Electroconvulsive therapy in a case of catatonia with severe somatic complications

Background Catatonia is a neuropsychiatric syndrome that may occur in as- sociation with mental, neurological and medical disorders. A delay in diagnosis and treatment of catatonic symptoms is re- lated to a high risk of medical complications such as dehydra- tion, malnutrition, pressure ulcers, thrombotic events, aspiration pneumonia and infections. Objectives The authors present the case of a bipolar patient, admitted to the Psychiatric Clinic of the Azienda Ospedaliero-Universitaria Pis- ana for catatonic syndrome, complicated by weight loss, deep vein thrombosis (DVT), pressure ulcers and systemic infection. Results Supportive therapy, including hydration, electrolytic restoration and antibiotics was adopted to stabilize the patient’s general conditions. Treatment with low molecular weight heparin was given for DVT and to prevent pulmonary embolism. Catatonic symptoms were initially treated with intravenous administration of delorazepam, with some improvement in catalepsy and waxy flexibility. As treatment with benzodiazepines was not complete- ly effective, electroconvulsive therapy (ECT) was used in combi- nation with delorazepam, which led to progressive resolution of catatonic symptoms. Conclusions The existence of medical complications requires a multidiscipli- nary therapeutic strategy, with the intervention of different spe- cialists. Our experience confirms the efficacy and safety of ECT in catatonia, even in the presence of serious complications such as DVT. In these cases, combination of ECT and benzodiazepines should be considered elective treatment to achieve quick resolu- tion of symptoms and reduce morbidity and mortality