title: Electroconvulsive therapy for catatonia: treatment characteristics and outcomes in 27 patients.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) has been described as an effective treatment option for catatonia in retrospective case series. We aimed to investigate treatment characteristics and outcomes of patients with catatonia who were treated with ECT.
  
  
  METHODS
  The medical records of 27 patients with catatonia treated with ECT (between 1991 and 2009) were scrutinized for clinical and treatment characteristics. Outcomes were measured using the Clinical Global Impression-Improvement (CGI-I) scale. Patients who improved (defined as CGI-I score "very much" or "much improved") were compared with those who did not improve (defined as a CGI-I score "no change" or "very much worse").
  
  
  RESULTS
  Mean age of all patients was 49 ± 19 years, of whom 15 (56%) were women. Of all patients, 13 (48%) had a diagnosis of a mood disorder and 12 (44%) of a psychotic disorder. Electroconvulsive therapy was mostly started after ineffective pharmacotherapy (n=23; 85%) within 2 to 3 months after catatonia had been diagnosed. In total, 16 (59%) patients improved. Improvement was significantly associated with younger age (P=0.05), presence of autonomic dysregulation at baseline (P=0.02), especially higher body temperature (P=0.02), daily ECT during the first treatment week (n=15 [56%]; P=0.03), longer duration of electroencephalogram seizure activity at last ECT session (P=0.04), and less morbidity in the year after ECT (P=0.03). Three of 11 nonimproved patients died in the year after ECT compared with none of the improved patients.
  
  
  CONCLUSIONS
  Most of our patients with catatonia benefited from ECT, especially younger patients with autonomic dysregulation. Daily administration of ECT may be more effective, whereas longer duration of seizure activity at the final ECT session was related to better response to ECT.
authors.affiliation: Alysis Zorggroep, Ziekenhuis Rijnstate, Arnhem, the Netherlands. jvanwaarde@alysis.nl
authors.forename: Jeroen A
authors.initials: JA
authors.lastname: van Waarde
authors.forename: Joep H A M
authors.initials: JH
authors.lastname: Tuerlings
authors.forename: Bastiaan
authors.initials: B
authors.lastname: Verwey
authors.forename: Rose C
authors.initials: RC
authors.lastname: van der Mast
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000628:therapy; D002389:Catatonia / Q000523:psychology / Q000628:therapy*; D016292:Procedural Sedation; D004565:Electroconvulsive Therapy; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult