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Case Report | DOI: https://doi.org/10.31579/2578-8868/010
Department of Neuropsychiatry, Aichi Medical University, Aichi Prefecture, Japan
*Corresponding Author: Sotaro Sugita, Department of Neuropsychiatry, Aichi Medical University, Aichi Prefecture, Japan,
Citation: Sotaro Sugita,Kotaro Sugita, Yasuhiro Mori, Mitiyo Yoshida, Kousuke Kanemoto, A Case Report: The Treatment-Resistant of Schizophrenia Shows the Granulocytopenia, Became to be prescribed theClozapine because of Stabilization of Cite Number after Administration of Non-Convulsive Electric Shock Therapy, J Neuroscience and Neurological Surgery. DOI ; 10.31579/2578-8868/010
Copyright: ©2018 Sotaro Sugita, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 20 January 2018 | Accepted: 30 January 2018 | Published: 06 February 2018
Keywords: Clozapine therapy; Electric shock; Schizophrenia; Granulocytes
In a former report, we observed the possibility that the non-convulsive electric shock
administration may contribute the stability of granulocytes number of the patients receiving clozapine [1].The instability and most critical drug side-effect [2]. We have an idea about the drug accumulated experiences of combined therapy. Moreover investigated the transitions of granulocytes number in eachcase. As per observations the gradual stabilization of cites number has been becoming apparent on thecurrent of therapy. In this report describes the passage of stabilization, the patient’s shows thegranulocytopenia before dosing of clozapine.
For the treatment resistant schizophrenic patients, the clozapine seems the last choice instead of its side effects. The agranulocytosis or the granulocytopenia is the most cumbersome obstacle for the continuation of clozapine dosing.2 By former report, we had already presented the non-convulsive electric shocks(modified ECT: m-ECT) which were administered to the patient showing granulocytopenia during the dosing of clozapine recovered the number of granulocytes.1 Now we continue to experience the effect of m-ECT on the number of cyte by administering it on the patients who show granulocytopenia under the therapy of clozapine as well as those dropping out from cantides for clozapine dosing because of the lower number of cyte than criterion for the dosing in spite of sivyer symptoms resistant against many kinds of drugs.
In this report, we show the process of stabilizations that occurred on the patient with granulocytopenia clearer under the criterion. We started the administration of m-ECT as an initial treatment and observed the transition of cyte number. Consequently, the number of cyte became upper the criterion. Then we could started the dosing of clozapine.
Case. 59 years old female schizophrenia:
She has been suffering from instinct delusion that someone poisoning her, continuous hallucination, behavioral difficulties caused by her obsessive thinking and the difficulties maintaining human relationships. The duration disease in for more than 25 years. Her personality seemed to breaking down gradually. Moreover, recently hard refusing against nutrition and drug ingestion appeared. Her number of cytes before given m-ECTs show below 4000/ml. After the m-ECT was started, her cytes number gradually stabilized. Then we introduced the simultaneous dosing of clozapine with m-ECT (Fig. 1). Now, It passed about one month and a half after the clozapine administration was started and she is administered 100 mg clozapine a day and receive the m-ECT once a week. Her refusal attitude gradually weaker. The panss score decreased from 167 to 145. That is not attractive but in the almost all issues the point decreased or stayed at same point. Moreover any symptom did not deteriorated.
Figure 1: Case 1 ; The vertical column shows the number of granulocytes with the amount presentedon the left vertical line. The polygonal line in a horizontal direction shows the doseof clozapine, with the amount presented on the right vertical line. Another lineshows the total amount of other antipsychotic drugs given except for clozapine ina relationship with the dose of chlorpromazine. Each m-ECT session is alsoplotted. Days after the start of drug administration are indicated on the bottomhorizontal line.
This case seems to indicate the possibility that the treatment resistant schizophrenic patients whose number of granular cyte is not enough for the criteria level could became allowed to prescribe the clozapine. We always have to treat those patients whose the number of cyte is low under the criteria levels or slightly over that. Almost those are female patients with relatively small and surender body. The experience of this case might be a suggestion for the narrow path to the clozapine treatment for the patients dropping out the therapy because the wall of the criteria. For the confirmation of the path, the carefully and persistent trial and observation are necessary.
Discussion:
This case is the first one for us that the clozapine treatment was prescribed after m-ECT were administered. The m-ECT only could slightly weakened the refusal attitude of patient. However, the effect was predicted not to lasting for long time. The cyte number became the safety rage under the observation. Then we started the administration of clozapine to make the recovery certain. Although our intention has not realized yet, the possibility that the sybiyer illed schizophrenic patients with the low number of granulocytes could be prescribed clozapine after stabilization of cyte number by m-ECT therapy. Although there are already the report that suggested the ECT increase the number of immunological active cyte or such substance. However, the me chanisms of stabilization is still speculative.3,4,5 In this period, what we should do is probably to gather the cases that the stabilization of cyte number by m-ECT was obvious whichever m-ECT or clozapine is first. These efforts might make the possibility more certain.
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