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Brain-Behavior Relationship in a Case of Successful ECT for Drug Refractory Catatonic OCD

D’Urso, Giordano MD*; Mantovani, Antonio MD, PhD; Barbarulo, Anna Maria PhD; Labruna, Ludovica PhD§; Muscettola, Giovanni MD*∥

doi: 10.1097/YCT.0b013e3182542649
Case Reports

This case report describes the successful response to electroconvulsive therapy (ECT) in a patient with an unusual presentation of catatonia, whose onset occurred in the context of an extremely severe form of refractory obsessive-compulsive disorder (OCD). We correlated the clinical improvement in catatonic and OCD symptoms with specific changes in brain function as shown by regional cerebral blood flow scans, neurological soft signs examination, and neuropsychological testing. All assessments were conducted before and after the ECT course. The results strongly suggest that a right hemisphere dysfunction was the neural correlate of our patient’s symptoms, and that ECT, by reverting this abnormality, may serve as an effective therapeutic approach for refractory catatonic OCD.

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From the *Department of Neuroscience and Behavior, Functional Area of Psychiatry, Psychiatry, AOU “Federico II,” Naples, Italy; †Department of Psychiatry, Division of Experimental Therapeutics, Columbia University, New York, NY; ‡Department of Neurological Sciences, First Division of Neurology, Second University of Naples, Caserta, Italy; §Department of Psychology, University of California, Berkeley, CA; and ∥Department of Health Science, University of Molise, Campobasso, Italy.

Received for publication February 20, 2011; accepted March 5, 2012.

Reprints: Giordano D’Urso, MD, Department of Neuroscience and Behavior, Functional Area of Psychiatry, AOU “Federico II,” via Pansini n.5, Edificio 18, Piano Terra, 80131 Naples, Italy (e-mail:

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

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© 2012 by Lippincott Williams & Wilkins