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<p><strong>Objective.</strong> Clozapine is the current gold standard treatment for severe treatment-refractory schizophrenia, but even so 40 - 70% of these patients will continue to experience disabling symptoms when treated with clozapine monotherapy. Current clinical practice at Stikland Hospital holds that known clozapine-refractory schizophrenia patients who relapse due to non-compliance are treated with an initial combination of clozapine and ECT (if able to consent) when readmitted. The purpose of this study was to evaluate the validity of this practice. <strong></strong></p><p><strong>Methods.</strong> Patients were divided into an ECT (EG) and non-ECT (CG) group. Clozapine was started and ECT administered as per protocol. Demographic data, psychiatric and medication history and data concerning adverse events were collected. Positive and Negative Symptom Scale (PANSS) scores were done at baseline and at days 21 and 42.<strong> </strong></p><p><strong>Results.</strong> At discharge, although numerically the average increase in clozapine dose was lower and the reduction in length of stay was greater in the EG, none of the variables measured were statistically significantly different between groups. More concomitants were also used in the EG. <strong></strong></p><p><strong>Conclusions.</strong> This pilot study represents the first controlled trial of ECT-clozapine bitherapy in a population with clozapine- refractory schizophrenia and schizoaffective disorder reported in the literature. The validity of our choice of current clinical practice in this population was not supported by our results. However, the study did provide us with preliminary evidence for the safety and efficacy of this combination. It would therefore be reasonable to continue to use this strategy in selected cases, at least until other clozapine-refractory treatment strategies become more available in our setting.</p>

This article prospectively explores the effects of collective team work engagement and organizational constraints during military deployment on individual-level psychological outcomes afterwards. Participants were 971 Dutch peacekeepers within 93 teams who were deployed between the end of 2008 and beginning of 2010, for an average of 4 months, in the International Security Assistance Force. Surveys were administered 2 months into deployment and 6 months afterwards. Multi-level regression analyses demonstrated that team work engagement during deployment moderated the relation between organizational constraints and post-deployment fatigue symptoms. Team members reported less fatigue symptoms after deployment if they were part of highly engaged teams during deployment, particularly when concerns about organizational constraints during deployment were high. In contrast, low team work engagement was related to more fatigue symptoms, particularly when concerns about organizational constraints were high. Contrary to expectations, no effects for team work engagement or organizational constraints were found for post-traumatic growth. The present study highlights that investing in team work engagement is important for those working in highly demanding jobs.

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