ECT In Neuropsychiatric Complications of COVID

Out on PubMed, from clinicians in Texas, is this paper;

"The Use of Electroconvulsive Therapy in Neuropsychiatric Complications of COVID-19: A systematic literature review and case report".

Austgen G, Meyers M, Gordon M, Livingston R.J Acad Consult Liaison Psychiatry. 2021 Aug 3:S2667-2960(21)00127-0. doi: 10.1016/j.jaclp.2021.07.010. Online ahead of print.PMID: 34358726 


The abstract is copied below:


Objective: This study reports on the use of electroconvulsive therapy (ECT) in neuropsychiatric symptoms (NPS) associated with COVID-19.

Methods: A review of the literature pertaining to the use of ECT in COVID-19 patients with NPS was performed through PubMed, PsycINFO, and MEDLINE. Search terms included "Electroconvulsive Therapy" and "ECT," combined with "COVID-19" and "SARS-COV-2." Additionally, we present a case in which ECT was used to achieve complete remission in a patient who developed new onset, treatment-resistant depression, psychosis, and catatonia, associated with COVID-19.

Results: 67 articles were reviewed with 3 selected for inclusion. These articles detailed 3 case reports of patients with new onset NPS (mania, psychosis and suicidality, and catatonia) that developed in the context of active COVID-19 and were treated successfully with ECT.

Conclusions: There is a significant prevalence of new onset NPS, some severe and persistent, in COVID-19 patients. ECT, a broad-spectrum treatment that has been found to be effective in various NPS (independent of etiology), is shown in our case report and others, to be safe and effective for NPS associated with COVID-19. Though we identified only 3 other cases in the literature, we believe that the probable anti-inflammatory mechanism of ECT, its safety and tolerability, and the faster time to symptom remission support the need for more research and increased clinician awareness about this life-saving procedure.

Keywords: COVID-19; catatonia; electroconvulsive therapy; neuropsychiatric; psychiatric; psychosis.

The pdf is here.

This is a well-meaning case report and literature review. The authors present what is apparently only the fourth case of the use of ECT for neuropsychiatric symptoms (NPS) of COVID- hard to believe that there are so few, if NPS is really so common. The new case is less than convincing, because, as the authors note, steroid psychosis is another plausible explanation for the presentation. On a positive note the description of ECT as "a broad spectrum treatment" is marvelous. How much better to say "broad spectrum," like an antibiotic, than "nonspecific". Perhaps the field should embrace the powerful, broad spectrum nature of ECT, rather than always looking for more focal stimulation...
There is considerable discussion of catatonia and neuroinflammation here; followers of the catatonia literature well want to read this in full, ~10 minutes.

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