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PP-45 Dual Mood Stabilizer Treatment in a Severe, ECT-Resistant Schizoaffective Disorder: A Case Report

PP-45 Dual Mood Stabilizer Treatment in a Severe, ECT-Resistant Schizoaffective Disorder: A Case Report

Ezgi Şişman1, İlay Dalkıran2

1. Psychiatry Clinic, Kocaeli City Hospital, İzmit, Kocaeli, Türkiye
2. Department of Psychiatry, Faculty of Medicine, Kocaeli University, İzmit, Kocaeli, Türkiye

DOI: 10.5080/61upk.ozt528 Page 243
OBJECTIVE Schizoaffective disorder is associated with recurrent hospitalizations and functional decline, and a subset of patients remains treatment-resistant despite adequate antipsychotic trials and electroconvulsive therapy(ECT).When standard strategies fail, evidence guiding subsequent options is limited.We present a severe case in which clinical improvement emerged after dual mood stabilizer therapy following insufficient response to antipsychotic optimization and adequately administered ECT. CASE A 43-year-old patient with schizoaffective disorder and multiple prior hospitalizations was admitted from the emergency setting due to severe psychomotor agitation, grandiosity, persecutory delusions, and medication refusal.Intramuscular haloperidol (20 mg/day) with biperiden(10 mg/day) was initiated.Quetiapine extended-release was started and titrated to 750 mg/day, and clonazepam was added.Despite treatment, the patient remained verbally aggressive, intermittently refused medication, and required seclusion. Subsequent optimization with oral risperidone(4 mg/day) followed by paliperidone long-acting injectable showed no improvement.Cranial magnetic resonance imaging was normal, and electroencephalography was planned.In a previous admission, the patient had undergone 12 sessions of ECT with adequate seizure duration but without sufficient clinical response.Given persistent symptom severity and significant impairment in self-care and caregiving, valproic acid was titrated to 1500 mg/day; due to insufficient response, lithium was added and titrated to 600 mg/day based on serum levels.Marked clinical improvement emerged following combined lithium and valproate therapy, with only mild residual psychotic themes.The patient was discharged with family collaboration and close outpatient follow-up.Over three months, functional recovery remained stable, and the family reported high satisfaction with stability.Written informed consent for publication was obtained. DISCUSSION This case suggests that dual mood stabilizer therapy may be associated with meaningful improvement in selected treatment-resistant schizoaffective presentations where antipsychotic strategies and adequately administered ECT have been insufficient.While findings from a single case cannot be generalized, this approach may warrant consideration in refractory cases characterized by severe agitation and functional deterioration. Keywords: Schizoaffective disorder, Treatment resistance, Dual mood stabilizer therapy