1/8. A case of agitated catatonia.Agitation is one of the diagnostic features of catatonia in the DSM IV classification, but permanent forms of agitated catatonia have occasionally been described. We report the case of a 43-year-old man who had already suffered from undifferentiated schizophrenia for 7 years, and in whom we diagnosed agitated catatonia. While our patient was being treated with a neuroleptic during a second episode of paranoia, a state of agitation was observed which persisted for a further 8 months. During this period, he was treated with several different neuroleptics and benzodiazepines, either alone or in association, without any improvement. No organic cause was found. He was then transferred to our electroconvulsive therapy (ECT) unit, with a diagnosis of schizophrenic agitation resistant to drug therapy. ECT was begun, and he was only given droperidol in case of agitation and alimemazine for insomnia, neither of which had any effect. In view of his persistent agitation without any purpose, echolalia and echopraxia, stereotyped movements with mannerisms and marked mimicking and grimacing, we diagnosed him as having agitated catatonia. After the fourth session of ECT, we decided to stop all treatment and gave him lorazepam at a dose of 12.5 mg daily. Twenty-four hours later, all symptoms of agitation had disappeared. In our opinion, permanent catatonic agitation is not rare. In our case, the neuroleptic treatment maintained and may even have worsened the symptomatology. lorazepam can be used as a therapeutic test for this type of agitation, especially if it does not respond to neuroleptics. This also allows the patient to be sedated rapidly and effectively, thus preventing him from injuring himself further.- - - - - - - - - - ranking = 1keywords = electroconvulsive (Clic here for more details about this article) |
2/8. Treatment of mania in dementia with electroconvulsive therapy.Symptoms of mania have been given inadequate attention as a source of agitated behavior in the dementia patient. Characterized by elevation in mood or grandiosity, pressured speech, and impulsivity, mania is common among the elderly population, with a prevalence approaching 20% in some studies. Because it is so highly associated with behavioral agitation, mania has a significant impact on patient management, and can often lead to the institutionalization of difficult patients. Here we present a case series of three elderly individuals who had signs of mania in conjunction with dementia. Refractory to psychotropic medications, all were given an acute plus maintenance courses of right-unilateral electroconvulsive therapy (ECT). The patients achieved significant improvement in signs of mania and agitation, as well as in mental status scores. We conclude that a short course of ECT, followed by maintenance treatments every 2 weeks, can contribute significantly to the management of dementia patients whose behavioral agitation is associated with signs of mania.- - - - - - - - - - ranking = 5keywords = electroconvulsive (Clic here for more details about this article) |
3/8. Clinical approach to agitation after electroconvulsive therapy: a case report and literature review.Agitation is a neurologic complication that may occur after electroconvulsive therapy (ECT). Severe agitation after ECT has been associated with multiple factors, both anesthetic and psychiatric. This case report describes severe postictal agitation after ECT in a patient with bipolar affective disorder. The clinical management of this challenging presentation is discussed, including both the anesthetic and psychiatric approaches.- - - - - - - - - - ranking = 5keywords = electroconvulsive (Clic here for more details about this article) |
4/8. electroconvulsive therapy for persistent neuroleptic-induced akathisia and parkinsonism: a case report.Neuroleptic-induced akathisia (NIA) and parkinsonism (NIP) continued for 3 months, despite two courses of anticholinergic treatments, a shift to low-potent neuroleptic (NL) and a NL-free period. The two adverse effects responded dramatically to electroconvulsive therapy (ECT) to reemerge 3 months after termination of ECT. The case supports the idea that ECT is effective for both NIA and NIP even when they are resistant.- - - - - - - - - - ranking = 1keywords = electroconvulsive (Clic here for more details about this article) |
5/8. Use of increased anesthetic dose prior to electroconvulsive therapy to prevent postictal excitement.The authors report on three patients who developed severe postictal excitement at several consecutive electroconvulsive therapy (ECT) treatments. In all three cases, an increase in the anesthetic (or equivalent medication) dosage prior to ECT prevented the emergence of postictal excitement at subsequent treatments. This strategy, among others, should be considered in the management of patients who repeatedly manifest this phenomenon during a course of ECT.- - - - - - - - - - ranking = 5keywords = electroconvulsive (Clic here for more details about this article) |
6/8. promethazine for the treatment of agitation after electroconvulsive therapy: a case series.OBJECTIVES: Agitation after electroconvulsive therapy (ECT) is observed in approximately 7% of patients. promethazine is an antihistamine with sedative properties that has no antiseizure effects and therefore can be administered before ECT to prevent the onset of agitation. In the current study, we present a series of 8 patients who reacted to ECT with severe agitation and improved under the treatment of promethazine. methods: Eight patients were included (5 women, 3 men), ages 22 to 77 years. All patients showed severe post-ECT agitation as demonstrated by severe restlessness, crying, or mumbling loudly. Seven of them required the administration of intravenous midazolam. ECT was given according to established clinical protocols at the Sheba Medical Center. All patients were prescribed either 25 to 50 mg of promethazine 2 hours before the treatment to avoid agitation. RESULTS: All 8 patients suffered from extreme agitation after ECT treatment, and 7 required the administration of intravenous midazolam. After a clinical protocol, these patients were prescribed 25-50 mg of promethazine orally 60-120 minutes before the ECT. Improvement was observed in all patients both immediately post-ECT and also in their overall sense of well-being after the ECT. No patient complained of adverse reactions to the promethazine. Most patients reported a relief in pre-ECT fears. CONCLUSION: In this small case series, we found that promethazine can be used to prevent post-ECT agitation. Further double-blind controlled studies are needed to better evaluate the usefulness and appropriateness of promethazine in the prevention of pre-ECT fears and post-ECT agitation.- - - - - - - - - - ranking = 5keywords = electroconvulsive (Clic here for more details about this article) |
7/8. electroconvulsive therapy emergence agitation and succinylcholine dose.In this prospective study, five patients who had repeatedly shown troublesome restless emergence agitation after each of 20 sessions of electroconvulsive therapy (ECT) with a succinylcholine dose about .7 mg/kg showed no agitation after 15 ECT sessions in which the succinylcholine dose was increased to about 1.0 mg/kg. The probability that the pattern of response to higher succinylcholine dose resulted from random processes is less than .005. This provides evidence that patients predisposed to emergence agitation are sensitive to seizure-induced metabolic changes in skeletal muscle tissue and that the likelihood of emergence agitation rises with the ratio of skeletal muscle mass to succinylcholine dose. Because ECT-inducted serum lactate elevations are blocked by succinylcholine, emergence agitation might be essentially the same phenomenon as lactate-induced panic.- - - - - - - - - - ranking = 1keywords = electroconvulsive (Clic here for more details about this article) |
8/8. hyperthyroidism in a patient with agitated depression: resolution after electroconvulsive therapy.A patient with hyperthyroidism is described whose clinical presentation was that of agitated depression. Her psychologic abnormality and thyroid hyperfunction responded to electroconvulsive therapy.- - - - - - - - - - ranking = 5keywords = electroconvulsive (Clic here for more details about this article) |