EPA-0596 – Catatonia and Electroconvulsive Therapy: are there Patients that Need a Higher Number of Sessions?

Abstract

Introduction:

The underlying diagnoses in catatonic patients can be affective disorder, schizophrenia, schizoaffective disorder and a range of medical/neurological illnesses. Benzodiazepine and 6 to 12 sessions of electroconvulsive therapy (ECT) have been considered the first-line treatments for almost all types of catatonia.

Objectives:

To discuss when ECT should be started, its risks and lateral effects, pointing the maximum number of sessions and if there are patients that need a higher number of ECT than what is referred in literature.

Methods:

A revision about catatonia etiology, diagnosis and treatment was done, based on two clinical cases.

Results:

The number of ECTs recommend in literature is 6 to 12, and although there isn’t a maximum number defined, the treatment should be reconsidered if there isn’t response after 6 sessions. The lateral effects of higher ECT number are not known to differ with ECT number. We present a case of a 63 years old woman with major depressive and catatonia whose symptoms only resolved after the 21 ECT, with a previous psychotic depression treated with 17 ECT. The second case is a 60 years old woman with the diagnosis of paranoid schizophrenia with catatonic symptoms that only recovered after 17 ECT. In both patients, the clinical improvements where noticed only after a higher number of sessions.

Conclusion:

The maximum ECT number should be adapted to each patient and the clinical response obtained, always considering the possibility of exceeding the numbers recommended in literature.