Improvement of cognition in a patient with Cotard's delusions and frontotemporal atrophy receiving electroconvulsive therapy (ECT) for depression.
A 69-year-old man presented with Cotard's delusions, insomnia, profound depression, amnesia, difficulty concentrating, and cognitive deficit after two different surgical interventions. Brain imaging showed frontotemporal-subcortical atrophy and lateral ventricular enlargement. He responded poorly to a combination of sertraline, amisulpride and mirtazapine, with modest benefit on insomnia, and developed hypotension. After 18 days he was switched to olanzapine and venlafaxine, but his cognition worsened. He underwent bilateral electroconvulsive therapy (ECT). His mood improved, cognitive performance increased and anxiety symptoms remitted. This improvement persisted through the one-month post-discharge follow-up and depression eventually remitted.
Spedali Civili Brescia, Azienda Ospedaliera, Presidio Ospedaliero di Montichiari, Servizio Psichiatrico Diagnosi e Cura-Unità Operativa di Psichiatria N. 23, Brescia, Italy.
Giuseppe
G
Fàzzari
Oliviero
O
Benzoni
Alessio
A
Sangaletti
Francesca
F
Bonera
Stefano
S
Nassini
Lorenzo
L
Mazzarini
Isabella
I
Pacchiarotti
Gabriele
G
Sani
Alexia Emilia
AE
Koukopoulos
Livia
L
Sanna
Roberto
R
Gasparotti
Pietro
P
De Rossi
Simone
S
Lazanio
Valeria
V
Savoja
Paolo
P
Girardi
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003702:Delusions / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003704:Dementia / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000379:methods*; D007839:Functional Laterality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D013577:Syndrome; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents