From the Guidelines
Adjunctive therapies for catatonia include Electroconvulsive Therapy (ECT).
Key Points
- ECT may be used to treat catatonia, particularly in cases where patients are nonresponsive to standard medication therapies or have severe symptoms such as refusal to eat or drink, severe suicidality, or florid psychosis 1.
- The decision to use ECT should be made on a case-by-case basis, taking into account the patient's diagnosis, severity of symptoms, and lack of treatment response to other therapies 1.
- ECT is generally reserved for adolescents with treatment-resistant conditions, and the criteria defining treatment-resistant vary among investigators 1.
- Bilateral ECT may be more effective for manic patients and in situations where speed of response is critical, such as catatonia or severe suicidality 1.
- The use of brief pulse and a lower dose of electricity, which is moderately above the threshold for inducing seizure of adequate duration, is recommended to minimize cognitive impact of ECT 1.
- Potential side effects of ECT include short-term cognitive impairment, anxiety reactions, disinhibition, and altered seizure threshold 1.
- Informed consent from the parents, including a detailed discussion of the potential cognitive deficits, is necessary before proceeding with ECT treatment 1.
From the Research
Adjunctive Therapies for Catatonia
The following adjunctive therapies have been identified for the treatment of catatonia:
- Electroconvulsive therapy (ECT) has been shown to be safe and effective in treating catatonia, particularly when pharmacologic treatment fails or is inadequate 2, 3, 4
- Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) may be promising alternative treatment strategies for patients who do not respond to benzodiazepines or when ECT is not available or contraindicated 3
- N-methyl-d-aspartate-receptor antagonists, anti-epileptic drugs, and atypical antipsychotic agents have been reported to be effective and safe in treating catatonia patients 5
- Dopamine-modulating second-generation antipsychotics, such as clozapine and aripiprazole, may be effective in some patient populations 6
- Benzodiazepines, such as lorazepam, are commonly used as a first-line treatment for catatonia, and may be used in conjunction with other therapies 2, 4, 6
Specific Therapies
Some specific therapies that have been used as adjuncts to primary treatment include: