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

Abstract

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...

The spectrum of involuntary vocalizations in humans: A video atlas

“…Inappropriate shouting is also a well‐documented feature in TS (Video 1I) and functional neurological disorders (Video 1J). Other associations of klazomania include depression and carbon monoxide poisoning . Clearly, as in the distinction of tics from tic‐like vocalizations, beyond phenomenological observation of vocalizing behaviors, historical information and the presence of additional clinical features are crucial to distinguish between the different etiological categories.…”

“…Inappropriate shouting is also a well-documented feature in TS 56 (Video 1I) and functional neurological disorders (Video 1J). Other associations of klazomania include depression [57][58][59] and carbon…”