Electroconvulsive Therapy in Drug-Induced Psychiatric States and Neuroleptic Malignant Syndrome

Abstract

In the late-stage idiopathic Parkinson's disease (IDP), comorbid conditions such as depression and drug-induced psychosis may be observed. A patient with Parkinson disease, major depression, and paranoid psychosis who developed neuroleptic malignant syndrome (NMS) as the result of the sudden termination of high-dose (1200 mg/d) levodopa treatment is presented in this report. Because the patient did not respond to other treatment modalities, electroconvulsive therapy (ECT) was applied, and a rapid improvement was observed both in the patient's NMS and also in Parkinson's and psychiatric symptoms, with no additional side effects other than transient post-ictal confusions. The application of ECT allowed the patient to remain stable for a 5-year period with a quite low dose of levodopa (300 mg/d). Later, the patient had two episodes of depressive and psychotic symptoms, which were again successfully treated with the ECT. We suggest that ECT might be an effective and life-saving therapy in patients with severe, drug-resistant NMS.

Neuroleptic malignant syndrome developing after acute overdose with olanzapine and chlorpromazine

“…Electroconvulsive therapy (ECT) has also been reported to be effective in reversal of signs of NMS toxicity in refractory or prolonged cases of muscle rigidity. Various case reports have suggested that ECT might be an effective and life-saving therapy in patients with severe drug resistant NMS, and therefore should be strongly considered in such a situation [20,21]. ECT was initially considered in our patient after no improvement in her clinical condition after 7 days, but her mental state and muscle rigidity was notably better the following day, and we did not proceed with this therapeutic option.…”

Psychiatric Care in Parkinson’s Disease

“…Some case reports suggest that electroconvulsive therapy (ECT) may be an option to consider in patients with PD and comorbid depression [155][156][157][158][159][160][161] or psychosis. 162,163 Open-label studies have also suggested that repetitive transcranial magnetic stimulation (rTMS) may have utility in the treatment of depression in PD.…”

Parkinson-Krankheit und Psychosen

“…Mehrere Fallberichte sprechen für eine mögliche Wirksamkeit von EKT, um psychotische Symptome bei Patienten mit PDP zu reduzieren, die ansonsten resistent gegen antipsychotische Behandlungen waren [137][138][139][140]. Ueda et al berichteten über eine positive retrospektive Studie bei fünf resistenten Patienten mit PDP [141].…”