title: Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review.
abstract: Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.
authors.affiliation: Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: B E R G
authors.initials: BE
authors.lastname: Bica
authors.affiliation: Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
authors.forename: A L D
authors.initials: AL
authors.lastname: Moro
authors.affiliation: Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Hax
authors.affiliation: Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: N A
authors.initials: NA
authors.lastname: Nicol
authors.affiliation: Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: G S
authors.initials: GS
authors.lastname: Campos
authors.affiliation: Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: L M S
authors.initials: LM
authors.lastname: Rivera
authors.affiliation: Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: A F C
authors.initials: AF
authors.lastname: da Costa
authors.affiliation: Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
authors.forename: R M
authors.initials: RM
authors.lastname: Xavier
authors.affiliation: Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil omonticielo@yahoo.com.br.
authors.forename: O A
authors.initials: OA
authors.lastname: Monticielo
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001938:Brazil; D002389:Catatonia / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020945:Lupus Vasculitis, Central Nervous System / Q000150:complications*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D007166:Immunosuppressive Agents
keywords: Electroconvulsive therapy; catatonia; neuropsychiatric lupus; systemic lupus erythematosus