• anticholinergic
• catatonia
• dopamine agonist
• electroconvulsive therapy
• mood disorder
• predictors of response

Catatonia is a severe neuropsychiatric syndrome frequently associated with mood disorder. Treatment approach is based on i.v. benzodiazepines and electroconvulsive therapy (ECT). The identification of predictors of non-response to ECT has relevant clinical implications.
The study sample comprised 59 catatonic in-patients Treated with ECT and evaluated with Bush-Francis Catatonia Rating Scale, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Young Mania Rating Scale and Clinical Global Improvement (CGI). The patients had a diagnosis of mood disorder with or without mixed or psychotic features. Response was defined as a CGI-Improvement subscale rating 1 “very much improved” or 2 “much improved”.
Response rate resulted of 83.1%. Comparing responders (n=49) and non-responders (n=10), the latter presented more frequently a neurological comorbidity and treatments with dopamine agonist and anticholinergic drugs, suggesting an association of extrapyramidal symptoms with the ECT non response. Non-responders also presented waxy flexibility and echophenomena. The last one was a significant predictor of non-response also after multivariate analysis. The major limitation of the present study is the low number of non-responders. In line with previous reports we confirm the efficacy of ECT in the vast majority of severe catatonic patients. The association of neurological comorbidity and use of dopamine-agonist and anticholinergic medications with ECT resistant catatonia is consistent with the hypothesis that ECT is more effective in “top-down” than in “bottom-up” variant of catatonia. Our results should be considered preliminary and further research is necessary.