Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response

Table 1 Studies that investigate efficacy of electroconvulsive therapy in catatonia (number of patients receiving electroconvulsive therapy ≥ 10)

Ref.	Sample(n)	Patients receiving ECT n (%)	Diagnosis	Design	ECT technique	Outcomemeasures	Results	Variables associated with response
Unal et al[23], 2013	57	57 (100)	63% Mood disorders 29% psychotic disorders (including schizophrenia) 3.5% pts mental retardation 3.5% pts without psychiatric disorders	Retrospective All pts. received ECT in combination with oral BZDs	BL (bifrontal)	CGI, HDRS, YMRS, PANSS	Response = 100%	Not assessed
Tuerlings et al[64], 2010	34	34 (100)	59% mood disorders 77% schizophrenia and other psychotic disorders 37% somatic, toxic, post-traumatic stress disorder, mental retardation	Retrospective	Non specified	No standard diagnostic instruments or catatonia scales	58% pts treated with BZDs and/or ECT had clinically complete remission. 50% pts treated with ECT after unsuccessful medication trials recovered completely	Responders: Autonomic dysregulation Non-responders: Initial treatment with amantadine, bromocriptina and dantrolene More comorbid disorders
Van Waarde et al[29], 2010	27	27 (100)	48% mood disorders 44% psychotic disorder (including schizophrenia) 19% others (alcohol/substance abuse, mental retardation)	Retrospective	BL (bifronto-temporal) or UL (according to d’Elia)	Response defined as CGI ≤ 2	Response = 59%	Responders: Younger age Autonomic dysregulation at baseline (especially higher body temperature) Daily ECT during the first treatment week Longer duration of motor and EEG seizure activity at the final ECT session Less morbidity in the year after ECT
Ravvendranathan et al[22], 2012	63	63 (100)	41% mood disorders, 49% psychotic disorders (including schizophrenia) 6% idiopathic catatonia	Retrospective	BL (bitemporal)	Response = complete resolutions of symptoms and/or BFCRS = 0	Response = 89%	The Authors divide the responders in faster ( ≤ 4 sessions) and slower (≥ 5 sessions) Faster responders: Lower duration of catatonia Greater severity of BFCRS Lesser electrical charge used overall Shorter duration of inpatient stay Waxy flexibility and gegenhalten. Lower responders: echophenomena
England et al[26], 2011	25	12 (48)	Total sample: 36% bipolar disorder 32% pts with psychosis NOS 4% depressive episode and anxiety disorder 16% schizophrenia 8% without previous psychiatric history	Retrospective	BL	BFCRS, clinical evaluation	83% pts treated with ECT definite beneficial effects > BZDs, APs, MS, ADs	Not assessed
Hatta et al[27], 2007	50	17 (34)	Total sample: 34% mood disorders 46% schizophrenia and other psychotic disordes 20% medical condition	Observational study I step: BZDs or ECT II step: APs (RIS or HAL) or ECT III step: CPZ or ECT IV step: ECT	BL (bitemporal)	“Partial response”: disappearance of one or more catatonic symptoms; “complete response”: disappearance of all catatonic symptoms	(Cumulative) ECT 100% > CPZ 68% > RIS 26% > HAL 16%	Not assessed
Dutt et al[24], 2011	51	42 (82)	75% psychotic disorders (including schizophrenia) 14% mood disorders 8% organic brain syndromes	Retrospective	Unspecified	Reduction of BFCRS assesses the response	Response = 100%	Not assessed
Rohland et al[25], 1993	22	22 (100)	59% mood disorders 32% schizophrenia and schizoaffective disorder 9% organic mental disorder	Retrospective	BL (bitemporal)	Response to ECT was assessed by not meeting Kahlbaum and Rosebush criteria for catatonia. Then, the number of single signs and symptoms prior and after ECT is another parameter	Response = 93%	Trend toward a better response in affective than psychotic pts (non statistically significant)
Medda et al (manuscript in preparation)	26	26 (100)	100% bipolar disorder	Observational	BL (bitemporal)	Response = CGI ≤ 2	Response = 81%	Non-responders: Older age at onset of mood disorders Lower number of mood episodes Higher BFCRS total score at baseline Less psychotic symptoms Higher rate of past treatment with anticholinergics and dopamine agonists and lower rate of past treatment with typical antipsychotics

APs: Antipsychotics; CPZ: Chlorpromazine; RIS: Risperidone; HAL: Haloperidol; ADs: Antidepressants; MS: Mood stabilizer; BZDs: Benzodiazepines; BFCRS: Bush-Francis Catatonia Rating Scale; CGI: Clinical Global Impressions scale; HDRS: Hamilton Depression Rating Scale; YMRS: Young Mania Rating Scale; PANSS: Positive and Negative Symptoms Scale; ECT: Electroconvulsive therapy.