P03-399 - Somatization disorder treated with electro convulsive therapy

Abstract

Electroconvulsive therapy (ECT) is predominantly being recommended for treatment of severe mood disorders and of catatonia. We report improvement with ECT in a patient suffering from somatization disorder.The patient, a 55-year-old man, suffered from intractable somatization disorder for more than thirty years. Numerous diagnostic and several futile surgical procedures had been performed in the past. On admission there had been no psychopharmacological therapy for one month. Subsequently treatment trials with duloxetine, mirtazapine, and venlafaxine were performed, but remained ineffective. Pregabalin lead to only slight amelioration of anxiety and no improvement of pain symptoms. After 3 months of unsuccessful clinical treatment, including pharmacotherapy, cognitive behavioral therapy, and regularly scheduled interdisciplinary medical consultations, ECT was first considered. A trial of right unilateral ECT was initiated. After five sessions the course had to be terminated due to severe ECT-related hypertension. During and following the ECT course, the patient reported rapid and significant improvement of somatic symptoms. In order to evaluate the effects of ECT the patient passed an assessment before and after the ECT (Hamilton Depression Rating Scale, Whiteley-Index, Quantification Inventory for Somatoform Syndroms, and an observer-rated version of the Screening for Somatoform Disorders). Assessment scores were in line with our clinical impression. Follow-up examination four months later showed no further change.Though somatic anxiety and hypochondriasis have been described to be negative predictors of successful remission with ECT, in our patient ECT has been particularly effective with regard to somatic symptoms of somatization disorder.