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Electroconvulsive Therapy in a Patient With Chronic Catatonia: Clinical Outcomes and Cerebral 18[F]Fludeoxyglucose Positron Emission Tomography Findings

Pigato, Giorgio MD; Roiter, Beatrice MD; Cecchin, Diego MD; Morbelli, Silvia MD, PhD; Tenconi, Elena PhD; Minelli, Alessandra PhD; Bortolomasi, Marco MD

doi: 10.1097/YCT.0000000000000333
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Abstract: Catatonia is a psychomotor syndrome that can be associated with both psychiatric diseases (mainly mood disorders, but also psychotic disorders) and medical conditions. Lorazepam (6-21 mg/day, occasionally up to 30 md/day) is the first choice treatment and electroconvulsive therapy (ECT) is the second line, regardless of the underlying clinical condition. There are some evidences also for effectiveness of other medications. Patients treated acutely usually show rapid and full therapeutic response but even longstanding catatonia can improve. However, some authors suggested that chronic catatonia in the context of schizophrenia is phenomenologically different and less responsive to lorazepam and ECT, especially if associated with echophenomena. We present here the case of a patient with longstanding catatonic schizophrenia treated with antipsychotics who significantly improved after ECT. Improvement regarded mainly catatonia, but also negative symptoms, cognition and psychosocial functioning. A slight amelioration in prefrontal metabolism (Brain18[F]FDG PET) one month following the ECT course was also noted.

From the *Section of Psychiatry, Department of Neurosciences; †Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua; ‡Nuclear Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa; §Department of Molecular and Translational Medicine, Biology and Genetic Division, University of Brescia, Brescia; and ∥Psychiatric Hospital “Villa S. Chiara”, Verona, Italy.

Received for publication January 21, 2016; accepted April 13, 2016.

Reprints: Beatrice Roiter, MD, Department of Neuroscience, University of Padua, Via Giustiniani 1, Padua, Italy (e-mail: beatrice.roiter@gmail.com).

The authors have no conflicts of interest or financial disclosures to report.

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