An Electro-Convulsive Refractory, Difficult to Treat Case of Recurrent Severe Depression with Catatonia (original) (raw)
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Chronic catatonia treated with electroconvulsive therapy: a case report
Journal of Medical Case Reports, 2013
Introduction: In the International Statistical Classification of Diseases and Related Health Problems 10 and Diagnostic and Statistical Manual of Mental Disorders IV classification systems, catatonia is classified as a subtype of schizophrenia. However, catatonia is more frequently associated with mood disorders than schizophrenia. It is also associated with organic conditions. Catatonia responds to treatment with benzodiazepines and electroconvulsive therapy rather than antipsychotics. These features support the categorization of catatonia as an independent syndrome. There is a lack of consensus regarding the definition of chronic catatonia. There are two previous case reports of effective treatment of chronic catatonia with electroconvulsive therapy. Case presentation: A 29-year-old South Asian woman was admitted to hospital because of poor food intake. Her condition had progressively worsened over the past seven months. She had features of catatonia. On admission, her Bush-Francis Catatonia Rating Scale score was 24. Her symptoms resolved after the administration of 17 electroconvulsive therapies but recurred later. She was given a further four electroconvulsive therapies. She remains well on aripiprazole at a dose of 60mg a day. Conclusions: Bilateral electroconvulsive therapy is effective in the treatment of chronic catatonia and should be considered as a treatment option. A relapse of symptoms can occur after the discontinuation of treatment.
Electroconvulsive Therapy for Depression
New England Journal of Medicine, 2007
An 82-year-old widowed woman with a history of recurrent unipolar major depression is referred to the electroconvulsive therapy (ECT) service of an academic medical center. During her illness, she has had four episodes of major depression consisting of periods of depressed mood, crying spells, loss of interest in usual activities, insomnia, loss of appetite and weight, difficulty with concentration, feelings of helplessness and hopelessness, and thoughts of suicide. During the current episode, which has lasted for 6 months, she has had typical symptoms of melancholic depression, as well as psychotic symptoms (e.g., a somatic delusion that she has terminal cancer), with suicidal ideation and a plan for taking a drug overdose. Previous treatment during this episode has included citalopram (Celexa), duloxetine (Cymbalta), and the combination of olanzepine (Zyprexa) and duloxetine, but the patient did not have a response to any of these agents. She could not tolerate the anticholinergic side effects of tricyclic antidepressants. Her psychiatrist seeks specialty consultation regarding the appropriateness and safety of ECT for this patient.
Journal of Ect, 2006
Most studies of trends in antidepressant pharmacotherapy have focused on relatively mildly ill, nonpyschotic outpatients. In this report, we provide detailed information on psychotropic use among patients with unipolar depression participating in a large, multisite electroconculsive therapy (ECT) study. Adequacy of antidepressant medication trials was assessed with the Antidepressant Treatment History Form. Among patients with nonpsychotic depression, 27% (60/220) had not had an adequate trial of an antidepressant before ECT, and 63% (139/220) had had at least one inadequate trial. Surprisingly, 33% (79/243) of nonpsychotic patients had been prescribed an antipsychotic. Among patients with psychotic depression, 95% (101/106) had not been given an adequate combination of an antidepressant and antipsychotic agent, mostly due to low doses of the latter class. Among all patients in the trial, 61% (213/352) had been prescribed at least one benzodiazepine, and only 7% (24/352) had been given a lithium augmentation trial. Use of hypnotic agents and anticonvulsants was common. In conclusion, patients with severe depression referred for ECT with a unipolar depressive episode have high rates of psychotropic usage, much of which is inadequate.
Antidepressant Pharmacotherapy Failure and Response to Subsequent Electroconvulsive Therapy
Journal of Clinical Psychopharmacology, 2010
Failure to respond to antidepressants probably is the most common indication for electroconvulsive therapy (ECT). The literature seems to be divided as to whether medication resistance has a negative influence on the efficacy of subsequent ECT. Therefore, we performed a systematic review to investigate the effect of previous pharmacotherapy failure on the efficacy of ECT. Relevant cohort studies were identified from systematic search of the PubMed electronic database. Seven studies were included in this meta-analysis: the overall remission rate amounts to 48.0% (281/585) for patients with and 64.9% (242/373) for patients without previous pharmacotherapy failure. An exact analysis with the Mantel-Haenszel method (fixed effect model) shows a reduced efficacy of ECT in patients that received previous pharmacotherapy (OR, 0.52; 95% confidence interval [CI], 0.39-0.69). In conclusion, the efficacy of ECT is significantly superior in patients without previous pharmacotherapy failure as compared with medication-resistant patients. Because this finding is based on observational studies, it might be caused by a confounding factor, for example, the presence of psychotic features or the duration of the index episode. Electroconvulsive therapy seems to be an effective treatment for severely depressed patients as well as for patients with previous pharmacotherapy failure.
Electroconvulsive therapy in a case of catatonia with severe somatic complications
Background Catatonia is a neuropsychiatric syndrome that may occur in association with mental, neurological and medical disorders. A delay in diagnosis and treatment of catatonic symptoms is related to a high risk of medical complications such as dehydration, malnutrition, pressure ulcers, thrombotic events, aspiration pneumonia and infections. Objectives The authors present the case of a bipolar patient, admitted to the Psychiatric Clinic of the Azienda Ospedaliero-Universitaria Pisana for catatonic syndrome, complicated by weight loss, deep vein thrombosis (DVT), pressure ulcers and systemic infection. Results Supportive therapy, including hydration, electrolytic restoration and antibiotics was adopted to stabilize the patient’s general conditions. Treatment with low molecular weight heparin was given for DVT and to prevent pulmonary embolism. Catatonic symptoms were initially treated with intravenous administration of delorazepam, with some improvement in catalepsy and waxy flexi...
Long-Term Outcome After ECT for Catatonic Depression
The Journal of ECT, 2001
This is the initial report of the course of major depression with catatonic features after hospitalization. Method: Telephone interviews and ratings were conducted 3-7 years after response to inpatient electroconvulsive therapy (ECT) for such catatonic depression. This was done for all 19 followable patients treated over a particular 4-year period. All had received left anterior right temporal brief-pulse ECT. Prior to data examination, we constructed rules to classify medications as antimelancholic. These rules led to the inclusion of lithium, tricyclics, bupropion, and venlafaxine in this antimelancholic classification and to the exclusion of selective serotonin reuptake inhibitors. Results: Ten of the 13 patients discharged on antimelancholic medication (AMM) had good function on follow-up and no more than one rehospitalization. In contrast, none of the six patients in the other group had as good an outcome (p ס 0.004, corrected 2 ס 8.26). The AMM group had no deaths, but three patients in the other group died of acute cardiopulmonary causes (p ס 0.015). In most cases, catatonia and depression were not identified by informant interview on follow-up. Discussion: ECT followed by AMM usually led to long-term outcome that was good and better than without such medication. Although benzodiazepines can acutely diminish catatonia, we found no relevant long-term study; accordingly, long-term benzodiazepine use in catatonia is speculative.
Long-term Follow-up After Successful Electroconvulsive Therapy for Depression
The Journal of ECT, 2007
Objectives: A long-term follow-up of depressed patients responsive to electroconvulsive therapy (ECT) with intensive pre-ECT pharmacotherapy treatment failure who also participated in a 6-month trial directly post-ECT in which imipramine was compared with placebo for relapse prevention. Methods: A total of 26 patients responsive to ECT who participated in the 6-month continuation trial were invited 4 to 8 years later to assess their follow-up status. The groups with and without relapse within 6 months were compared with regard to recurrence of depression up to 8 years later. Recurrence was defined as a new episode of depression that needed antidepressant medication and/or readmission in hospital and/or a new ECT course. Results: At the time of follow-up (mean duration, 6.8 years), the recurrence rate of depression for the total sample was 42.3%. There was no significant difference in the recurrence rates and number of recurrences between the nonrelapse and relapse groups. The small study population limits generalization of the results; the design of the study is naturalistic and retrospective. Conclusion: In our small sample of depressed patients with pharmacotherapy treatment failure, recurrence is not influenced by relapse after terminating ECT. Continuation of medication started immediately after ECT seems to be an important factor in preventing recurrence.
The use of electroconvulsive therapy (ECT) as a treatment for depression (Atena Editora)
The use of electroconvulsive therapy (ECT) as a treatment for depression (Atena Editora), 2024
Objective: Evaluate how Electroconvulsive Therapy impacts treatment efficacy and quality of life in patients with resistant depression, as well as its safety and adverse effects. Methods: Bibliographic review using the PVO strategy, carried out in the PubMed - MEDLINE database, using the terms “Electroconvulsive Therapy”, “ECT” and “Depression”. Initially covering 1,454 articles, articles were selected between 2019-2024, in English and that addressed the research theme, thus selecting 19 articles. Review: Despite being a treatment surrounded by stigma and doubts from both professionals and patients, the present study was essential to elucidate the real benefits and care linked to ECT. It was found that the treatment is very cost-efficient for controlling patients with severe and refractory depressive episodes, as well as suicidal ideation, even more efficient when compared to drug therapy and psychotherapy. Furthermore, this proposal involves possible adverse effects related to structural changes in the Central Nervous System, as well as symptoms of nausea, amnesia and headache. Final considerations: Despite being associated with adverse effects, mainly temporary changes in the Central Nervous System, the benefits in quality of life justify its use. It is vital that healthcare professionals stay informed and clearly communicate the risks and benefits of ECT while continuing to explore and develop new approaches to treating complex and refractory psychiatric conditions.
Life-saving electroconvulsive therapy in a patient with near-lethal catatonia
Rivista di psichiatria
A young woman with bipolar I disorder and comorbid catatonia on enteral nutrition from several months, developed a form of near-lethal catatonia with weight loss, pressure sores, muscle atrophy, electrolyte imbalance, and depression of vital signs. A compulsory treatment was necessary, and informed consent was obtained from her mother for electroconvulsive therapy (ECT). After 7 ECT sessions, the patient recovered and resumed feeding. ECT may save the life of a patient with catatonia provided that legal obstacles are overcome. Clinicians should carefully evaluate patients with near-lethal catatonia, taking into account the risk of pulmonary embolism and other fatal events. The medical-legal issues, which vary across state regulations, should be addressed in detail to avoid unnecessary and potentially harmful delay in intervention.
Catatonia Development in a Schizoaffective Patient following Electroconvulsive Therapy
Iranian journal of psychiatry and behavioral sciences, 2010
riteria of Diagnostic and Statistical Manual of Mental Disorders, published by the American Association (DSMIV), for Catatonia syndrome is as follows: Motor immobility which is evidenced by catalepsy (including waxy flexibility) or stupor, excessive motor activity (which is apparently purposeless and is not influenced by external stimuli), extreme negativism (which is an apparently motiveless resistance to all instructions or maintenance of a rigid posture against all attempts to be moved) or mutism, peculiarities of voluntary movements evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing and echolalia or echopraxia (1). Catatonia can be treated with electroconvulsive therapy (ECT), benzodiazepines or barbiturates (2). ECT can also be a treatment for lifethreatening depression or anti-depressant