Title |
A case of malignant catatonia with idiopathic pulmonary arterial hypertension treated by electroconvulsive therapy
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Published in |
BMC Psychiatry, May 2016
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DOI | 10.1186/s12888-016-0835-4 |
Pubmed ID | |
Authors |
Mizue Hobo, Akihito Uezato, Mitsunori Nishiyama, Mayumi Suzuki, Jiro Kurata, Koshi Makita, Naoki Yamamoto, Toru Nishikawa |
Abstract |
Idiopathic 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. A 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. ECT 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. |
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Unknown | 1 | 100% |
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Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 70 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Master | 12 | 17% |
Student > Bachelor | 11 | 16% |
Researcher | 9 | 13% |
Student > Doctoral Student | 7 | 10% |
Other | 6 | 9% |
Other | 12 | 17% |
Unknown | 13 | 19% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 35 | 50% |
Psychology | 8 | 11% |
Nursing and Health Professions | 5 | 7% |
Neuroscience | 4 | 6% |
Biochemistry, Genetics and Molecular Biology | 1 | 1% |
Other | 2 | 3% |
Unknown | 15 | 21% |