Psychiatric Annals

CME Article 

Catatonia and Prediction of Response to Electroconvulsive Therapy

Stanley N. Caroff, MD; Gabor S. Ungvari, MD; Mahendra T. Bhati, MD; Catherine J. Datto, MD, MS; John P. O’Reardon, MD

Abstract

In contemporary psychiatric practice, catatonia is depicted as a relatively infrequent and simplistic clinical syndrome. Catatonia is recognized as an acute state of mutism or stupor that can occur in patients with diverse neuropsychiatric disorders. Patients usually respond to lorazepam or electroconvulsive therapy (ECT). However, closer inspection of the literature reveals catatonia as a complex clinical phenomenon with potential implications for psychiatric nosology and for advancing understanding of brain-behavior relationships underlying the major endogenous psychoses.

ABOUT THE AUTHORS

Stanley N. Caroff, MD, is with the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, and the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Gabor S. Ungvari, MD, is with the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China. Mahendra T. Bhati, MD, is with the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Catherine J. Datto, MD, MS, is a researcher for Astra Zeneca Pharmaceuticals, Wilmington, Delaware. John P. O’Reardon, MD, is with the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Address correspondence to: Stanley N. Caroff, MD, VA Medical Center-116A, University Avenue, Philadelphia, PA 19104; fax 215-823-4610; or email Stanley.caroff@va.gov.

Drs. Ungvari, Bhati, Datto, and O’Reardon disclosed no relevant financial interest. Dr. Caroff has received research grants from Pfizer, Bristol-Myers Squibb, and Ortho-McNeil Neurologics.

EDUCATIONAL OBJECTIVES

  1. Review the evidence of the efficacy of electroconsulsive therapy (ECT) in catatonia.
  2. Review clinical signs predicting response to ECT.
  3. Identify the use of ECT in different subtypes of catatonia.

Abstract

In contemporary psychiatric practice, catatonia is depicted as a relatively infrequent and simplistic clinical syndrome. Catatonia is recognized as an acute state of mutism or stupor that can occur in patients with diverse neuropsychiatric disorders. Patients usually respond to lorazepam or electroconvulsive therapy (ECT). However, closer inspection of the literature reveals catatonia as a complex clinical phenomenon with potential implications for psychiatric nosology and for advancing understanding of brain-behavior relationships underlying the major endogenous psychoses.

ABOUT THE AUTHORS

Stanley N. Caroff, MD, is with the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, and the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Gabor S. Ungvari, MD, is with the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China. Mahendra T. Bhati, MD, is with the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Catherine J. Datto, MD, MS, is a researcher for Astra Zeneca Pharmaceuticals, Wilmington, Delaware. John P. O’Reardon, MD, is with the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Address correspondence to: Stanley N. Caroff, MD, VA Medical Center-116A, University Avenue, Philadelphia, PA 19104; fax 215-823-4610; or email Stanley.caroff@va.gov.

Drs. Ungvari, Bhati, Datto, and O’Reardon disclosed no relevant financial interest. Dr. Caroff has received research grants from Pfizer, Bristol-Myers Squibb, and Ortho-McNeil Neurologics.

EDUCATIONAL OBJECTIVES

  1. Review the evidence of the efficacy of electroconsulsive therapy (ECT) in catatonia.
  2. Review clinical signs predicting response to ECT.
  3. Identify the use of ECT in different subtypes of catatonia.

In contemporary psychiatric practice, catatonia is depicted as a relatively infrequent and simplistic clinical syndrome. Catatonia is recognized as an acute state of mutism or stupor that can occur in patients with diverse neuropsychiatric disorders. Patients usually respond to lorazepam or electroconvulsive therapy (ECT). However, closer inspection of the literature reveals catatonia as a complex clinical phenomenon with potential implications for psychiatric nosology and for advancing understanding of brain-behavior relationships underlying the major endogenous psychoses.

ABOUT THE AUTHORS

Stanley N. Caroff, MD, is with the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, and the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Gabor S. Ungvari, MD, is with the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China. Mahendra T. Bhati, MD, is with the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Catherine J. Datto, MD, MS, is a researcher for Astra Zeneca Pharmaceuticals, Wilmington, Delaware. John P. O’Reardon, MD, is with the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Address correspondence to: Stanley N. Caroff, MD, VA Medical Center-116A, University Avenue, Philadelphia, PA 19104; fax 215-823-4610; or email Stanley.caroff@va.gov.

Drs. Ungvari, Bhati, Datto, and O’Reardon disclosed no relevant financial interest. Dr. Caroff has received research grants from Pfizer, Bristol-Myers Squibb, and Ortho-McNeil Neurologics.

EDUCATIONAL OBJECTIVES

  1. Review the evidence of the efficacy of electroconsulsive therapy (ECT) in catatonia.
  2. Review clinical signs predicting response to ECT.
  3. Identify the use of ECT in different subtypes of catatonia.

10.3928/00485713-20070101-07

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