ULTRABRIEF RIGHT UNILATERAL ECT AND CATATONIA: A CASE SERIES AND LITERATURE REVIEW

Abstract

Introduction Catatonia is a neuropsychiatric syndrome that affects both behavior and motor function, resulting potentially in unresponsiveness in an individual who otherwise appears to be awake. Catatonia can occur in the context of several underlying psychiatric or medical condition. Electroconvulsive Therapy (ECT) is an evidence-based, first-line treatment for catatonia and its efficacy has been demonstrated since the early 1930s. ECT is not only proven to relieve catatonia but some of the underlying psychopathology including mood disorders. The conventional modality of ECT that has been used for the treatment of catatonia is bilateral (BL) lead placement with brief pulse width (>0.5 milisec). Although (BL) ECT placement is more commonly used, cognitive side effects are an important limitation for the use of this technique. The literature is limited regarding the use of ultrabrief pulse width (UB) ( Methods A case series of two catatonic patients successfully treated with RUL ECT at an academic center is presented. Ms. B, a 66-year-old female with bipolar disorder with psychotic features and a recent history of intentional overdose, presenting for depression and catatonia. During the past four years she had 6 hospital admissions due to similar episodes.Ms. K, a 55-year-old female with MDD with psychotic features and catatonia presenting for worsening mood, neurovegetative symptoms, psychosis and catatonic symptoms. Her catatonic symptoms had partially improved with initiation and titration of Lorazepam.Existing literature is reviewed to compared with other published cases and discussion of treatment effectiveness. A table presenting the cases found in the literature will be added. Results The patients were cleared by anesthesia. Ms. B completed an acute course of 11 UB-RUL ECT treatments with 2 more UB-RU ECT treatments were completed as taper. Her baseline QIDS improved from baseline 10 to post-ECT 1. CGI post treatment was very much improved. No major side effects were noted or reported.Ms. K completed an acute course of 13 UB-RUL ECT treatments. 3 more UB-RUL ECT treatments were completed as taper over a period of twenty-three days. Her baseline QIDS improved from 18 to 6 post treatment. Her CGI was rated as very much improved. No major side effects were noted or reported.Both patients experienced significant improvement of their symptoms. Conclusions UB RUL ECT is a safe and effective treatment modality for patients with Catatonia independent of the underlying cause. Patient with catatonia are vulnerable to relapse and may require prolonged courses of ECT and maintenance. To mitigate the risk of cognitive side effects these patients may benefit from UB RUL ECT. This research was funded by: No funding