title: Electroconvulsive therapy in the intensive care unit for the treatment of catatonia: a case series and review of the literature.
abstract: OBJECTIVE
  Catatonia is an underdiagnosed syndrome that may occur in severely ill patients. The malignant subtype, consisting of motor symptoms, autonomic instability and fever, is associated with high mortality rates, though exact current mortality rates are unknown. This subtype requires a fast detection and treatment with high doses of a benzodiazepine or electroconvulsive therapy (ECT), preferably in an intensive care unit (ICU) setting.
  
  
  METHODS
  Case series and qualitative literature review.
  
  
  RESULTS
  This paper presents four patients admitted to the ICU of an academic hospital diagnosed with malignant catatonia. All patients received ECT after an ineffective trial of high-dose intravenous benzodiazepine treatment. The duration of ECT ranged from 6 to 23 treatments after which the catatonic features partially or fully remitted. In addition, we have reviewed the diagnostic challenges, neurobiology, possible causes, differential diagnosis and treatment options of catatonia, focusing on the treatment with ECT and the importance of detection and multidisciplinary collaboration.
  
  
  CONCLUSIONS
  Malignant catatonia is an underdiagnosed, potentially life-threatening syndrome that requires fast recognition and prompt treatment, preferably in an ICU setting.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: F.M.Dessens@lumc.nl.
authors.forename: Femke M
authors.initials: FM
authors.lastname: Dessens
authors.affiliation: Department of Intensive Care Medicine of Leiden University Medical Center, Leiden, The Netherlands. Electronic address: J.van_Paassen@lumc.nl.
authors.forename: Judith
authors.initials: J
authors.lastname: van Paassen
authors.affiliation: Department of Intensive Care Medicine of Leiden University Medical Center, Leiden, The Netherlands. Electronic address: D.J.van_Westerloo@lumc.nl.
authors.forename: David J
authors.initials: DJ
authors.lastname: van Westerloo
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: N.J.A.van_der_Wee@lumc.nl.
authors.forename: Nic J
authors.initials: NJ
authors.lastname: van der Wee
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: I.M.van_Vliet@lumc.nl.
authors.forename: Irene M
authors.initials: IM
authors.lastname: van Vliet
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: M.S.van_Noorden@lumc.nl.
authors.forename: Martijn S
authors.initials: MS
authors.lastname: van Noorden
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications; D002389:Catatonia / Q000150:complications / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000150:complications; D011618:Psychotic Disorders / Q000150:complications; D012563:Schizophrenia, Paranoid / Q000150:complications
keywords: Catatonia; ECT; Electroconvulsive therapy; Intensive care unit; Malignant catatonia