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Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.
World J Psychiatry. 2015 Jun 22; 5(2):182-92.WJ

Abstract

Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelopmental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy (ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other brain stimulation techniques.

Authors+Show Affiliations

Federica Luchini, Pierpaolo Medda, Michela Giorgi Mariani, Mauro Mauri, Cristina Toni, Giulio Perugi, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, 56100 Pisa, Italy.Federica Luchini, Pierpaolo Medda, Michela Giorgi Mariani, Mauro Mauri, Cristina Toni, Giulio Perugi, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, 56100 Pisa, Italy.Federica Luchini, Pierpaolo Medda, Michela Giorgi Mariani, Mauro Mauri, Cristina Toni, Giulio Perugi, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, 56100 Pisa, Italy.Federica Luchini, Pierpaolo Medda, Michela Giorgi Mariani, Mauro Mauri, Cristina Toni, Giulio Perugi, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, 56100 Pisa, Italy.Federica Luchini, Pierpaolo Medda, Michela Giorgi Mariani, Mauro Mauri, Cristina Toni, Giulio Perugi, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, 56100 Pisa, Italy.Federica Luchini, Pierpaolo Medda, Michela Giorgi Mariani, Mauro Mauri, Cristina Toni, Giulio Perugi, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, 56100 Pisa, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26110120

Citation

Luchini, Federica, et al. "Electroconvulsive Therapy in Catatonic Patients: Efficacy and Predictors of Response." World Journal of Psychiatry, vol. 5, no. 2, 2015, pp. 182-92.
Luchini F, Medda P, Mariani MG, et al. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. World J Psychiatry. 2015;5(2):182-92.
Luchini, F., Medda, P., Mariani, M. G., Mauri, M., Toni, C., & Perugi, G. (2015). Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. World Journal of Psychiatry, 5(2), 182-92. https://doi.org/10.5498/wjp.v5.i2.182
Luchini F, et al. Electroconvulsive Therapy in Catatonic Patients: Efficacy and Predictors of Response. World J Psychiatry. 2015 Jun 22;5(2):182-92. PubMed PMID: 26110120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. AU - Luchini,Federica, AU - Medda,Pierpaolo, AU - Mariani,Michela Giorgi, AU - Mauri,Mauro, AU - Toni,Cristina, AU - Perugi,Giulio, PY - 2014/09/26/received PY - 2015/02/12/revised PY - 2015/03/05/accepted PY - 2015/6/26/entrez PY - 2015/6/26/pubmed PY - 2015/6/26/medline KW - Antipsychotics KW - Benzodiazepines KW - Catatonia KW - Electroconvulsive therapy KW - Mood disorders KW - Schizophrenia SP - 182 EP - 92 JF - World journal of psychiatry JO - World J Psychiatry VL - 5 IS - 2 N2 - Recent evidence favors the view of catatonia as an autonomous syndrome, frequently associated with mood disorders, but also observed in neurological, neurodevelopmental, physical and toxic conditions. From our systematic literature review, electroconvulsive therapy (ECT) results effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient's medical condition. Little is known about the long-term treatment outcomes following administration of ECT for catatonia. The presence of a concomitant chronic neurologic disease or extrapyramidal deficit seems to be related to ECT non-response. On the contrary, the presence of acute, severe and psychotic mood disorder is associated with good response. Severe psychotic features in responders may be related with a prominent GABAergic mediated deficit in orbitofrontal cortex, whereas non-responders may be characterized by a prevalent dopaminergic mediated extrapyramidal deficit. These observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, in which an extrapyramidal dysregulation may be prevalent. Future research should focus on ECT response in different subtype of catatonia and on efficacy of maintenance ECT in long-term prevention of recurrent catatonia. Further research on mechanism of action of ECT in catatonia may also contribute to the development of other brain stimulation techniques. SN - 2220-3206 UR - https://www.unboundmedicine.com/medline/citation/26110120/Electroconvulsive_therapy_in_catatonic_patients:_Efficacy_and_predictors_of_response_ L2 - http://www.wjgnet.com/2220-3206/full/v5/i2/182.htm DB - PRIME DP - Unbound Medicine ER -
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