ECT in the treatment of the catatonic syndrome.

OBJECTIVE: To determine the efficacy of ECT in the treatment of the catatonic syndrome and to identify predictors of good response.

METHOD: 28 cases of catatonia in 22 patients admitted to a psychiatry or medical psychiatry inpatient unit between January 1989 and June 1992 were retrospectively evaluated. Cases were included if they met criteria for catatonia as described by Kahlbaum, i.e., 4 or more signs including immobility, mutism, withdrawal, staring, rigidity, posturing/gimacing, negativism, waxy flexibility, echo phenomena, stereotypy, and verbigeration. Primary diagnoses were: Major Depressive Disorder (8), Bipolar Affective Disorder (5), schizophrenia (5), schizoaffective disorder (2) and organic mental disorder (2). Mean age was 54.5 years; sex ratio was 15 females to 7 males. Patients received a mean of 12.0 treatments with mean seizure duration 50.9 s (by EEG) per treatment.

RESULTS: By Kahlbaum criteria, resolution of the catatonic syndrome occurred in 26 out of 28 cases (93%). The mean number of signs present per patient prior to ECT was 5.6 versus 0.93 following ECT (p = 0.00001). Overall, ECT brought about resolution of 83.5% of all symptoms with 98% resolution of primary symptoms and 74% resolution of secondary symptoms.

CONCLUSIONS: ECT is an effective treatment of the catatonic syndrome. ECT is effective in the resolution of both cardinal (primary) and secondary signs of catatonia. In this study, there is not a statistically significant difference in the effectiveness of the resolution of catatonic symptoms in persons with affective disorder versus schizophrenia.