Delirious Mania, Pregnant, COVID-Positive, Successful ECT: Case Report From India

 Out on PubMed, from clinicians in New Delhi, India, is this LTE case report:

Effectiveness of electroconvulsive therapy in acute management of delirious mania in COVID-19 positive woman in second trimester pregnancy.

Bhasin A, Saini R, Verma R, Rajkumar TS, Singh A, Singh AK, Tousifullah M.Asian J Psychiatr. 2022 Aug 9;76:103230. doi: 10.1016/j.ajp.2022.103230. Online ahead of print.PMID: 35994926

The abstract is copied below:

Delirious mania has been described as a state of acute excitement, fluctuating sensorium, affective and catatonic symptoms. Electroconvulsive therapy (ECT) despite being an effective treatment modality in such cases, has been under-utilised during pregnancy, mainly due to safety concerns. Here, we report the effectiveness of ECT in acute management of delirious mania in a 24 weeks pregnant woman who also tested COVID-19 positive during hospitalisation. Patient presented with three weeks history of acute manic excitement with period of altered sensorium and catatonic symptoms with no response to trials of two antipsychotic agents. After organic causes ruled out, patient was planned for ECT while ongoing antipsychotic was continued. After the first ECT session, patient tested positive for COVID-19, though asymptomatic and had to be shifted to COVID-19 isolation facility. Complete resolution of psychiatric symptoms occurred after fifth ECT. All five ECT sessions, including those in COVID-19 isolation facility were carried out under supervision of a multidisciplinary team. None of the ECT sessions had any major adverse event. Symptom remission sustained even following ECT discontinuation. No neonatal or maternal adverse effects observed after an uneventful delivery at 35 weeks. Both mother and child continued to maintain well in follow-up period of one year on oral olanzapine. In this unusual concurrent presentation of mania, delirium and catatonic symptoms during second trimester pregnancy, we highlighted the effectiveness and safety of ECT as a viable treatment modality. Additionally, management challenges posed by patient testing COVID-19 positive and then, administering ECT in COVID-19 isolation facility using personal protective equipment by multidisciplinary team has been highlighted.

Keywords: COVID-19; Catatonic excitement; Delirious mania; ECT in Pregnancy.

The LTE is here.

And here:




ECT to the rescue! Here we have a desperately psychiatrically ill, pregnant woman with COVID, quickly and effectively treated with ECT. A multidisciplinary team guided sophisticated medical management for the procedures that resulted in a good outcome for mother and baby.
Kudos to these authors for adding to the evidence bases of ECT in delirious mania, pregnancy and COVID!
 

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