More on ECT in Correctional Settings: Case of Catatonia in Prison
Out on PubMed, from authors at UCSF, is this case report:
Electroconvulsive therapy use in the adult U.S. correctional setting: A case report and literature review.
J Forensic Sci. 2021 Jan 4. doi: 10.1111/1556-4029.14652. Online ahead of print.PMID: 33394509
The abstract is copied below:
Mr. C is a 45-year-old male inmate who was found in his cell unresponsive and mute. He had poor food and fluid intake for the last four days and was later found standing in place, frozen, and resistant to movement when encouraged by a corrections officer to rest in his bed. His symptoms were consistent with catatonia, a severe motor syndrome that can be life-threatening. The patient had a psychiatric history of bipolar I disorder with multiple past episodes of catatonia. Lorazepam was ineffective at reversing his catatonic symptoms, and his serum creatinine kinase level eventually began to rise, suggestive of muscle breakdown and worsening severity. The treating psychiatrist wanted access to electroconvulsive therapy (ECT) to treat Mr. C's catatonia but encountered numerous legal and logistical barriers which made this treatment option unavailable. The article reviews the scant literature on ECT use in the adult U.S. correctional system, identifies barriers, and discusses a recommended ECT referral process for inmates.
Keywords: catatonia; correctional system; electroconvulsive therapy; forensic psychiatry; malingering; prisons and jails.
The pdf is here.
This case report is of interest from the forensic point of view as well as for the classic presentation of catatonia. The authors highlight the obstacles of getting timely, appropriate ECT care in the correctional system. Worth a full read (~8 minutes).
(Please see also blog posts of June 27 and July 9, 2020)
The below comment is from Dr. Vaughn McCall:
ReplyDeleteIn 1987 I began my required rotation in community psychiatry, and I chose a state’s central prison as my site. My faculty preceptor at the site quickly learned of my interest in ECT and offered to gift to me the Medcraft B-24 device that was sitting in his garage and waiting for disposal. The device was being tossed because the correctional system was dismantling its in-house ECT service. (I am looking at my treasured antique device as I write this comment). The in-house ECT service was being dismantled because the correctional system has decided that the in-house provision of ECT was increasingly complex and the optics were increasingly hard to explain to advocates for prisoners, legislators, and the general public. This story, I am sure, is prototypical of how reasonable access to ECT has been lost for inmates with serious, life-threatening mental illness - such as catatonia. Martin and Ureste’s paper does a service in preserving our awareness of the plight of mentally ill inmates, and the need to somehow arrange ECT for those inmates that desperately need it
-Vaughn McCall