ECT: An Effective Treatment in the Screaming Demented Patient

Carlyle, W.; Killick, Lyn; Ancill, R. J.

doi:10.1111/j.1532-5415.1991.tb03610.x

Cited by 50 publications

(28 citation statements)

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“…Thus, after five ECT treatments, VDB had completely ceased and had not reappeared during divalproex sodium maintenance treatment one year after ECT (Roccaforte et al, 2000). Three elderly patients with medication-resistant VDB, one of whom had major depression and two who had a substantial degree of cognitive impairment, exhibited rapid resolution of screaming early in their course of ECT (Carlyle et al, 1991). …”

Section: A U T H O R S N U M B E R O F C a S E S I N T E R V E N T I mentioning

confidence: 99%

Vocally disruptive behavior in the elderly: a systematic review

Gunten¹,

Alnawaqil²,

Abderhalden

et al. 2008

Int. Psychogeriatr.

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Section: A U T H O R S N U M B E R O F C a S E S I N T E R V E N T I mentioning

confidence: 99%

Vocally disruptive behavior in the elderly: a systematic review

Gunten¹,

Alnawaqil²,

Abderhalden

et al. 2008

Int. Psychogeriatr.

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“…However, there is no consensus on whether screaming is a meaningful attempt at communication or merely a type of agitation [3]. Electroconvulsive therapy (ECT) has been demonstrated to be effective for screaming behavior in patients with mental retardation or dementia, particularly in the presence of depression [4,5]. To our knowledge compulsive screaming has not been observed as a symptom of an Affective Disorder in the absence of an intellectual disability or a neurodegenerative disorder.…”

Section: Discussionmentioning

confidence: 99%

Klazomania: A Rare Case of Compulsive Screaming, Complicating Major Depression, Effectively Treated with Electroconvulsive Therapy (ECT)

Pillai¹,

Krishna²,

Regenold³

2017

J Aging Sci

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We describe a rare case of a 57-year-old women diagnosed with Klazomania (compulsive shouting), rarely reported in literature, complicated by Major Depressive Disorder (MDD), refractory to medical management and treated successfully using electroconvulsive therapy (ECT). This is a unique presentation in which compulsions occurring in the context of MDD involved shouting rather than more typical compulsions such as hand washing or counting. Potential neurological disorders were ruled out through an extensive diagnostic workup prior to a course of electroconvulsive therapy (ECT). Her episodic compulsive shouting abated and eventually remitted after a 12-session course of ECT.Keywords: Klazomania; Compulsive screaming; ECT; Complication of major depression; Adult psychiatry; Elderly depression; Elderly screaming; Aging psychiatry Case ReportMs. X, a 57-year-old Ethiopian woman was admitted to the psychiatric service with a 2-year history of increasingly frequent episodic paroxysmal compulsive shouting (from once every month to a quotidian occurrence), complicated by treatment resistant Major Depressive Disorder (MDD). The shouting episodes were characterized by loud screaming and screeching sounds, occasionally in speech that was perseverative and stereotypic with small sentences, and concurrently accompanied by crying. During these episodes, she was completely oriented; aware she was screaming and able to recollect her thoughts. Afterwards, she reported feeling anxious and irritated because of her inability to control her vocalizations. The episodes occurred daily, 3-7 per hour every hour she was awake, variable in duration, and were emotionally consonant with her mood state (precipitated by intrusive thoughts of a recently deceased fiance). They occurred in a variety of settings (work, home, social) that affected her quality of life and interfered with her work performance. She was admitted twice on previous occasions for the same complaint.Her psychiatric history was significant for MDD that was likely triggered by several major life stressors beginning with the death of her fiancé 2-years prior. During this time she developed severe depression characterized by a low mood, decreased energy, poor concentration, sleep disturbances, lack of appetite, anhedonia, and feelings of worthlessness and hopelessness. As mentioned earlier, it was also during this period that her shouting episodes gradually increased in frequency to a quotidian occurrence. She endorsed no history of hallucinations or head trauma. Ms. X's past medical history was significant for Type 2 Diabetes Mellitus, Hypertension, Chronic Back and Neck Pain, Anxiety, and Mood disturbances. Laboratory evaluations, Lumbar Puncture (LP) revealed a slightly elevated protein level of 60mm/dL (otherwise LP results were within normal limits), a Electroencephalogram (EEG) with and without vocalizations was negative, and a Head-CT revealed periventricular white matter hypodensities with global atrophy. Magnetic Resonance Imaging (MRI) was remarkable for num...

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“…Electro Convulsive Therapy (ECT) has been reported as helpful in the reduction of screaming in case reports of four elderly patients (Carlyle et al, 1991;Snowdon et al, 1994). The authors postulated that screaming in dementia may be a presentation of depression where the other symptoms may be difficult to elicit and ECT could provide an alternative to endless trials of progressively more toxic psychotropic drugs.…”

Section: Symptomatic Pharmacotherapymentioning

confidence: 97%