ETD

Digital archive of theses discussed at the University of Pisa

 

Thesis etd-10082020-184408


Thesis type
Tesi di specializzazione (4 anni)
Author
TRIPODI, BENIAMINO
URN
etd-10082020-184408
Thesis title
Clinical features and predictors of non-response in severe catatonic patients treated with Electroconvulsive Therapy
Department
MEDICINA CLINICA E SPERIMENTALE
Course of study
PSICHIATRIA
Supervisors
relatore Prof. Perugi, Giulio
correlatore Dott. Medda, Pierpaolo
Keywords
  • catatonia
  • predictors of response
  • dopamine agonist
  • anticholinergic
  • electroconvulsive therapy
  • mood disorder
Graduation session start date
16/11/2020
Availability
Withheld
Release date
16/11/2090
Summary
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.
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