed SA, Schooler NR, Shon SP, Stroup S, Tarin-Godoy B. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry. 2004 Apr;65(4):500-8. doi: 10.4088/jcp.v65n0408.

Reference Type BACKGROUND
PMID: 15119912 (View on PubMed)

Tang WK, Ungvari GS. Efficacy of electroconvulsive therapy in treatment-resistant schizophrenia: a prospective open trial. Prog Neuropsychopharmacol Biol Psychiatry. 2003 May;27(3):373-9. doi: 10.1016/S0278-5846(02)00354-8.

Reference Type BACKGROUND
PMID: 12691772 (View on PubMed)

Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev. 2002;(2):CD000076. doi: 10.1002/14651858.CD000076.

Reference Type BACKGROUND
PMID: 12076380 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

http://www.ipqhc.org.br/

Institute of Psychiatry - University of Sao Paulo

http://www.psiquiatriafmusp.org.br/departamento/

Department of Psychiatry - University of Sao Paulo Medical School

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

ECT Schizo

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.