ABSTRAK Laporan kes ini mengetengahkan kaedah penstablian terapi elektrokonvulsif (ECT) yang cepat bagi pesakit kemurungan major (MDD) yang mempunyai indeks jisim berat badan (BMI ABSTRACTA case of rapid stabilization using electroconvulsive therapy (ECT) for a major depressive disordered (MDD) patient with life-threatening low body mass index (BMI) is reported. This case report focuses on a 55-year-old Malay housewife with underlying hyperthyroidism in a euthyroid state who presented with MDD with mood congruent psychotic features, which were precipitated by the death of her husband. Her BMI was only 11 kg/m 2 due to severe anorexia, and she was highly suicidal. Peripheral total parenteral nutrition was started and ECT was commenced for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was 84 Med & Health 2016;11(1): 83-86 Loo J.L. et al. thinking that her internal organs ceased to function and she no longer existed in this world. To add to it, she had second person auditory hallucination commanding her to kill herself. There were persistent thoughts of ending her life, but she was too weak to attempt suicide. She was admitted for one month and treated with oral fluoxetine, which was optimized until 40 mg daily. In view of poor response to pharmacotherapy and the need of rapid stabilization due to deteriorating physical health, she was transferred to another hospital with psychiatry service and ECT facility. Upon transfer, the patient's depressive symptoms and psychotic symptoms persisted. Examination revealed an alert, dehydrated cachexic Malay lady who appeared older than her age. Her BMI was only 11 (weight 25kg, height 152.5cm) with no hypothermia, hypotension or bradycardia. She was guarded and not fully cooperative. Prominent psychomotor retardation was noticed. Her speech was not spontaneous but relevant and coherent with reduced in tone, volume, rate, and amount. She was depressed and her affect was appropriate, non-reactive and restricted. She had active suicidal idea, nihilistic delusion, and second person auditory hallucination that commanding her to commit suicide. achieved after nine ECTs and steady healthy weight gain was achieved throughout admission. The patient was discharged at BMI of 13 kg/m 2 with good appetite. ECT was safe for very low BMI MDD patient.
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