1
|
Guhra M, Kreisel SH, Zilles-Wegner D, Sartorius A, Sappok T, Freundlieb N. [Electroconvulsive therapy in people with intellectual disability]. DER NERVENARZT 2024:10.1007/s00115-024-01713-6. [PMID: 39240313 DOI: 10.1007/s00115-024-01713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 09/07/2024]
Abstract
Electroconvulsive therapy (ECT) is a highly effective treatment option for severe mental illness. Although people with intellectual disability (ID) have similar prevalence rates of mental disorders in comparison to the general population their access to ECT remains challenging. A systematic literature review was carried out on treatment with ECT in patients with ID and a case report on a patient with ID who underwent ECT is presented, to highlight a typical clinical routine. A total of 100 articles with 208 different case reports were retrieved. In summary, the results underline the effectiveness of ECT in people with ID, with side effects comparable to those in the general population. The ECT is effective in the treatment of severe affective and psychotic disorders and particularly in people with catatonia. The use of ECT can improve the patient's mental health and quality of life and is often a life-saving treatment option. The prophylaxis of relapses should be included as early as possible in the planning process. Providing an easy access to ECT treatment for people with ID is corroborated by its effectiveness and is in line with the right to equal treatment in accordance with article 25 of the United Nations Convention on the Rights of Persons with Disabilities.
Collapse
Affiliation(s)
- M Guhra
- Medizinische Fakultät und Universitätsklinikum OWL, Evangelisches Klinikum Bethel, Universitätsklinik für Psychiatrie und Psychotherapie, Abt. für Gerontopsychiatrie, Universität Bielefeld, Bielefeld, Deutschland.
| | - S H Kreisel
- Medizinische Fakultät und Universitätsklinikum OWL, Evangelisches Klinikum Bethel, Universitätsklinik für Psychiatrie und Psychotherapie, Abt. für Gerontopsychiatrie, Universität Bielefeld, Bielefeld, Deutschland
| | - D Zilles-Wegner
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - A Sartorius
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim/Universität Heidelberg, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - T Sappok
- Medizinische Fakultät und Universitätsklinikum OWL, Krankenhaus Mara, Universitätsklinik für Inklusive Medizin, Universität Bielefeld, Bielefeld, Deutschland
| | - N Freundlieb
- MZEB Berlin-Nord der GIB-Stiftung, Berlin, Deutschland, Germanenstr. 33, 13156.
| |
Collapse
|
2
|
Valerstain D, Zaydlin M, Bez Y, Coffey BJ. Clonazepam Treatment of Adolescent Catatonia in A Setting of Lorazepam-Related Hypotension. J Child Adolesc Psychopharmacol 2023; 33:34-37. [PMID: 36799960 DOI: 10.1089/cap.2022.29233.bjc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Dennis Valerstain
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| | - Michelle Zaydlin
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| | - Yasin Bez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| |
Collapse
|
3
|
Catatonia with Psychosis in an 8-Year-Old Child: A Case Report and a Literature Review. Case Rep Psychiatry 2022; 2022:4124733. [PMID: 35371578 PMCID: PMC8975680 DOI: 10.1155/2022/4124733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objective We present a narrative review of pediatric catatonia and a case report illustrating the complexity of management of psychosis in a child with catatonia. Method The literature search used the text terms pediatric, catatonia, and antipsychotics and the search engines PubMed and EBSCO. All references from peer-reviewed journals were reviewed for treatment strategies specific to management in children who are also psychotic. Findings. This 8-year-old girl presented with psychotic symptoms which were initially treated with antipsychotics and evolved into life-threatening catatonia that was eventually stabilized with a total daily dose of 46 mg of lorazepam. Lower doses led to recurrence. Once catatonia improved, she tolerated combined benzodiazepine and antipsychotic treatment. Long-term maintenance over 5 years required maintenance treatment with both benzodiazepines and antipsychotics to prevent relapse. Conclusions The extraordinary doses of benzodiazepines found to be optimal for management of catatonia in this child led to improved alertness and orientation, without evident sedation. Catatonia did not recur with later management of psychosis using neuroleptics when added to lorazepam. The current literature on pediatric catatonia does not provide guidance on dose maintenance or when and if to rechallenge with antipsychotics.
Collapse
|
4
|
Wachtel LE. Far From an Elective Procedure: Electroconvulsive Therapy and Autism in the Era of COVID-19. J ECT 2021; 37:10-12. [PMID: 32826708 PMCID: PMC7889038 DOI: 10.1097/yct.0000000000000720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
|
5
|
Stein ALS, Sacks SM, Roth JR, Habis M, Saltz SB, Chen C. Anesthetic Management During Electroconvulsive Therapy in Children. Anesth Analg 2020; 130:126-140. [DOI: 10.1213/ane.0000000000004337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
Wachtel LE. The multiple faces of catatonia in autism spectrum disorders: descriptive clinical experience of 22 patients over 12 years. Eur Child Adolesc Psychiatry 2019; 28:471-480. [PMID: 30069655 DOI: 10.1007/s00787-018-1210-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/24/2018] [Indexed: 01/25/2023]
Abstract
A retrospective review was conducted from the inpatient and outpatient records of twenty-two autistic youth presenting to a neurobehavioral service over a twelve-year period for combined psychiatric and behavioral pathology who also met DSM5 criteria for catatonia. Six autistic girls and 16 autistic boys ranging from ages eight to 26 years old were identified, and their variegated symptoms evaluated. Stereotypy, posturing, negativism, mutism and stupor were the most common catatonic symptoms, each present in more than half of the study patients. One patient had abnormal vital signs indicative of malignant catatonia. Twenty patients had concomitant repetitive self-injurious behaviors that had led to significant tissue injury and were refractory to psychotropic and behavioral interventions. The sample was weighted towards patients with severe self-injurious behavior, which often was the reason for admission. The many "faces" of catatonia in autism spectrum disorders are seen in this sample, and the novel recognition of repetitive self-injury as an under-recognized motor symptom of catatonia is highlighted. The preliminary findings in this study open many important future vistas for ongoing research regarding catatonia in ASDs.
Collapse
|
7
|
Abstract
OBJECTIVE To review the treatment courses of 22 autistic patients diagnosed with catatonia over a 12-year period, including treatment with benzodiazepines and electroconvulsive therapy. METHOD Retrospective review of inpatient and outpatient records of 22 autistic youth presenting to a neurobehavioral service who were treated for catatonia. RESULTS Six girls and 16 boys ranging from ages 8 to 26 years old presenting for neurobehavioral assessment were found to meet criteria for catatonia according to the DSM5 and were treated for such. All but one patient was initially unsuccessfully treated with benzodiazepines in dosages ranging from 1 to 27 mg daily, and all patients underwent electroconvulsive therapy. Mean age of ECT start was 15.6 years old, and the total number of ECT received ranged from 16 to 688, with 13 patients still receiving maintenance ECT at the end of the study period. ECT conferred prominent patient benefit in terms of catatonic symptom reduction, including alleviation of incapacitating, treatment-resistant self-injury. CONCLUSION Myriad symptoms of catatonia were seen in this sample of 22 autistic youth. Implementation of anti-catatonic paradigms, particularly electroconvulsive therapy, conferred vast patient benefit.
Collapse
Affiliation(s)
- L E Wachtel
- Kennedy Krieger Institute, Baltimore, MD, USA
| |
Collapse
|
8
|
Abstract
An increasing number of case reports and series document the safe and effective use of electroconvulsive therapy (ECT) in children, adolescents, and young adults with autism spectrum disorder who engage in severe, intractable, repetitive self-injurious behavior (SIB) without environmental or operant function. Although the treatment is very effective for such patients, they typically remain highly dependent on frequent maintenance ECT (M-ECT) to maintain suppression of the SIB achieved during the acute course. Some patients receive M-ECT as frequently as once every 5 days. Such a regimen is quite burdensome for the patient and the patient's family, and the long-term effects of such regimens, starting as early as childhood, are unknown. In this review, we explore the expanding literature supporting the use of ECT for suppressing severe SIB associated with autism spectrum disorder. We also focus on the possible development of alternate nonconvulsive focal forms of brain stimulation, which might replace frequent M-ECT or reduce how frequently a patient needs to receive it. Although there are scarce clinical data currently available supporting these latter treatments, future studies are clearly indicated.
Collapse
|
9
|
Advances in the Application of Electroconvulsive Therapy. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Kakooza-Mwesige A, Dhossche DM, Idro R, Akena D, Nalugya J, Opar BT. Catatonia in Ugandan children with nodding syndrome and effects of treatment with lorazepam: a pilot study. BMC Res Notes 2015; 8:825. [PMID: 26710961 PMCID: PMC4693437 DOI: 10.1186/s13104-015-1805-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 12/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Nodding syndrome (NS) is a severe neuropsychiatric syndrome of an unknown etiology affecting children and adolescents mostly in Eastern Africa. Symptoms of NS and catatonia seem to overlap. We investigated the presence and types of catatonic symptoms in NS and their response to one or two doses of lorazepam, the first-line treatment for catatonia. Methods A cross-sectional descriptive study with systematic assessment of catatonia in 33 patients with NS using a modified version of the Bush Francis Catatonia Rating Scale. Sixteen patients met criteria for catatonia and were observed in an open and uncontrolled study to examine the effects of one or two doses of lorazepam in them. Results Sixteen of 33 patients with NS had an average of 5 catatonia symptoms and met criteria for catatonia. The highest scores were found for mutism, staring, poor eating/drinking, stupor, and grimacing. Excitement, rigidity, negativism and impulsivity had lower scores. None of the children had echolalia or echopraxia. In 6 children, there was a reduction of more than 50 % in catatonia ratings, representing a positive response to lorazepam. Three out of six children whose catatonia ratings did not change after the first dose, responded after administration of a second double dose. There were no unusual or critical side-effects. Conclusions About half of a selected sample of children with NS met criteria for catatonia. Catatonia scores decreased in most patients after one or two doses of lorazepam. Larger, longer, and controlled studies are warranted to assess the prevalence of catatonia in NS and to assess the use of lorazepam in NS through its effects on catatonia. Trial Registration: ClinicalTrials.gov NCT02462109 Date of formal registration: June 2, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1805-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. .,Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | - Dirk M Dhossche
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Richard Idro
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. .,Nuffield Department of Medicine, Centre for Global Health and Tropical Medicine, University of Oxford, Oxford, UK.
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Joyce Nalugya
- Department of Psychiatry, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | | |
Collapse
|
11
|
Abstract
There is lot of skepticism about the use of electroconvulsive therapy (ECT) in children and adolescents. However, available literature suggests that use of ECT can be at times life-saving in adolescents, especially those presenting with severe catatonia. We treated a 16-year-old female who presented to us with catatonia with a course of nine ECTs, with which she showed marked improvement. Review of the literature suggests that ECT should be considered as the second line treatment in the management of catatonia in adolescents.
Collapse
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Natasha Kate
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Gupta
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
12
|
Gahr M, Schönfeldt-Lecuona C, Kölle MA, Pfenninger E, Freudenmann RW. Electroconvulsive therapy in patients with diagnoses other than major depression and/or difficult characteristics: a combined psychiatric-anesthesiological approach based on a retrospective chart analysis. Psychiatry Res 2013; 210:159-65. [PMID: 23602135 DOI: 10.1016/j.psychres.2013.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 11/25/2022]
Abstract
Though electroconvulsive therapy (ECT) requires a close cooperation between anesthesiology and psychiatry, literature lacks of approaches that consider both disciplines in parallel. Special problems might be posed by patients with complicated features or ECT-indications other than treatment-refractory depression (TRD). Considering these patients there is a particular paucity of data, especially regarding anesthesiological aspects. Therefore, we sought (1) to discuss special issues of the peri-interventional management of non-TRD-cases from a combined psychiatric-anesthesiological point of view and (2) to assess the efficacy of ECT in the classical indication of TRD as compared to cases undergoing ECT for other indications or under difficult conditions (non-TRD) by means of Clinical Global Impression-Improvement (CGI-I) scale scores. A retrospective chart analysis of patients treated with ECT between the years 2009 and 2011 at the University of Ulm, Department of Psychiatry, was conducted. Special anesthesiological efforts were necessary in cohort non-TRD. There was no difference in the clinical outcome between cohort non-TRD (n=7) and TRD (n=22) with a median CGI-I score of 2 ("much improved") in both groups. Close cooperation between psychiatry and anesthesiology is indispensable in non-TRD patients. Our results provide preliminary evidence that ECT is equally effective in the standard indication of TRD compared to other indications.
Collapse
Affiliation(s)
- Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
| | | | | | | | | |
Collapse
|
13
|
Goetz M, Kitzlerova E, Hrdlicka M, Dhossche D. Combined use of electroconvulsive therapy and amantadine in adolescent catatonia precipitated by cyber-bullying. J Child Adolesc Psychopharmacol 2013; 23:228-31. [PMID: 23607413 DOI: 10.1089/cap.2012.0045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Michal Goetz
- Charles University in Prague, 2nd Faculty of Medicine, Department of Child and Adolescent Psychiatry, University Hospital Motol, Prague, Czech Republic
| | - Eva Kitzlerova
- Charles University in Prague 1st Faculty of Medicine, Department of Psychiatry, General Teaching Hospital Prague, Prague, Czech Republic
| | - Michal Hrdlicka
- Charles University in Prague, 2nd Faculty of Medicine, Department of Child and Adolescent Psychiatry, University Hospital Motol, Prague, Czech Republic
| | - Dirk Dhossche
- Department of Psychiatry, University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, Medical director of Child Psychiatry, Jackson, Mississippi
| |
Collapse
|
14
|
Abstract
OBJECTIVE Catatonia, a disorder of movement and mood, was described and named in 1874. Other observers quickly made the same recognition. By the turn of the century, however, catatonia was incorporated as a type within a conjured syndrome of schizophrenia. There, catatonia has lain in the psychiatric classification for more than a century. METHOD We review the history of catatonia and its present status. In the 1970s, the tie was questioned when catatonia was recognized among those with mood disorders. The recognition of catatonia within the neuroleptic malignant syndrome offered effective treatments of high doses of benzodiazepines and electroconvulsive therapy (ECT), again questioning the tie. A verifying test for catatonia (the lorazepam sedation test) was developed. Soon the syndromes of delirious mania, toxic serotonin syndrome, and the repetitive behaviors in adolescents with autism were recognized as treatable variations of catatonia. RESULTS Ongoing studies now recognize catatonia among patients labeled as suffering from the Gilles de la Tourette's syndrome, anti-NMDAR encephalitis, obsessive-compulsive disease, and various mutisms. CONCLUSION Applying the treatments for catatonia to patients with these syndromes offers opportunities for clinical relief. Catatonia is a recognizable and effectively treatable neuropsychiatric syndrome. It has many faces. It warrants recognition outside schizophrenia in the psychiatric disease classification.
Collapse
Affiliation(s)
- Max Fink
- Department of Psychiatry and Neurology Emeritus, Stony Brook University, Long Island, NY, USA.
| |
Collapse
|
15
|
Wachtel LE, Dhossche DM, Reti IM, Hughes-Wheatland R. Stability of intellectual functioning during maintenance electroconvulsive therapy. Pediatr Neurol 2012; 47:219-21. [PMID: 22883291 DOI: 10.1016/j.pediatrneurol.2012.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/17/2012] [Indexed: 11/30/2022]
Abstract
We describe the stability of neuropsychologic testing in a 16-year-old boy with cerebellar dysgenesis who received 61 acute and maintenance electroconvulsive therapy treatments for malignant catatonia. Measures of nonverbal intelligence and visual memory before treatment onset and after 61 electroconvulsive therapy treatments indicated no evidence of decline in intellectual functioning and acute or delayed memory. This case offers further support for the safety and efficacy of maintenance electroconvulsive therapy in both pediatric and developmentally disabled populations.
Collapse
Affiliation(s)
- Lee E Wachtel
- Department of Psychiatry, Kennedy Krieger Institute, Johns Hopkins School of Medicine, 707 North Broadway Street, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|