Electroconvulsive therapy reverses cerebral hypoperfusion in a patient with psychotic depression and catatonia

Howells, David, Rees, John, Townsend, Rebecca and Kirov, George ORCID: https://orcid.org/0000-0002-3427-3950 2022. Electroconvulsive therapy reverses cerebral hypoperfusion in a patient with psychotic depression and catatonia. The Journal of ECT 38 (2) , pp. 141-143. 10.1097/YCT.0000000000000836

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Abstract

A 72-year-old man suffering with severe depression with psychotic symptoms, marked apathy, and psychomotor retardation was treated with electroconvulsive therapy (ECT) after resistance to treatment with psychotropic medications. His age, comorbidities, and dysexecutive syndrome prompted consideration of a diagnosis of frontotemporal dementia (FTD), and a 99mTechnetium-labeled hexamethyl propylene amine oxime single-photon emission computed tomography (SPECT) brain perfusion scan showed bilateral perfusion defects that were most pronounced in the frontal regions of the brain. The scan was judged to be abnormal and in keeping with a neurodegenerative dementia. We reasoned that the fluctuation in symptoms was inconsistent with a diagnosis of FTD and that his severe depression could be improved with ECT even if he had FTD, so we decided to proceed with this treatment. A course of 12 sessions of ECT resulted in remission of his psychiatric symptoms and improvement in cognitive performance. A repeat SPECT scan 5 weeks after the last ECT demonstrated a substantial improvement in cerebral blood flow, favoring the diagnosis of depression, rather than dementia. Similar case reports from the literature suggest that ECT does reverse brain hypoperfusion in severe cases of depression and catatonia. Clinicians should be aware that abnormal SPECT findings are nonspecific and can be caused by various conditions, including psychiatric illness, and are not necessarily diagnostic of a neurodegenerative disease.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher:	Lippincott, Williams & Wilkins
ISSN:	1533-4112
Date of First Compliant Deposit:	12 July 2022
Date of Acceptance:	29 December 2021
Last Modified:	10 Nov 2022 11:37
URI:	https://orca.cardiff.ac.uk/id/eprint/151242

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