ECT-Resistant Catatonia: New Case Report and Literature Review in J Acad Consult Liaison Psychiatry

 Out on PubMed, from researchers in Pennsylvania, is this review:

ECT-resistant Catatonia: Case Report and Literature Review.

Hasoglu T, Francis A, Mormando C.J Acad Consult Liaison Psychiatry. 2022 Jul 13:S2667-2960(22)00295-6. doi: 10.1016/j.jaclp.2022.07.003. Online ahead of print.PMID: 35842127 Review.


The abstract is copied below:

Background: Untreated catatonia is associated with serious medical complications that can necessitate urgent medical attention1,2. Lorazepam and electroconvulsive therapy (ECT) are effective for catatonia across various psychiatric or medical diagnoses1,3. In rare cases, ECT fails to achieve full response in catatonic symptoms, particularly in patients with chronic catatonia or primary psychotic disorder4,5. Evidence on treating catatonia that does not respond to ECT is lacking.

Objectives: Conduct a literature review on treatment of ECT-resistant catatonia which is defined as reported lack of full response to ECT treatments. We present a case of a 52-year-old male with schizophrenia where catatonia did not respond to lorazepam and robust ECT but resolved after memantine titration.

Methods: A literature review was performed using Medline/PubMed with the following keywords: treatment-resistant, catatonia, electroconvulsive therapy. References in eligible articles and most recent systematic reviews on catatonia treatment were reviewed.

Results: Seventeen patients in twelve case reports were identified where the treatment of catatonia was described after failed ECT trials. Most had chronic catatonia and a diagnosis of schizophrenia. ECT parameters and ictal outcome measures were not consistently reported. Treatment modalities for ECT-resistant catatonia included amantadine, memantine, lorazepam augmentation to ECT, antiepileptic and antipsychotic medications such as aripiprazole and clozapine.

Conclusions: The literature review and new case suggest reconsideration of catatonia diagnosis, optimizing ECT treatments, cautious use of antipsychotics, consideration of lorazepam augmentation to ECT treatments and/or use of N-methyl-D-aspartate (NMDA) receptor antagonists.

Keywords: NMDA receptor antagonists; catatonia; electroconvulsive therapy; memantine; treatment resistant.

The article is here.

And from the text:



 This is a very well-presented case report and literature review. Most of you will know that this Francis A is THE Francis of the Bush-Francis Catatonia Rating Scale.
Catatonia typically responds very well to ECT, so resistant cases are rare. But no treatment is perfect and some patients will only respond to other treatments; in this case report, memantine.
To play devil's advocate: while I certainly agree that ECT treatments described in this case were "robust," they were certainly not maximized, either in terms of schedule or stimulus dosing. It is unlikely that the results would have been different, but just sayin'...
I recommend a full read of this excellent article to all ECT practitioners, ~15 minutes.



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