title: Efficacy and safety of electroconvulsive therapy in the first trimester of pregnancy: a case of severe manic catatonia.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) is an appropriate, albeit often neglected, option for managing severe or life-threatening psychiatric symptoms during pregnancy. We report on the rapid effectiveness and safety of ECT during the first trimester of pregnancy in a 28-year-old woman with severe catatonia.
  
  
  METHODS
  Catatonic symptoms were assessed using the Catatonia Rating Scale (CRS). The patient was treated with unilateral ECT using left anterior right temporal (LART) placement. Seizure quality and duration were monitored by a two-lead electroencephalograph (EEG) and by one-lead electromyography (EMG). During each ECT session, the fetal heart rate was monitored with electrocardiogram (ECG).
  
  
  RESULTS
  After the second ECT treatment (day 13 of hospitalization), we observed remission of the catatonic symptoms, as shown by the drop in the CRS score from 22 to 0. No cognitive abnormalities were reported and no gynecological complications were detected (e.g. vaginal bleeding, abdominal pain, or uterine contraction). The patient delivered at term a healthy male neonate who presented normal growth as well as normal psychomotor development.
  
  
  CONCLUSIONS
  This case highlights the effectiveness of ECT in treating severe catatonic mania during the first 3 months of pregnancy. In addition, ECT proved to be a safe therapeutic option, since neither mother nor infant experienced any adverse event. We suggest that ECT might be considered as a valid and safe option in the therapeutic decision-making process when catatonic symptoms manifest during pregnancy.
authors: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy.
authors: Martina
authors: M
authors: Pinna
authors: Psychiatry Unit, Department of Public Health, Molecular and Clinical Medicine, University of Cagliari, Cagliari, Italy.|Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
authors: Mirko
authors: http://orcid.org/0000-0003-4175-6413
authors: M
authors: Manchia
authors: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy.
authors: Gianluca
authors: G
authors: Pillai
authors: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy.
authors: Piergiorgio
authors: P
authors: Salis
authors: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Italy.
authors: Gian Paolo
authors: GP
authors: Minnai
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy*; D002389:Catatonia / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology / Q000628:therapy*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D016896:Treatment Outcome
keywords: bipolar I disorder; catatonia; electroconvulsive therapy (ECT); perinatal mental health; psychotic mania