ECT for Somatic Delusions: Case report from Japan

Out on PubMed is this case report from clinicians in Yamagata, Japan:

Improvement of Somatic Delusions with Altered Regional Cerebral Blood Flow Following Electroconvulsive Therapy in a Patient with Schizoaffective Disorder.

Hayashi H, Kobayashi R, Morioka D, Saito Y, Toyoshima T, Otani K.

Am J Case Rep. 2021 Mar 16;22:e929800. doi: 10.12659/AJCR.929800.

PMID: 33724980

The abstract is copied below:

BACKGROUND Somatic delusions are false and fixed beliefs about health and organ function, which are observed in various psychiatric disorders. Psychotropic drugs such as antipsychotics and antidepressants are effective for some patients, while the efficacy of electroconvulsive therapy (ECT) for pharmacotherapy-resistant cases has been reported. Previous reports suggest that somatic delusions in delusional disorder somatic type are associated with reduced regional cerebral blood flow (rCBF), but it remains unclear whether this association is also observed in other psychiatric disorders. We report the case of a patient with schizoaffective disorder whose drug-resistant somatic delusions showed remarkable improvement accompanied by altered rCBF after successful ECT. CASE REPORT The patient was a Japanese man aged 52 years with a diagnosis of schizoaffective disorder. He was suffering from severe and persistent somatic delusions such as "There is a thick stick or bowl in my head" and "Something like a film stretches over my head and face", which were resistant to several antipsychotics and antidepressants. In our hospital, he received bitemporal ECT 8 times. His somatic delusions started to improve from the third administration, and they disappeared by the eighth administration. In parallel with this clinical improvement, reduction of rCBF in the bilateral parietal and occipital lobes observed before ECT disappeared. CONCLUSIONS The present study suggests that ECT is a useful choice for drug-resistant somatic delusions. Reduction of rCBF in the bilateral parietal and occipital lobes may be associated with manifestation of somatic delusions in schizoaffective disorder.

Figure 1 shows single-photon emission computed tomography (SPECT) with 99mTc-ethylcysteinate dimer images obtained in November of 2019 before ECT (A) and in December of 2019 after ECT (B). rCBF was reduced in the bilateral cerebral hemispheres when somatic delusions were prominent. After improvement of these by ECT, reduction of rCBF disappeared in the parietal and occipital lobes, but not in the frontal and temporal lobes.

This is an interesting case report, mainly because somatic delusions are sometimes very difficult to treat; here is a patient, with an atypical presentation (not clearly associated with depressive symptoms) who responded quickly to ECT. I'm not exactly sure what to make of the SPECT findings, but they are a nice corollary to the clinical resolution.

Worth a full read,~7 minutes.