Maintenance electroconvulsive therapy for catatonia

Abstract

Introduction We describe a case of a woman admitted to the psychiatric unit with characteristics of excited catatonia. Two years ago she had an episode of triggered by social and economic problems presented with mutism, psychomotor retardation and compromised oral intake. She recovered with 15 ECT sessions and was discharged in a stable state on quetiapine, divalproex sodium, venlafaxine and diazepam. This time she was treated with 13 ECT sessions and was discharged on previous treatment. Three weeks after her condition gradually deteriorated again. She recovered with 7 ECT sessions and was derived to our ECT program. Objective To describe and discuss the use of electroconvulsive therapy (m-ECT) in catatonia. Methods Clinical case report and PubMed search with the keywords catatonia and maintenance electroconvulsive therapy. Results Catatonia is characterized by motor disorders, mutism and negativism, autonomic dysfunction is also possible, sharing symptoms and severity with neuroleptic malignant syndrome. In the DSM 5 is as a specifier of a primary disorder (Tr. Psychotic, affective, substances or unspecified) and not a schizophrenia subtype. Benzodiazepines are most utilized as first-line treatment for catatonia, and/or electroconvulsive therapy (ECT). The role of antipsychotics is unclear. Use of ECT in responders appears beneficial. Conclusion Catatonia guidelines recommend ECT treatment if benzodiazepines are not effective. Maintenance ECT is a good option in long-term prevention of recurrent catatonia. More specific research is required.