<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

Abstract

Catatonia is a serious, common syndrome of motoric and behavioral dysfunction, which carries high morbidity and mortality. Electroconvulsive therapy (ECT) is the definitive treatment for catatonia, but access to ECT for the treatment of catatonia remains inappropriately limited. Catatonia is observable, detectable, and relevant to various medical specialties, but underdiagnosis impedes the delivery of appropriate treatment and heightens risk of serious complications including iatrogenesis. Current understanding of catatonia's pathophysiology links it to the current understanding of ECT's mechanism of action. Definitive catatonia care requires recognition of the syndrome, workup to identify and treat the underlying cause, and effective management including appropriate referral for ECT. Even when all of these conditions are met, and despite well-established data on the safety and efficacy of ECT, stigma surrounding ECT and legal restrictions for its use in catatonia are additional critical barriers. Addressing the underdiagnosis of catatonia and barriers to its treatment with ECT is vital to improving outcomes for patients. While no standardized protocols for treatment of catatonia with ECT exist, a large body of research guides evidence-based care and reveals where additional research is warranted. The authors conducted a review of the literature on ECT as a treatment for catatonia. Based on the review, the authors offer strategies and future directions for improving access to ECT for patients with catatonia, and propose an algorithm for the treatment of catatonia with ECT.

A case of catatonia in the aftermath of the COVID-19 pandemic: does autism spectrum matter?

“…Catatonia is a potentially life-threatening, motor syndrome, characterized by mental and physical immobilization and stereotypic behaviors, which may alternate with agitation and complicated with rigidity, hyperthermia and autonomic dysfunction. The mainstay of treatment for established catatonia is benzodiazepines and electroconvulsive therapy (ECT) [ 9 ]. Furthermore, antipsychotics discontinuation—especially first-generation ones—is recommended for the treatment of catatonia [ 10 ].…”

Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges

“…Dopamine dysfunction has also long been postulated as a cause for catatonia symptoms. There is some evidence that the potency of a dopamine D2 receptor blockage is directly related to the risk of exacerbating catatonia or even provoking malignant features [ 36 ]. This can be seen in neuroleptic malignant syndrome, which can manifest as catatonia.…”

‘Shock tactics’, ethics and fear: an academic and personal perspective on the case against electroconvulsive therapy

“…A 2020 review by prominent ECT critics concludes 'There is no evidence that ECT is effective for … its target diagnostic groupseverely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents'. 8 Such claims, common within anti-ECT literature, 9,10 seem strange and are easily challenged, given considerable evidence and abundant patient and clinical testimonies to major benefits, 1,3,[11][12][13][14][15] including many calling for ECT's use not to be restricted to 'last-resort' treatment. 1,3,11,12,15 Research on ECT's effectiveness is too extensive to summarise or assess here.…”