Maintenance Electroconvulsive Therapy Is an Essential Medical Treatment for Patients With Catatonia: A COVID-19 Related Experience.

Neera Ghaziuddin,Wael Shamseddeen,Priyanka Reddy,Daniel Maixner,Tareq Yaqub,Hannah Reynard

doi:10.3389/fpsyt.2021.670476

Abstract

Aim: Describe naturalistic clinical course over 14 weeks in a mixed adolescent and a young-adult patient group diagnosed with developmental delays and catatonia, when the frequency of maintenance electroconvulsive therapy (M-ECT) was reduced secondary to 2020 COVID-19 pandemic restrictions.Methods: Participants were diagnosed with catatonia, and were receiving care in a specialized clinic. They (n = 9), F = 5, and M = 4, ranged in age from 16 to 21 years; ECT frequency was reduced at end of March 2020 due to institutional restrictions. Two parents/caregivers elected to discontinue ECT due to concern for COVID-19 transmission. Majority (n = 8) were developmentally delayed with some degree of intellectual disability (ID). Observable symptoms were rated on a three point scale during virtual visits.Results: All cases experienced clinically significant decline. Worsening of motor symptoms (agitation, aggression, slowness, repetitive self-injury, stereotypies, speech deficits) emerged within the first 3 weeks, persisted over the 14 week observation period and were more frequent than neurovegetative symptoms (appetite, incontinence, sleep). Four participants deteriorated requiring rehospitalization, and 2 among these 4 needed a gastrostomy feeding tube.Conclusion: Moderate and severe symptoms became apparent in all 9 cases during the observation period; medication adjustments were ineffective; resuming M-ECT at each participant's baseline schedule, usually by week 7, resulted in progressive improvement in some cases but the improvement was insufficient to prevent re-hospitalization in 4 cases. In summary, rapid deterioration was noted when M-ECT was acutely reduced in the setting of COVID-19 related restrictions.

Highlights

The global pandemic caused by the SARS-CoV-2 (COVID-19) virus led to new challenges in medical treatment, including delivery of care to psychiatric patients [1]
The clinical information presented in the current study was based on routine medical care, albeit modified by COVID-19 restrictions and the data were retrospectively extracted from the electronic medical records
All patients were diagnosed with intellectual disability with the exception of one participant who was diagnosed with a psychotic disorder

Summary

Introduction

The global pandemic caused by the SARS-CoV-2 (COVID-19) virus led to new challenges in medical treatment, including delivery of care to psychiatric patients [1]. A new debate arose regarding whether or not ECT should be regarded as an essential, life-saving procedure in the context of hospitals having to reduce elective procedures to minimize the transmission of the novel coronavirus [2] Within this context, the American Psychiatric Association (APA) released multiple statements explicitly stating its position that ECT is an essential and a non-elective procedure [3]. Espinoza et al noted inadequate understanding of ECT at the healthcare system level, skepticism among medical colleagues about the role and place of ECT in medical practice, and stigma and misperceptions which questioned whether mental illness is “real” or “serious” [2] This skepticism is concerning, given multiple studies that have repeatedly shown both the safety and efficacy of ECT across various psychiatric diagnoses across the lifespan, including in adolescents [4,5,6,7,8]

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