Objectives: Electroconvulsive therapy (ECT) has been described as an effective treatment option for catatonia in retrospective case series. We aimed to investigate treatment characteristics and... Show moreObjectives: Electroconvulsive therapy (ECT) has been described as an effective treatment option for catatonia in retrospective case series. We aimed to investigate treatment characteristics and outcomes of patients with catatonia who were treated with ECT. Methods: The medical records of 27 patients with catatonia treated with ECT (between 1991 and 2009) were scrutinized for clinical and treatment characteristics. Outcomes were measured using the Clinical Global Impression-Improvement (CGI-I) scale. Patients who improved (defined as CGI-I score "very much" or "much improved") were compared with those who did not improve (defined as a CGI-I score "no change" or "very much worse"). Results: Mean age of all patients was 49 +/- 19 years, of whom 15 (56%) were women. Of all patients, 13 (48%) had a diagnosis of a mood disorder and 12 (44%) of a psychotic disorder. Electroconvulsive therapy was mostly started after ineffective pharmacotherapy (n = 23; 85%) within 2 to 3 months after catatonia had been diagnosed. In total, 16 (59%) patients improved. Improvement was significantly associated with younger age (P = 0.05), presence of autonomic dysregulation at baseline (P = 0.02), especially higher body temperature (P = 0.02), daily ECT during the first treatment week (n = 15 [56%]; P = 0.03), longer duration of electroencephalogram seizure activity at last ECT session (P = 0.04), and less morbidity in the year after ECT (P = 0.03). Three of 11 nonimproved patients died in the year after ECT compared with none of the improved patients. Conclusions: Most of our patients with catatonia benefited from ECT, especially younger patients with autonomic dysregulation. Daily administration of ECT may be more effective, whereas longer duration of seizure activity at the final ECT session was related to better response to ECT. Show less
Waarde, J.A. van; Wielaard, D.; Wijkstra, J.; Verwey, B.; Mast, R.C. van der 2010
Objectives: To examine patient and treatment characteristics in continuation electroconvulsive therapy (c-ECT), defined as prolonged treatment with ECT with a maximum frequency of once a week to... Show moreObjectives: To examine patient and treatment characteristics in continuation electroconvulsive therapy (c-ECT), defined as prolonged treatment with ECT with a maximum frequency of once a week to prevent relapse. Methods: Medical charts of 50 patients (mean age, 59 years; 74% were female) undergoing c-ECT were examined retrospectively for patient and treatment characteristics. Electrical stimulus dosage, seizure duration, and postictal suppression indices between the first and the last 4 ECT sessions were compared, and their associations with the time interval between c-ECT sessions were analyzed. Results: Almost all the patients (n = 46; 92%) experienced recurrent medication-resistant mood disorders. During a median c-ECT period of 393 days (interquartile rate, 211-677 days), the frequency of c-ECT ranged from once a week (n = 15; 30%) to once every 4 to 6 weeks (n = 17; 34%), and ECT was administered almost exclusively bifrontotemporally (n = 46, 92%). The mean (SD) time interval between consecutive c-ECT sessions was 19 (11) days. The number of days between c-ECT sessions correlated positively with median seizure duration (motor activity: r = 0.390, P = 0.005; electroencephalographic activity: r = 0.351, P = 0.013). Conclusions: In 50 patients with long-standing, recurrent, medication-resistant mood disorders who were treated with c-ECT, increased time interval between consecutive c-ECT sessions was correlated with increased seizure duration. Whether bifrontotemporal c-ECT requires a lower frequency to sustain remission compared with unilateral c-ECT needs further investigation. Show less
Verwey, B.; Waarde, J.A. van; Bozdag, M.A.; Rooij, I. van; Beurs, E. de; Zitman, F.G. 2010
