Successful ECT in a case of Leonhard's cycloid psychosis

In Leonhard's nosological system, acute, episodic psychoses with good short-term and long-term prognoses, characterized by mixed affective and schizophrenic features, confusion, and alternating psychomotor retardation and excitement are called cycloid psychoses. According to clinical lore, patients with cycloid psychoses show an excellent and prompt response to electroconvulsive therapy (ECT). We describe a patient with typical motility psychosis, a subtype of cycloid psychoses, who failed to respond to a combination of antipsychotic and benzodiazepine medication but quickly recovered after the administration of ECT.     

Electroconvulsive Therapy in the Treatment of Episodic Aggressive Dyscontrol in Psychotic Patients

Five patients with chronic psychosis and episodic aggressive dyscontrol were treated with electroconvulsive therapy (ECT). Four patients also demonstrated clinical evidence of seizure disorder. ECT resulted in marked reduction of both episodic aggressive dyscontrol and clinical seizures, with modest improvement of psychosis. No patient developed clinical signs of organic brain syndrome during ECT. Albeit in a small number of patients, our findings indicate that ECT may have short-term therapeutic effects on episodic aggressive dyscontrol in patients with chronic psychoses.     

The use of ECT in children: case report

A case is presented in which electroconvulsive therapy (ECT) was successfully used to treat childhood depression. In addition, the literature of ECT use in childhood disorders is briefly reviewed. It is proposed that ECT is a valid therapy for children only in depression, mania, or acute schizophreniform psychoses, refractory to pharmacotherapy.     

Electroconvulsive Therapy of the Lethal Catatonia Syndrome

Lethal catatonia (LC) is a life-threatening syndrome associated with diverse neuropsychiatric or systemic disorders. Neuroleptic agents appear inadequate in treating LC. We report a case of LC successfully treated by electroconvulsive therapy (ECT) that adds to the experience of ECT as a safe and effective treatment for LC occurring in the context of the major psychoses. Anecdotal evidence suggests that ECT is dramatically effective in LC regardless of etiology. The use of ECT in the treatment of neuroleptic malignant syndrome (NMS), viewed here as a subtype of LC, is considered and compared with that of specific drug therapies for NMS.     

Electroconvulsive Therapy in Nigeria

An overview of the use of electroconvulsive therapy (ECT) in Nigeria is presented. Unmodified ECT with bilaterally placed electrodes remains the main method of administration and is widely used for all forms of functional psychoses. ECT is used as an adjunct to chemotherapy both for inpatients and outpatients. Complications associated with the therapy are relatively few. Despite the use of unmodified ECT since 1952, there has been no report of tardive (spontaneous) seizures in patients treated by this method. In view of the widespread usage, a continuing assessment of the therapy and guidelines for its use in Nigeria seem desirable.     

Electroconvulsive therapy in a major teaching hospital: diagnoses and indications

The use of ECT over an eleven year period in the University of Alberta Hospitals is reviewed. Five percent of patients received ECT, the mean number of treatments per course was 5.2, and the most frequent type of treatment was bilateral ECT. Discharge diagnoses showed that three-quarters of the patients had affective psychoses and one-fifth were schizophrenic. All patients had had a mandatory consultation before treatment and the most frequent reasons for choosing ECT were given as: failed antidepressant treatment, previous good response to ECT, failure to respond to other treatment, uncontrollable delusions or psychotic behavior, acute suicidal risk requiring a rapid response, and adverse reaction to medication. The mandatory consultation process has worked well and has helped to clarify the situations where ECT may be used with benefit. It is hoped that this may assist those who may be responsible for defining guidelines for the use of ECT.     

Electroconvulsive therapy in patients with late-onset psychoses and structural brain changes

The authors describe the brain magnetic resonance imaging results and the clinical courses of three patients with late-onset psychoses who were treated with electroconvulsive therapy (ECT). Consistent with previous work, preexisting structural brain changes were present in all three patients. The two patients with the more severe structural changes (lateral ventricular enlargement and large deep-white-matter hyperintensities) failed to respond to ECT. In addition, all three patients had caudate hyperintensities and developed a prolonged interictal ECT-induced delibrium. These observations are also consistent with previous studies that have reported that patients with caudate hyperintensities may be at an increased risk for developing an interictal delirum during a course of ECT.     

Results of electroconvulsive therapy in restrictive indications. A retrospective study of 15 years]

In Tübingen ECT is restricted to severely ill patients who do not respond to other somatic therapies; especially to patients with endogenous depression and pernicious catatonia. Between 1976 and 1990, 45 patients were treated with ECT, of whom 22 suffered from endogenous depression and 10 from pernicious catatonia. Thirteen patients with other diagnoses (schizophrenic and schizoaffective psychoses, borderline schizophrenia and obsessive-compulsive disorder) were treated with ECT for severe depressive states after failure of psychopharmacological therapy. A positive therapeutic response to ECT was observed in 46% of patients with endogenous depression and in all 10 with pernicious catatonia. In the patients with schizophrenia and schizoaffective psychosis, borderline schizophrenia and obsessive-compulsive disorder, an amelioration of the depressive or anxiety syndrome was observed only in individual cases. Side effects of ECT were transit syndromes (20%), reversible amnestic syndromes (20%) and cardiac arrhythmias (6%). According to our results, ECT is highly effective in therapy-resistant endogenous depression and pernicious catatonia, and therefore remains a necessary part of psychiatric therapy.     

Treatment of Phencyclidine-Associated Psychosis with ECT

Phencyclidine (PCP) abuse usually causes a short, self-limited period of intoxication but may lead to a prolonged psychosis, poorly responsive to antipsychotic medications. Prior reports indicate that electroconvulsive therapy (ECT) is a safe, rapidly effective treatment in such cases, but longer-term outcome has not been studied. We report three cases of PCP-associated psychosis that did not respond to at least 2 weeks of antipsychotic treatment but subsequently responded rapidly to ECT. Follow-up at 14 to 21 months after treatment show that recovery was maintained except in one subject who relapsed after continuing to abuse PCP. ECT should be considered as a treatment early in the course of drug-associated psychoses in which an adequate trial of antipsychotic medication has not been effective.     

Continuation ECT

A renaissance of electroconvulsive therapy in psychiatry can be observed in Germany. Here, ECT was named as a first line therapy for treating psychotic depression, depressive stupor, schizoaffective psychoses with severe depressive symptoms. Suprisingly, ECT is most commonly not used as a continuation therapy after achieving acute remission. With rare exceptions, antidepressive medication is chosen for this purpose. The use of continuation ECT (cECT) and subsequent maintenance ECT (mECT) is not (or just marginally) mentioned in practice guidelines. In our case report we report a successful cECT and mECT of a geriatric patient with severe comorbidity. This case is exemplified with respect to recent guidelines and study results. Particularly suggestions for interval duration, total duration of treatment, effects on cognition and memory, comorbidity and comedication, and reflections on quality of life and costs were discussed. We would therefore recommend a broader use of this proven treatment tool for keeping major depressions in remission.     

The treatment of late age onset psychoses with electroconvulsive therapy

The authors describe the clinical course and the brain imaging findings of six patients with late age onset psychoses who were treated with electroconvulsive therapy (ECT). In all five patients who failed to respond to ECT, one or more structural brain changes (lateral ventricular enlargement and/or subcortical structural changes) were observed. In addition, all six patients developed an interictal ECT-induced delirium. Consistent with previous ECT-induced delirium studies, caudate hyperintensities were present in the three patients who received brain MRI scans. The potential clinical correlates of structural brain changes in LAOP patients will be described, along with proposed areas of future research.     

The practice of electroconvulsive therapy: current contributions. I.--Indications, contraindications and adverse effects]

In this first of a two-part review about electroconvulsive therapy (ECT) practice, the author reviews main treatment indications, contraindications and complications. Major diagnostic indications are major depression, mania and some other functional psychoses. Other indications, primary use of ECT, and use in special population (children, adolescents, elderly, pregnancy) are also discussed. There are now no absolute contraindications to treatment but high risk situations. Cardiovascular complications are the leading cause of post-ECT morbidity, as are, but at a least degree, prolonged and tardive seizures. Factors that contribute to cognitive side effects are also presented.     

The management of the levodopa psychoses.

Parkinson's disease (PD) is frequently associated with psychiatric problems. Depression generally responds to antidepressant medications or to electroconvulsive therapy (ECT). The nondepressive psychoses generally require a reduction in parkinsonian medications, or possibly a "drug holiday." In patients whose psychosis fails to respond to a reduction in medication or who cannot tolerate the worsening parkinsonism, an antipsychotic drug should be added. Clozapine is probably the drug of choice, with low potency neuroleptics being second-line options.     

Differenzierte Diagnostik, Verlauf und Ausgang postpartaler Psychosen Eine katamnestische Untersuchung

In a polydiagnostic study, a systematically recruited collective of 34 women with a first-episode postpartum psychosis was reexamined after a period of 6-26 years (averaging 12.6 years) in order to establish lifetime-diagnoses according to ICD-10 and Leonhard's classification, and to determine course and outcome. According to ICD-10, unipolar depressive disorders (32%) and acute polymorphous psychotic disorders (28%) represented the most frequent diagnoses. Applying Leonhard's classification revealed a marked predominance of cycloid psychoses (62%) with the subform of motility psychosis being the most frequent diagnosis (38%). Schizophrenias occurred rarely according to both classifications. Investigating the long-term course, we found in 59% multiphasic disorders. The mean number of episodes per patient was 2.5 (range 2-6) with a mean duration of 9.8 weeks (SD = 5.2). 6 patients (18%) had undergone a monophasic course, in 4 cases (12%) the course was not determinable. 17 women (50%) had 19 further deliveries during the follow-up period. The frequency of relapses in connection with a further delivery was 47%. Administering the Strauss-Carpenter-Outcome-Scale revealed a favourable outcome with a mean value of 14.1 (SD = 2.83) for our total sample. Only 4 patients (12%) had never recovered fully since the onset of the illness. Our findings suggest that cycloid psychoses, in particular motility psychoses, account for the majority of postpartum psychoses, and do not support the hypothesis of a nosological independence of postpartum psychoses. They provide further evidence of a favourable prognosis of severe postpartum psychiatric disorder despite a relatively high rate of non-puerperal and especially puerperal relapses.     

Leonhard and the classification of psychomotor psychoses in childhood and adolescence

The classification 'psychomotor psychoses' goes back to Wernicke, Kleist and Leonhard. The incidence of psychomotor deficiencies is a typical trait. The motility psychoses (a form of the cycloid psychosis), the periodical catatonia (a form of unsystematic schizophrenias) and the catatonic forms of systematic schizophrenias belong to the group of 'psychomotor psychoses'. To some extent they correspond with the 'catatonic type' according to DSM-III (295.2). The number of children and adolescents with psychomotor psychoses, who were examined by Leonhard and Neum?rker have shown beside different clinical-psychopathological features a significant difference as regards the age-related manifestation of each psychomotor psychosis.     

Prognostic validity of the cycloid psychoses. A prospective follow-up study

In a prospective 4-year follow-up study, 26 out of 31 patients initially diagnosed as cycloid psychoses were investigated (anxiety-happiness psychosis n = 15; confusion psychosis n = 8; motility psychosis n = 3). Patients were independently interviewed by two clinical researchers. 61.5% showed one or several 'first-rank symptoms' according to Schneider. In addition, the SADS-LA was applied for RDC and DSM-IIIR diagnoses. According to these classification systems most of the patients were diagnosed as schizophrenic or schizoaffective. Personal interview as well as application of the Strauss-Carpenter Outcome Scale indicated a highly favorable clinical outcome, i.e. lack of affective or behavioral defective states in literally all patients of the study. These results justify the distinction of the cycloid psychoses as a nosological entity in general and--less convincingly--of the three subtypes of cycloid psychoses.     

Tissue Injury-Inducing Potential of Unmodified ECT: Serial Measurement of Acute Phase Reactants

Eight subjects with acute functional psychoses receiving unmodified electroconvulsive therapy (ECT) at Ibadan were investigated for occult or subclinical internal tissue damage by serial measurements of eight acute phase reactants. Samples of venous blood were collected from each patient at pretreatment, two within treatment, and one at posttreatment. The acute phase proteins assayed were C-reactive protein (CRP), alpha-2-macroglobulin, ceruloplasmin, factor B, C-4 protein, C-3 protein, transferin, and alpha-1-antitrypsin. Except for CRP, the values of the proteins did not change during treatment. CRP values decreased posttreatment and were not detectable in the last sample in five subjects in whom values had been present pretreatment. Our data do not support fears of occult internal tissue damage during unmodified ECT. The consistent decrease in CRP levels posttreatment when patients no longer exhibited psychotic symptoms could not be explained by type of psychosis, intramuscular injections, or changes in drugs and diet; its significance is not known.     

Derangement of one-carbon metabolism in episodic schizoaffective psychoses

The so-called cycloid or degeneration psychoses form a subgroup of the vaguely defined schizoaffective psychotic disorders, or according to the DSM III criteria: "Psychotic Disorders Not Elswhere Classified" (295.40; 298.80; 295.70; 298.90). Recovery from these acute psychoses is always complete, though episodic recurrence is commonly observed. The clinical syndrome is characterized by a kaleidoscopic, polymorphous clinical picture, e.g. sudden mood swings, motility disturbances, states of pananxiety and ecstasy with visionary experiences, perfunctory delusional ideas and visual hallucinations. At the onset of the psychoses many patients experienced psychedelic phenomena. It was postulated that these patients suffered from an abnormality in one-carbon metabolism resulting in the formation of beta-carbolines which were held responsible for evoking the psychotic symptoms. Since serine is the principle donor for one-carbon units, serine was administered to nonsymptomatic patients. Two to three hours after the administration patients became psychotic again. Analysis of blood samples from these patients showed a decreased fasting plasma concentration of serine and an increased fasting plasma level of taurine. In addition a decreased formation of serine from glycine was found. These findings are in agreement with the postulated derangement of one-carbon metabolism. Moreover, the beta-carboline norharman was present in blood obtained during acute psychotic episodes and was not present in blood of nonsymptomatic patients nor in blood of healthy controls. No abnormal activities of enzymes were found in skin fibroblasts from these patients.(ABSTRACT TRUNCATED AT 250 WORDS)