Malignant catatonia: role of right unilateral electroconvulsive therapy

Malignant catatonia is defined as a life-threatening febrile neuropsychiatric disorder, characterized by psychosis with autonomic instability, hyperactivity, mutism, and stuperous exhaustion. Although historically nearly always fatal, there has been a recent decline in mortality, secondary to earlier diagnoses and appropriate treatment implementation. This includes administration of standing benzodiazepines, and without timely response to this pharmacological intervention, electroconvulsive therapy is the next appropriate treatment. We present a case of a young woman with malignant catatonia who was successfully treated with right-unilateral electroconvulsive therapy.     

右单侧刺激电休克治疗研究进展

右单侧刺激电休克治疗是将电极放置于颞顶叶位置给予患者电刺激,是一种疗效显著、 不良反应较轻的电休克治疗模式,现就右单侧刺激电休克治疗的设置、作用机制、疗效、不良反应进行 综述。     

Treatment of catatonia with electroconvulsive therapy in an 11-year-old girl

OBJECTIVE: To report the case of an 11-year-old girl who presented with acute onset of psychotic symptoms with catatonic features treated with electroconvulsive therapy (ECT). METHOD: Described herein is the case of an 11-year-old, prepubertal girl who represented with catatonic symptoms unresponsive to conventional medical treatment. After thorough clinical investigation and obtaining a second opinion we gained consent from her parents to perform ECT as a life saving procedure. RESULTS: Six ECT treatments were administered with clinical improvement, the patient did develop hypomanic symptoms as a side-affect of ECT. CONCLUSION: The patient exhibited potentially life-threatening self-harming behaviour secondary to catatonic and psychotic symptoms. Her behaviour and symptoms responded to ECT. The patient developed hypomania that responded to mood stabilization. ECT was a safe and effective treatment for catatonia in this prepubescent girl.     

Antidepressant effects of high-dose right unilateral electroconvulsive therapy

In a random-assignment, double-blind, controlled comparison in 38 melancholic men, overall antidepressant potency of high-dose electroconvulsive therapy (378-mC charge) given with right unilateral electrode placement was not significantly different from that with bilateral placement, although there was a trend for faster improvement with bilateral ECT. The suprathreshold character of the stimulus, about 2.5 times the expected seizure threshold, may have contributed to the high efficacy of brief-pulse right unilateral electroconvulsive therapy found in this study.     

Efficacy and cognitive effects of right unilateral electroconvulsive therapy

The efficacy, memory, and cognitive effects of right unilateral (RUL) electroconvulsive therapy (ECT) at 2.5 times threshold in 32 inpatients with moderate to severe major depressive disorder were evaluated at baseline, during the course of treatment, and 1 month after treatment. Neuropsychological assessment included the Randt Memory Test, Personal Memory Test, short-version Wechsler Adult Intelligence Scale-Revised, and Self-Rating Scale of Memory Functions. At the treatment end point, although the Hamilton Depression Rating Scale mean score was decreased by 54.2%. the response rate of 2.5 times threshold RUL ECT using stringent criteria was only 31.2%. Treatment was associated with significant anterograde memory impairment in the short term. Mean total scores of the Randt Memory Test and Personal Memory Test were decreased from baseline by 14.8% and 32.5%, respectively, after six sessions of ECT. These memory deficits were significantly improved by the 1 month follow-up examination. Subjective memory scores increased consistently during treatment, correlating with improvements in mood. No adverse effects on nonmemory cognition were found. Although RUL ECT at 2.5 times threshold is not associated with marked or persistent cognitive disturbances, its efficacy may be insufficient in clinical practice.     

The successful use of electroconvulsive therapy in a patient with interferon-induced psychotic depression

We report the successful use of electroconvulsive therapy in a patient who developed major depression with psychotic features while being treated with interferon alfa-2b for hepatitis C. We reviewed the literature of similar cases and discuss treatment options for interferon-induced depression and psychosis.     

Respiratory failure secondary to malignant catatonia and klinefelter pulmonary deficits: successful electroconvulsive therapy

Catatonia is a motor syndrome associated with disorders in behavior. Malignant catatonia (MC) is the form of acute catatonia dominated by fever and autonomic instability that may be fatal if inadequately treated. We present a case of MC complicated by respiratory failure in a patient with previously undiagnosed Klinefelter syndrome. Patients with Klinefelter syndrome have one or more extra X-chromosome(s), and mental illness is a recognized association. The use of electroconvulsive therapy in these patients is well recognized, however, to our knowledge, this report is the first for MC in Klinefelter syndrome. We also describe, for the first time, type II respiratory failure as a secondary phenomenon occurring because of the combination of MC and thoracic abnormalities associated with Klinefelter syndrome. Interestingly, this is only the fourth reported case of respiratory failure due to any cause in MC. The positive outcome in this case confirms the efficacy of electroconvulsive therapy for MC and supports its safety for use in patients with Klinefelter syndrome and in those with secondary respiratory failure.     

The relationship between changes in learning and memory after right unilateral electroconvulsive therapy

SUMMARY: OBJECTIVE: We investigated whether the ability to learn new information, as opposed to recall information, would change significantly in depressed individuals treated by low- or high-dose right unilateral electroconvulsive therapy and tested whether change in learning explained changes in recall. METHOD: Fifty-four depressed patients randomized to receive right unilateral electroconvulsive therapy (ECT) at approximately 2.25 times their seizure threshold (ST) or at doses greater than 2.25 times ST were evaluated for verbal and figural memory as well as verbal and figural learning both pre- and post-ECT. A subset of scores from the Rey Auditory Visual Learning Test and the Rey Figure Test were analyzed using analysis of variance and linear regression techniques. RESULTS: Scores reflecting verbal learning decreased by a mean of approximately 50% immediately after a completed course of ECT as compared with pre-ECT verbal learning scores. Stratification of effect by dose of electrical charge revealed trends that did not achieve statistical significance. Approximately 8% of the change in delayed verbal recall was predicted by changes in verbal learning. Figural learning was not significantly changed in the aggregate (pre-versus post-treatment) or when the effect was stratified by electrical charge. CONCLUSIONS: Verbal learning scores declined immediately after ECT, but the change in learning scores explained only a minor part of the observed changes in verbal recall. These findings support the notion that the deficits in delayed recall after ECT represent a relatively specific cognitive effect that is not completely explained by changes in other aspects of cognition such as learning.     

Resolution of catatonia by successful seizure induction via electroconvulsive therapy with electrodes applied bilaterally to the parietotemporal region

Electroconvulsive therapy (ECT) has been shown to be effective in cases of medically intractable mood disorder and schizophrenia. However, some patients receiving ECT have only a short electroencephalographic seizure or no seizure at the maximum stimulus intensity and thus fail to obtain a therapeutic effect. A new treatment option is needed to induce therapeutic seizures in such patients. We report a case of catatonic schizophrenia that was resolved by successful seizure induction by means of ECT with electrodes applied bilaterally to the parietotemporal region after bifrontotemporal ECT failed to induce adequate seizure. We note that parietotemporal ECT can induce therapeutic seizures in patients with a high seizure threshold because more current penetrates the brain due to a decrease in shunted current.     

Heart rate differences between right and left unilateral electroconvulsive therapy.

Left and right unilateral electrode placements were alternately applied in electroconvulsive therapy given to 21 men with melancholia. Accompanying heart rate elevations were greater following right unilateral treatment than left unilateral, apparently because of longer persistence of peak rates. This is consistent with right cerebral hemisphere superiority in the control of heart rate activity in neurologically intact humans.     

Bifrontal versus right unilateral and bitemporal electroconvulsive therapy in major depressive disorder

OBJECTIVES: We sought to evaluate the safety and efficacy of three electroconvulsive therapy (ECT) methods: moderate-dose bifrontal, low-dose bitemporal, and high-dose right unilateral in the treatment of a major depressive episode. METHODS: In an 8-session, double-blinded parallel group study, 45 consecutive depressive patients who were referred for ECT to Noor Hospital were assigned randomly to bifrontal, moderate dose (50% above seizure threshold; n = 15); bitemporal, low dose (just above seizure threshold; n = 15); and right unilateral, high dose (400% above the seizure threshold; n = 15) ECT applications. Primary outcome measures included assessment by Mini-Mental State Examination and Hamilton Depression Rating Scale. RESULTS: Thirty-nine of the patients completed the course of treatment. Two patients in bifrontal, 1 in bitemporal, and 3 in right unilateral dropped out of the study. The 3 groups did not show any difference in baseline characteristics. There was a significant difference between standardized Mini-Mental State scores of patients in bifrontal group compared with bitemporal and right unilateral patients (P < 0.05). The effectiveness of the 3 ECT methods, assessed by Hamilton Depression Rating Scale, did not show any significant difference (P > 0.05). CONCLUSION: Moderate-dose bifrontal ECT revealed fewer cognitive side effects in comparison with bitemporal and right unilateral. Moderate-dose bifrontal ECT had the same efficacy compared with low-dose bitemporal and high-dose right unilateral in the treatment of depression.     

Postpartum catatonia treated with electroconvulsive therapy: a case report

Catatonia is a rare syndrome that occurs in mood and psychotic disorders, and general medical conditions. Postpartum depression affects 10%-15% of women within 6 months after delivery. Postpartum psychosis affects 0.1%-0.5% of women within weeks after delivery, though it can occur within hours; it carries risk for suicide and infanticide. There is limited evidence available to guide treatment. We review a case of postpartum psychosis that presented with catatonia and was resistant to medications, but responded to electroconvulsive therapy.     

Rate of continuing acute course treatment using right unilateral ultrabrief pulse electroconvulsive therapy at a large academic medical center

European Archives of Psychiatry and Clinical Neuroscience - Right unilateral ultrabrief pulse (RUL-UBP) ECT has emerged as a promising technique for minimizing cognitive side effects of ECT while...     

Effects of right unilateral electroconvulsive therapy on motor cortical excitability in depressive patients

Electroconvulsive therapy (ECT) is a widely acknowledged effective treatment for severe major depression. ECT produces considerable anticonvulsant effects that may be related to an increased GABA-ergic neurotransmission. We aimed to explore whether motor cortical excitability as assessed with single and paired pulse transcranial magnetic stimulation (TMS) could be used to investigate these anticonvulsant effects. Therefore, parameters of motor cortical excitability were investigated in 10 patients before and after 10 sessions of right unilateral ECT. After 10 sessions of right unilateral ECT, an enhanced activity of inhibitory circuits in human motor cortex had been observed, as measured by both increased intracortical inhibition and cortical silent period duration, whereas intracortical facilitation and resting motor threshold remained unchanged. The reduction of seizure duration in the course of ECT was associated with clinical improvement and an increase in intracortical inhibition. We interpret this finding as further indirect evidence for changes in inhibitory circuits in the course of ECT in patients with major depression.