A clinical case of treatment resistant schizophrenia: 60 hospitalizations and 342 ECT sessions in 36 Years; lack of social support or under treatment?

It is reported that twenty and 25 percentages of patients with schizophrenia is resistant to treatment. The treatment resistance in schizophrenia is defined by many authorities. One of the generally accepted definition criteria is inadequate response despite treatment with different atypical antipsychotics, two or three times at least four-six weeks; the other acceptable one is although the use of two different typical or atypical antipsychotics in monotherapy during four-six weeks, inadequate treatment response is obtained. Duration of hospitalization in treatment resistant cases is longer. In addition, when considering all the expenses and loss of functions, the cost of resistant cases to population is higher. In this case, sixty years old female with schizophrenia was presented. She was hospitalized from emergency department where she came with his son, because of acute psychotic symptoms, refusal of treatment and homicidal thoughts. It was learned that age of onset schizophrenia was 24, her complaints was begun in a postpartum period, she was diagnosed with schizophrenia and her number of hospitalization was 60. Although clozapine, haloperidol, amisulpride, risperidone, olanzapine, aripiprazole, quetiapine, chlorpromazine, sulpiride, zuclopenthixol, şuphenazine, lithium and valproate were used adequate doses and duration; a total of 342 ECT sessions were administered in her hospitalizations; response or partial response was achieved, she had no long-term adequate functioning and well-being. In most recent admission, she had significant improvement with clozapine 275 mg/day and valproate 1000 mg/day. In this presentation, schizophrenic patient with excessive hospitalizations and many more recurrences despite all treatment procedures is discussed.