SEVERE CATATONIA SUCCESSFULLY TREATED WITH TWICE-DAILY ECT: A CASE REPORT AND A BRIEF REVIEW

Abstract

Catatonia is a severe motor dysregulation syndrome. It is a subtype of schizophrenia, but it can also occur in association with other psychiatric conditions as well as with some general medical and neurological diseases. In emergency departments and inpatient units, catatonia may not be familiar and can be under-recognized. Untreated catatonia may lead to death in the worst case. Early detection and diagnosis of catatonia is life-saving. The collaboration, education and liaison between somatic and psychiatric specialities in emergency departments is essential to improve diagnostics and treatment. Lorazepam is the first-line therapy for catatonia, but in life-threatening situations and refractory cases ECT is preferable. It should be started with bilateral high-dose technique and given daily until the symptoms are relieved. Antipsychotics worsen the symptoms of catatonia, but if psychotic symptoms complicate the catatonic state, antipsychotic treatment should be considered, favouring second-generation antipsychotics. Clozapine can be used in very delusional patients. Here is described a very severe catatonia case, successfully treated with twice-daily ECT and close collaboration of different specialities. This case highlights the power of ECT in lifethreatening catatonia, as well as the essential support from other ECT specialists in decision making and not giving up too early when treating rare and most refractory cases with ECT.

Keywords

• catatonia
• ect
• electroconvulsive therapy