Clinical features and predictors of non-response in severe catatonic patients treated with electroconvulsive therapy

Tripodi, Beniamino; Barbuti, Margherita; Novi, Martina; Salarpi, Gianluca; Fazzari, Giuseppe; Medda, Pierpaolo; Perugi, Giulio

doi:10.1080/13651501.2021.1951294

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…The impressive effectiveness of ECT in the treatment of catatonia, with a response rate of 95%, parallels previous reports 13 16 17 21 22 23 26 . One catatonia study reported lower response rates to ECT at 59% 25 .…”

Section: Discussionsupporting

confidence: 89%

“…The strength of the study is its sample, which includes a large proportion of severely ill patients with catatonia and schizophrenia (90 %) as the underlying mental disorder. Most recent studies examining the effectiveness of ECT included mixed samples with patients with unipolar or bipolar depression and only a small proportion of patients with schizophrenia [11,26,50]. The patients in our sample were well-characterized and received multiple sessions of ECT.…”

Section: Discussionmentioning

confidence: 99%

“…In general, predictors of poor or slow ECT response have been equivocal. Chronicity, non-affective catatonia, and the presence of echophenomena seem to indicate poor response, while other signs, such as waxy flexibility, have been found in patients with fast or slow responses [16,23,26].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Electroconvulsive Therapy on Specific Catatonia Symptoms and Predictors of Late Response

Bracht,

Walther,

Breit

et al. 2023

Pharmacopsychiatry

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Introduction Electroconvulsive therapy (ECT) is known to be effective in the treatment of catatonia, reaching response rates of about 80 to 100%. It is indicated in cases of treatment resistance to benzodiazepines and in life-threatening conditions such as malignant catatonia. Beneficial effects on specific symptoms or predictors of response are less clear. The objective of this retrospective study is to examine the ECT effect on specific catatonia symptoms in the acute phase of the illness and to identify predictors of response. Methods A retrospective study examined data from 20 patients with catatonia, 18 associated with schizophrenia and 2 with bipolar disorder, who underwent ECT from 2008 to 2021. Ten subjects had more than one ECT-series, resulting in a total of 31 ECT-series. Catatonia symptom severity was assessed with the Bush Francis Catatonia Rating Scale (BFCRS). Results ECT yielded excellent response. Nineteen of 20 patients and 30 of 31 ECT-series achieved response. The mean number of ECT sessions to response was 4.2. Response to ECT was more pronounced for motor inhibition symptoms such as stupor and mutism, while echophenomena, dyskinesia, stereotypy and perseveration responded less well. A predictor of late response was the presence of grasp reflex. Discussion The present study corroborates the high and rapid effectiveness of ECT in the treatment of catatonia. Focus on single catatonia signs may help to identify those who are most likely to achieve remission quickly, as well as those who might need longer ECT-series.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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The Effect of Electroconvulsive Therapy on Specific Catatonia Symptoms and Predictors of Late Response

Bracht,

Walther,

Breit

et al. 2023

Pharmacopsychiatry

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“…The presence of at least two symptoms on this scale allows the hypothesis of catatonia to be made [9]. A total score above 30 indicates severe symptomatology, as confirmed by studies or other observations [20,21].…”

Section: Discussionmentioning

confidence: 95%

A Case of Delirious Mania Treated with Electroconvulsive Therapy

Tripodi

Carbone

Matarese

et al. 2023

Life

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(1) Background: Delirious mania is a neuropsychiatric condition characterized by the rapid onset of delirium, psychosis, and mania. Due to the presence of catatonic signs and symptoms, some authors considered this syndrome to be a specific excited catatonia subtype. Usually, delirious mania is responsive to intravenous benzodiazepines (BZDs) or to electroconvulsive therapy (ECT). (2) Methods: In the present study, we describe the case of a 64-year-old woman with a diagnosis of recurrent major depressive disorder. We assessed the severity of the clinical picture and the response to ECT treatment with the Bush–Francis Catatonia Rating Scale (BFCRS). (3) Results: After eleven sessions of ECT, the patient presented a reduced BFCRS total score, with a resolution of the autonomic abnormalities (temperature, respiratory, and heart rate). (4) Conclusions: These data demonstrate how important it is to diagnose this syndrome as soon as possible to set up an effective therapy, avoiding the use of antipsychotic drugs and preventing potentially fatal complications. The initial administration of BZDs IV and the subsequent ECT application, associated with intensive care of life-threatening general medical conditions, guaranteed us a good level of efficacy in obtaining a complete resolution of the clinical picture.

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“…Since Leroy et al’s review, four additional studies of ECT with pre/post-quantitative outcomes have been published ( Perugi et al, 2017 ; Pierson et al., 2021 ; Tor et al, 2021 ; Tripodi et al, 2021 ). All were naturalistic case series or retrospective analyses, using Clinical Global Impression (CGI) or BFCRS quantitative outcomes.…”

Section: Treatmentmentioning

confidence: 99%

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

et al. 2023

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The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

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Clinical features and predictors of non-response in severe catatonic patients treated with electroconvulsive therapy

Cited by 5 publications

References 38 publications

The Effect of Electroconvulsive Therapy on Specific Catatonia Symptoms and Predictors of Late Response

The Effect of Electroconvulsive Therapy on Specific Catatonia Symptoms and Predictors of Late Response

A Case of Delirious Mania Treated with Electroconvulsive Therapy

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

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