Although the data are limited, they suggest that ECT is relatively safe when administered during the first trimester of pregnancy. The possible adverse consequences of ECT during the first trimester of pregnancy should be carefully weighed against the potential benefits of ECT on untreated mental illness.

Objective: To inform obstetricians and psychiatrists about the safety of electroconvulsive therapy (ECT) administration during pregnancy and to reconcile conflicting recommendations concerning this treatment. Methods: A systematically conducted overview was undertaken on the safety of ECT during pregnancy. The Cochrane Library, MEDLINE/ PubMed, PsycINFO, and Ovid were independently searched by 2 of the authors from January 2015 to March 2017 using the following search terms: electroconvulsive therapy, ECT, and electroshock combined with pregnancy and reviews. Articles were reviewed and critically appraised using components of the PRISMA and AMSTAR systematic review assessment tools. Results: Of the 9 articles that were identified, 5 publications of varying methodological quality met inclusion criteria and involved a range of 32 to 339 patients. The most common problems that occurred in association with ECT were fetal arrhythmia, fetal bradycardia, premature birth, developmental delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption, and threatened abortion. The number of fetal deaths in each of the reviews ranged from 2 to 12. The authors of 1 of the 5 reviews recommended that ECT only be used as a last resort, whereas the authors of the other reviews took the stance that the administration of ECT during pregnancy was relatively safe. Differences in recommendations among reviews were in part due to inclusion criteria and how adverse events were attributed to ECT. Conclusions: Our overview supports the conclusion, which has also been endorsed by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, that administration of ECT during pregnancy is relatively safe. Conclusions about safety, however, will become better established with the availability of more data.

Catatonia is a neuropsychiatric syndrome that can mimic or accompany a variety of psychiatric and medical conditions. An etiology is often elusive, especially when patients present with a history with multiple confounding features. Workup for rapidly progressive illnesses such as N-methyl-D-aspartate receptor (NMDAR) encephalitis can involve multiple laboratory tests and brain imaging, such as [ 18 F]fluorodeoxyglucosepositron emission tomography (FDG-PET). However, some catatonic behaviors may confound FDG-PET results and delay appropriate treatment. This case highlights the diagnostic and therapeutic challenges in catatonia and the potential danger of overreliance on imaging before proceeding with symptomatic treatment.

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