title: A case of malignant catatonia with idiopathic pulmonary arterial hypertension treated by electroconvulsive therapy.
abstract: BACKGROUND
  Idiopathic pulmonary arterial hypertension (IPAH) is a progressive and fatal cardiovascular disease if left untreated. In patients with IPAH with psychiatric illness or other complications, careful attention is required when administering medical therapies that may affect their hemodynamics. Patients suffering from IPAH who undergo anesthesia and surgery have a high mortality and morbidity rate. We describe the treatment of intractable psychiatric symptoms with electroconvulsive therapy (ECT) in a patient with IPAH.
  
  
  METHODS
  A 23-year-old woman with IPAH and type I diabetes mellitus (DM) presented with malignant catatonia. Her heart function was classified as New York Heart Association (NYHA) class III. She required a rapid cure and ECT due to various psychiatric symptoms resistant to conventional medications. Pulmonary hypertensive (PH) crisis is the most concerning complication that can be induced by the sympathetic stimulation of ECT. To avoid PH crisis, we administered oxygen using a laryngeal mask and administered remifentanil for anesthesia. We also prepared standby nitric oxide for possible PH crisis, although it was ultimately not needed. With 14 ECT sessions, her malignant catatonia was ameliorated without physical complications.
  
  
  CONCLUSIONS
  ECT is an acceptable option for the treatment of medication-refractory psychiatric disturbances in patients with IPAH, provided careful management is assured to prevent or address complications.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.|Clinical Center for Pleasant Sleep, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mizue
authors.initials: M
authors.lastname: Hobo
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.|Clinical Center for Pleasant Sleep, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Uezato
authors.affiliation: Department of Pediatrics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Nishiyama
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Kurata
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Makita
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. tnis.psyc@tmd.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Nishikawa
mesh_terms: D002389:Catatonia / Q000150:complications / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D065627:Familial Primary Pulmonary Hypertension / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D055815:Young Adult
keywords: Electroconvulsive therapy; Idiopathic pulmonary arterial hypertension; Malignant catatonia; Pulmonary hypertensive crisis; Remifentanil