Electroconvulsive Therapy: a Clinical Case of Malignant Catatonia

The essence of catatonia symptoms are: movement disorders, mutism, negativ­ism, waxy flexibility, stereotypical move­ment, impulsive actions, duality, and paramimics. It is a psychosis that affects movement and speech. Lethal catatonia is a life-threatening psychiatric syn­drome which is very difficult to differenti­ate because of prevailing somatic and neurological symptoms and still remains a very difficult question in psychiatry. The outcome depends on rapid detection and complete treatment.

Objective. The authors, reviewing the clinical data and the differential diag­nosis and treatment, illustrate the effec­tiveness of ECT for the patient to whom malignant catatonia developed for the first time in her life.

Method: a case report.

Results. A 19-year-old student who was healthy until this episode of malig­nant catatonia. Until the malignant cata­tonia episode there was a half-year prodromal period which consisted of worsen­ing depression with depersonalization and derealisation which later acquired a delusional nature. At syndrome culmina­tion the patient was hospitalized in the neurologic department because of hyper­thermia and chorea-like hyperkinesis and myoclonus which are often mistaken for seizures. At that point there were ob­vious catatonic symptoms. When neuro­logical and somatic pathology was not found, the correct condition of malignant catatonia was diagnosed. The patient re­covered under electroconvulsive therapy with benzodiazepines and olanzapine.

Conclusion. The use of pharmacoi therapy by itself, is not always efiective because the most important and effective treatment is ECT.