Transient Febrile Reaction After Electroconvulsive Therapy (ECT) in a Young Adult With Intellectual Disability and Bipolar Disorder

Abstract

We report the case of a 27-year-old man with mild-moderate intellectual disability (ID) and bipolar disorder treated with electroconvulsive therapy (ECT). He was psychiatrically hospitalized for agitation, aggression, and manic symptoms including insomnia, rapid and pressured speech, and hyperactivity. After multiple medication trials, ECT was recommended. The treatment was delayed owing to the need to obtain evaluation for incapacity and then substituted consent from the patient's mother. He received 2 ECT treatments with marked improvement but complicated by transient fevers, which resolved without treatment. Fever workup was unremarkable. The patient became calm and cooperative and was discharged home. He was readmitted 3 weeks later, again in an agitated manic state. He received 5 additional ECT treatments, but this time with no post-ECT fevers. Once again, his manic symptoms resolved, and he was safely discharged. Whereas patients with ID pose special challenges, our case is in keeping with the previous literature, which supports the use of ECT in patients with ID and comorbid psychiatric disorders.

Post–Electroconvulsive Therapy Hyperthermia

“…Similar case has been reported earlier in a 15-year-old adolescent girl with cerebral palsy and catatonic schizophrenia 1 . Similarly, ECT-induced hyperthermia has been reported in a 35-year-old man with cerebral palsy presenting with catatonia 2 and also in a 27-year-old man with mild-moderate intellectual disability and bipolar disorder treated with ECT 3 . Similar occurrences have been reported in a 65-year-old woman with bipolar disorder within hours of every session of ECT 4 .…”

Interventions for sleep difficulties in adults with an intellectual disability: a systematic review

“…; Majeske et al . ; Hamers, Festen & Hermans ). This indicates that the improvement of sleep in adults with an ID may involve a careful consideration of co‐occurring morbidities and what works for those morbidities.…”

“…The goal of this study was to examine the effectiveness of sleep interventions on sleep in adults with an ID. There is evidence, however, that sleep improvement can be a secondary consequence of mental health or lifestyle interventions (Altabet, Newman & Watson-Johnson 2001;Biswas, Bhaumik & Branford 2001;Verhoeven, Egger, Willemsen, de Leijer & Kleefstra 2012;Wilhite, Biren & Spencer 2012;Majeske, Garakani, Maloutas, Bryson & Kellner 2013). As having an ID is frequently comorbid with other physical, behavioural and mental health conditions, sleep disruption is often an indirect consequence of co-morbidity.…”

“…As having an ID is frequently comorbid with other physical, behavioural and mental health conditions, sleep disruption is often an indirect consequence of co-morbidity. For instance, results from studies focusing on fitness, depression and bipolar disorder indicate positive effects on sleep following interventions (Altabet et al 2001;Wilhite et al 2012;Majeske et al 2013;Hamers, Festen & Hermans 2018). This indicates that the improvement of sleep in adults with an ID may involve a careful consideration of co-occurring morbidities and what works for those morbidities.…”

Transient Febrile Episodes After Electroconvulsive Therapy (ECT)

“…Electroconvulsive therapy (ECT) remains the most effective acute treatment for depression. Although fever is not a commonly noted adverse effect, previous case reports have described episodes of hyperthermia after treatment with ECT 1–5 . These episodes have tended to be brief and resolve after discontinuation of ECT.…”