Life-saving electroconvulsive therapy in a patient with near-lethal catatonia (original) (raw)
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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...
Bipolar disorders, 2015
We describe the clinical characteristics and short-term outcomes of a sample of inpatients with bipolar disorder with severe catatonic features resistant to pharmacological treatment. The study involved 26 catatonic patients, resistant to a trial of benzodiazepines, and then treated with electroconvulsive therapy (ECT). All patients were evaluated prior to and one week following the ECT course using the Bush-Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI). In our sample, women were over-represented (n = 23, 88.5%), the mean (± standard deviation) age was 49.5 ± 12.5 years, the mean age at onset was 28.1 ± 12.8 years, and the mean number of previous mood episodes was 5.3 ± 2.9. The mean duration of catatonic symptoms was 16.7 ± 11.8 (range: 3-50) weeks, and personal history of previous catatonic episodes was present in 10 patients (38.5%). Seventeen (65.4%) patients showed abnormalities at cerebral computerized tomography and/or magnetic resonance imag...
Lifesaving electroconvulsive therapy; A physician’s prospective
2018
Depression and dementia have a very intimate relationship and hence differentiating the two can be technically challenging. Severe depression can masquerade as dementia and it is therefore extremely important to differentiate between these two as it can impact the management. A patient was admitted with acute confusion, poor mobility and poor oral intake and was initially treated for Urinary Tract Infection (UTI). However, as confusion remained fluctuant, patient was started on treatment for presumed encephalitis. Due to poor response treatment was withdrawn. Patient was then referred to gastroenterology department for consideration of enteral feeding due to malnourishment secondary to confusion and possibly dementia. However, on further assessment a psychiatric opinion was sought and as expected a diagnosis of severe depression was made and hence Electroconvulsive Therapy (ECT) was proposed. Patient made a remarkable recovery with ECT and was subsequently discharged to a rehab faci...
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.
Current Neuropharmacology, 2017
Objective: We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features. Method: 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features. Results: Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse. Conclusion: ECT resulted to be an effective and safe treatment for all the phases of severe and drugresistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a "last resort".
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.
Challenges during Electroconvulsive Therapy—A Review
Journal of Neuroanaesthesiology and Critical Care, 2021
Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders pr...