Diminished ECT Response in Catatonia Due to Chronic Neurologic Condition

Swartz, Conrad M.; Acosta, Daniel; Bashir, Anjum

doi:10.1097/00124509-200306000-00010

Cited by 17 publications

(8 citation statements)

References 9 publications

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“…Furthermore, 32% (n = 9) of our patients with catatonia experienced neurological comorbidity; these patients may be less responsive to ECT than other forms of catatonia. 11 In addition, our data indicate a physician-related delay of at least 2 months before starting ECT for catatonia. Although the mean time interval before ECT among the improved patients was much less than that among the nonimproved group, this difference did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 64%

Electroconvulsive Therapy for Catatonia

Waarde¹,

Tuerlings²,

Verwey³

et al. 2010

The Journal of ECT

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Section: Discussionmentioning

confidence: 64%

Electroconvulsive Therapy for Catatonia

Waarde¹,

Tuerlings²,

Verwey³

et al. 2010

The Journal of ECT

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“…Patients showed only transient and partial improvement to ECT. The authors suggest that advanced pathological changes of the CNS might explain a diminished response and that these states require a particularly intensive treatment ( 48 ).…”

Section: Prognosismentioning

confidence: 99%

A Clinical Review of the Treatment of Catatonia

Sienaert¹,

Dhossche²,

Vancampfort³

et al. 2014

Front. Psychiatry

235

312

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Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

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“…57-59 On the other hand, several authors have observed that ECT for catatonia is generally less efficacious in neurologically based disorders than in primary psychiatric disorders and that patients with certain neurological conditions may be at higher risk of adverse effects of ECT. 56,60,61 A small case series of patients with multiple sclerosis undergoing ECT suggested that white matter damage predisposed to neurologic deterioration during treatment. 62 Other authors have expressed specific concern that ECT after cerebral hypoxia may cause further harm by increasing metabolic demand in neurons damaged by oxygen deprivation.…”

Section: Cerebral Hypoxia and Catatoniamentioning

confidence: 99%

Catatonia After Cerebral Hypoxia: Do the Usual Treatments Apply?

Quinn

Abbott

2014

Psychosomatics

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Introduction Neurologic deterioration occurring days to weeks after a cerebral hypoxic event accompanied by diffuse white matter demyelination is called delayed post-hypoxic leukoencephalopathy (DPHL). Manifestations of DPHL are diverse, and include dementia, gait disturbance, incontinence, pyramidal tract signs, parkinsonism, chorea, mood and thought disorders, akinetic mutism, and rarely catatonia. Methods The authors report a case of malignant catatonia in a patient diagnosed with DPHL that was refractory to electroconvulsive therapy (ECT), and review the literature on catatonia in DHPL. Results The patient was a 56 year-old female with schizoaffective disorder who was admitted with catatonia two weeks after hospitalization for drug overdose and respiratory failure. Her catatonic symptoms did not respond to lorazepam, amantadine, methylphenidate, or ten sessions of bilateral ECT at maximum energy. Repeat magnetic resonance imaging revealed extensive periventricular white matter lesions not present on admission scans, and she was diagnosed with DPHL. Discussion No treatment for DPHL has been proven to be widely effective. Hyperbaric oxygen treatments may reduce the rate of development, and symptom improvement has been reported with stimulants and other psychotropic agents. Review of the literature reveals rare success with GABAergic agents for catatonia after cerebral hypoxia, and no cases successfully treated with ECT. There are seven case reports of neurologic decompensation during ECT treatment after a cerebral hypoxic event. Conclusion Caution is advised when considering ECT for catatonia when delayed sequelae of cerebral hypoxia are on the differential diagnosis, as there is a dearth of evidence to support this treatment approach.

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Diminished ECT Response in Catatonia Due to Chronic Neurologic Condition

Cited by 17 publications

References 9 publications

Electroconvulsive Therapy for Catatonia

Electroconvulsive Therapy for Catatonia

A Clinical Review of the Treatment of Catatonia

Catatonia After Cerebral Hypoxia: Do the Usual Treatments Apply?

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