A case of malignant catatonia with idiopathic pulmonary arterial hypertension treated by electroconvulsive therapy

BMC Psychiatry

Case Report

Koshi Makita¹  Jiro Kurata¹  Mayumi Suzuki¹  Mitsunori Nishiyama²  Naoki Yamamoto³  Toru Nishikawa³  Akihito Uezato⁴  Mizue Hobo⁴ 

[1] Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;Department of Pediatrics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;Clinical Center for Pleasant Sleep, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan;

关键词: Electroconvulsive therapy;    Idiopathic pulmonary arterial hypertension;    Malignant catatonia;    Pulmonary hypertensive crisis;    Remifentanil;   

DOI  :  10.1186/s12888-016-0835-4

 received in 2015-08-10, accepted in 2016-04-27,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundIdiopathic pulmonary arterial hypertension (IPAH) is a progressive and fatal cardiovascular disease if left untreated. In patients with IPAH with psychiatric illness or other complications, careful attention is required when administering medical therapies that may affect their hemodynamics. Patients suffering from IPAH who undergo anesthesia and surgery have a high mortality and morbidity rate. We describe the treatment of intractable psychiatric symptoms with electroconvulsive therapy (ECT) in a patient with IPAH.Case presentationA 23-year-old woman with IPAH and type I diabetes mellitus (DM) presented with malignant catatonia. Her heart function was classified as New York Heart Association (NYHA) class III. She required a rapid cure and ECT due to various psychiatric symptoms resistant to conventional medications. Pulmonary hypertensive (PH) crisis is the most concerning complication that can be induced by the sympathetic stimulation of ECT. To avoid PH crisis, we administered oxygen using a laryngeal mask and administered remifentanil for anesthesia. We also prepared standby nitric oxide for possible PH crisis, although it was ultimately not needed. With 14 ECT sessions, her malignant catatonia was ameliorated without physical complications.ConclusionECT is an acceptable option for the treatment of medication-refractory psychiatric disturbances in patients with IPAH, provided careful management is assured to prevent or address complications.

【 授权许可】

CC BY   
© Hobo et al. 2016