title: Rapid Response of Long-Standing, Treatment-Resistant Non-Catatonic Mutism in Paranoid Schizophrenia with Single ECT session.
abstract: BACKGROUND
  Mutism is a common manifestation of catatonia, but mutism due to other forms of psychopathology and neurological disorders have also been described. Although not common, long-standing mutism has also been a feature of non-catatonic schizophrenia and traditionally responds less to conventional therapies.
  
  
  METHODS
  We describe a rare case of paranoid schizophrenia presenting with continuous mutism for about 4 years. This 26-year-old male had symptoms of schizophrenia without catatonia. After failed trial of adequate pharmacotherapy and psychological intervention and considering his level of dysfunction, he was started on electroconvulsive therapy (ECT). To our surprise, he improved with a single session of ECT while he was on concurrent pharmacotherapy. We also discuss the possible explanation for this rapid effect of ECT in such clinical presentation. To our knowledge, this is the first case of non-catatonic mutism of schizophrenia of this long duration responding so promptly to ECT, although there are other reports as well in literature, but multiple ECT sessions were applied in those cases.
  
  
  CONCLUSIONS
  Non-catatonic mutism is perhaps presenting as a cultural variant in this part of the world and whenever encountered, ECT should be an option. Further research should be carried out to validate this idea.
authors.affiliation: Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
authors.forename: Mansoor Ahmad
authors.initials: MA
authors.lastname: Dar
authors.affiliation: Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
authors.forename: Yasir Hassan
authors.initials: YH
authors.lastname: Rather
authors.affiliation: Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
authors.forename: Majid Shafi
authors.initials: MS
authors.lastname: Shah
authors.affiliation: Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
authors.forename: Rayees Ahmad
authors.initials: RA
authors.lastname: Wani
authors.affiliation: Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India.
authors.forename: Arshad
authors.initials: A
authors.lastname: Hussain
keywords: Electroconvulsive therapy; Mutism; Paranoid; Schizophrenia