Clinical features and predictors of non-response in severe catatonic patients treated with electroconvulsive therapy.

Abstract

OBJECTIVE:

To explore the demographic and clinical features of severe catatonic patients, comparing responders and non-responders to ECT in order to detect possible predictors of non-response.

METHODS:

This naturalistic study included 59 catatonic inpatients with a diagnosis of mood disorder according to DSM-IV-TR criteria. All patients were treated with bilateral ECT and evaluated before and after ECT course. The response to ECT was defined as a Clinical Global Impression (Improvement subscale) rating 1 'very much improved' or 2 'much improved'. Clinical variables were compared between responders and non-responders; logistic regression was used to predict the probability of non-response, with regard to the symptoms presented by the patients.

RESULTS:

The response rate was 83.1%. Non-responders (n = 10) to ECT showed neurological comorbidities, treatments with dopamine agonists and anticholinergic drugs, waxy flexibility, and echophenomena more frequently than respondents (n = 49). Echophenomena resulted a significant predictor of non-response in the multivariate analysis.

CONCLUSION:

In line with previous reports, ECT resulted effective in the vast majority of severe catatonic patients. The association between ECT resistant catatonia and neurological comorbidity, use of dopamine-agonist and anticholinergic medications is consistent with the hypothesis that ECT is more effective in 'top-down' than in 'bottom-up' variant of catatonia.Key pointsCatatonic symptoms are frequently associated with severe and psychotic mood disorders.Electroconvulsive therapy is effective in treating most forms of severe catatonia.Neurological comorbidity and the presence of 'echopraxia/echolalia' could represent predictors of non-response to ECT.

• Authors: Beniamino Tripodi, Margherita Barbuti, Martina Novi, Gianluca Salarpi, Giuseppe Fazzari, Pierpaolo Medda, Giulio Perugi
• Journal: International journal of psychiatry in clinical practice (Int J Psychiatry Clin Pract) Vol. 25 Issue 3 Pg. 299-306 (Sep 2021) ISSN: 1471-1788 [Electronic] England
• PMID: 34382488 (Publication Type: Journal Article)

Topics

• Catatonia (therapy)
• Electroconvulsive Therapy
• Humans
• Patient Acuity
• Treatment Failure