Catatonia, HIV, Ketamine Induction For ECT: Case Report From South Africa

 Out on PubMed, from clinicians in South Africa, is this case report:

Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient.

Nel Y, Bracken CA.S Afr J Psychiatr. 2023 Jan 30;29:1944. doi: 10.4102/sajpsychiatry.v29i0.1944. eCollection 2023.PMID: 36756540 

The abstract is copied below:

Introduction: The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia.

Patient presentation: This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previous psychotherapeutic interventions.

Management and outcome: We describe the course of management of this patient with ECT, following poor initial clinical response to ECT with propofol induction, the subsequent use of ketamine as an anaesthetic induction agent for ECT, with associated improvement in seizure quality, and good overall clinical response to ECT demonstrated thereafter.

Conclusion and contributions: This case report suggests that ketamine may be a viable induction agent for ECT in this clinical setting.

Keywords: ECT; HIV; Ketamine; case report; catatonia.

The article is here.

And from the text:

I'm going to give this one a pass, as a well-intended addition to the ECT-for-catatonia literature. The ECT procedural details documented in the table above appear, let's just say, inconsistent. My conclusion is that ECT is so safe and effective that most techniques will work, as they did in this case.

Kudos to our South African colleagues for this contribution to the ECT literature.