Copyright ©The Author(s) 2015.
World J Psychiatr. Jun 22, 2015; 5(2): 182-192
Published online Jun 22, 2015. doi: 10.5498/wjp.v5.i2.182
Table 1 Studies that investigate efficacy of electroconvulsive therapy in catatonia (number of patients receiving electroconvulsive therapy ≥ 10)
Ref.Sample(n)Patients receiving ECT n (%)DiagnosisDesignECT techniqueOutcomemeasuresResultsVariables associated with response
Unal et al[23], 20135757 (100)63% Mood disorders 29% psychotic disorders (including schizophrenia) 3.5% pts mental retardation 3.5% pts without psychiatric disordersRetrospective All pts. received ECT in combination with oral BZDsBL (bifrontal)CGI, HDRS, YMRS, PANSSResponse = 100%Not assessed
Tuerlings et al[64], 20103434 (100)59% mood disorders 77% schizophrenia and other psychotic disorders 37% somatic, toxic, post-traumatic stress disorder, mental retardationRetrospectiveNon specifiedNo standard diagnostic instruments or catatonia scales58% pts treated with BZDs and/or ECT had clinically complete remission. 50% pts treated with ECT after unsuccessful medication trials recovered completelyResponders: Autonomic dysregulation Non-responders: Initial treatment with amantadine, bromocriptina and dantrolene More comorbid disorders
Van Waarde et al[29], 20102727 (100)48% mood disorders 44% psychotic disorder (including schizophrenia) 19% others (alcohol/substance abuse, mental retardation)RetrospectiveBL (bifronto-temporal) or UL (according to d’Elia)Response defined as CGI ≤ 2Response = 59%Responders: Younger age Autonomic dysregulation at baseline (especially higher body temperature) Daily ECT during the first treatment week Longer duration of motor and EEG seizure activity at the final ECT session Less morbidity in the year after ECT
Ravvendranathan et al[22], 20126363 (100)41% mood disorders, 49% psychotic disorders (including schizophrenia) 6% idiopathic catatoniaRetrospectiveBL (bitemporal)Response = complete resolutions of symptoms and/or BFCRS = 0Response = 89%The Authors divide the responders in faster ( ≤ 4 sessions) and slower (≥ 5 sessions) Faster responders: Lower duration of catatonia Greater severity of BFCRS Lesser electrical charge used overall Shorter duration of inpatient stay Waxy flexibility and gegenhalten. Lower responders: echophenomena
England et al[26], 20112512 (48)Total sample: 36% bipolar disorder 32% pts with psychosis NOS 4% depressive episode and anxiety disorder 16% schizophrenia 8% without previous psychiatric historyRetrospectiveBLBFCRS, clinical evaluation83% pts treated with ECT definite beneficial effects > BZDs, APs, MS, ADsNot assessed
Hatta et al[27], 20075017 (34)Total sample: 34% mood disorders 46% schizophrenia and other psychotic disordes 20% medical conditionObservational study I step: BZDs or ECT II step: APs (RIS or HAL) or ECT III step: CPZ or ECT IV step: ECTBL (bitemporal)“Partial response”: disappearance of one or more catatonic symptoms; “complete response”: disappearance of all catatonic symptoms(Cumulative) ECT 100% > CPZ 68% > RIS 26% > HAL 16%Not assessed
Dutt et al[24], 20115142 (82)75% psychotic disorders (including schizophrenia) 14% mood disorders 8% organic brain syndromesRetrospectiveUnspecifiedReduction of BFCRS assesses the responseResponse = 100%Not assessed
Rohland et al[25], 19932222 (100)59% mood disorders 32% schizophrenia and schizoaffective disorder 9% organic mental disorderRetrospectiveBL (bitemporal)Response to ECT was assessed by not meeting Kahlbaum and Rosebush criteria for catatonia. Then, the number of single signs and symptoms prior and after ECT is another parameterResponse = 93%Trend toward a better response in affective than psychotic pts (non statistically significant)
Medda et al (manuscript in preparation)2626 (100)100% bipolar disorderObservationalBL (bitemporal)Response = CGI ≤ 2Response = 81%Non-responders: Older age at onset of mood disorders Lower number of mood episodes Higher BFCRS total score at baseline Less psychotic symptoms Higher rate of past treatment with anticholinergics and dopamine agonists and lower rate of past treatment with typical antipsychotics