Although antipsychotics are the mainstay of treatment for schizophrenia, clozapine-refractory schizophrenia represents a clinical challenge, as reported by Tyler Kaster, MD, from the Centre for Addiction and Mental Health in the Department of Psychiatry at the University of Toronto, Ontario, in his presentation, “ECT Augmentation in Schizophrenia: Clinical Effectiveness and Cognitive Impact.” While there is limited evidence supporting the use of electroconvulsive therapy (ECT) in schizophrenia, recent research revealed a 50% response rate when added to clozapine therapy. In a discussion with Psychiatry Advisor, Dr Kaster described favoring a neurophysiologic model for the mechanism of action of ECT, stating that “with more cortical inhibition, patients may be better able to ‘filter out’ extraneous information, which are the initial pieces of information that may lead to delusions and hallucinations.” In his retrospective review of 144 patients with schizophrenia, the investigators assessed treatment response and cognitive impairment using a 4-point scale. The study revealed that 76.7% of patients demonstrated a response to ECT, with 9% of patients experiencing significant cognitive impairment. Factors associated with treatment response included failed pharmacotherapy, prior good response to ECT, use of anti-epileptic drug, and electrode placement. The researchers found that patients had an equivalent response rate with or without clozapine treatment. Overall, they determined that ECT was effective for the acute treatment of schizophrenia, with relatively minimal cognitive impairment, and that the factors identified as being associated with treatment response may help in the selection of patients who would benefit most from treatment.
An impromptu invitation to travel to Greece resulted in a eye-opening clinical and educational experience for Nicole Perras, MD, from the department of psychiatry at George Washington University, in Washington, DC. In her presentation, “The Dilemma of Syrian Refugees’ Migration to the West,” Dr Perras recounts her participation as part of a response team deployed to Greece to perform a psychiatric needs assessment in response to the Syrian refugee crisis. By “hitting the ground running,” Dr Perras and her colleagues traveled to refugee camps, beach arrival stations, and local businesses to assess myriad challenges facing both refugees and those helping them. Aside from immediate psychiatric and medical issues such as somatization of stress, hypothermia, and war injuries, caregivers were also faced with managing such social concerns as child marriages, domestic violence, and sex trafficking. The team focused their efforts on prioritizing refugee support using Maslow’s Hierarchy of Needs and ensuring that refugee families were kept together. In closing, Dr Perras stressed the need for volunteer support, including supervision/mentoring and self care, as well as training in psychological first aid and cultural competency.