ECT in the treatment of a patient with catatonia: consent and complications

The American Journal of Psychiatry
Marc H Zisselman, Richard L Jaffe

Abstract

Acute catatonia in an adolescent or young adult can present complex clinical challenges. Prominent issues include those involving diagnosis, timely and effective treatment, and diminished capacity to provide consent. The authors describe a 19-year-old woman presenting initially with manic excitement followed by a lengthy period of mutism, immobility, and food and fluid refusal. Elevated temperature, an elevated creatine phosphokinase level, and autonomic dysfunction led to consideration of a malignant catatonic syndrome. The patient manifested rigidity accompanied by posturing and waxy flexibility. Neurologic, medical, and laboratory evaluations failed to identify an organic cause for the likely catatonia. Treatment with amantadine, bromocriptine, and lorazepam was unsuccessful. ECT was deemed appropriate but required emergency guardianship because of the patient's inability to provide consent. At the initial ECT session, the elicited seizure was followed by an episode of torsade de pointes requiring immediate cardioversion. In reviewing the ECT complication, it appeared that muscle damage due to catatonic immobility led to acute hyperkalemia with the administration of succinylcholine. Discussions were held with the patient's g...Continue Reading

Citations

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Methods Mentioned

BETA
pregnancy test
electrophoresis
pharmacotherapy

Related Concepts

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Catatonia

Catatonia is a psychomotor syndrome with motor and behavioral symptoms, and can occur in both patients with or without psychiatric illness. Discover the latest research on Catatonia here.

Catatonic Schizophrenia

Catatonia is a psychomotor symptom in which patients present with stupor, although catatonic excitement may also present at the other end of the spectrum. Catatonia has been historically associated with schizophrenia although it is also associated with other neuropsychiatric disorders. Find the latest research on catatonic schizophrenia here.

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