Electroconvulsive therapy for persistent neuroleptic-induced akathisia and parkinsonism: a case report

Current electroconvulsive therapy practice and research in the geriatric population

Electroconvulsive therapy (ECT) is utilized worldwide for various severe and treatment-resistant psychiatric disorders. Research studies have shown that ECT is the most effective and rapid treatment available for elderly patients with depression, bipolar disorder and psychosis. For patients who suffer from intractable catatonia and neuroleptic malignant syndrome, ECT can be life saving. For elderly patients who cannot tolerate or respond poorly to medications and who are at a high risk for drug-induced toxicity or toxic drug interactions, ECT is the safest treatment option. Organic causes are frequently associated with late-life onset of neuropsychiatric conditions, such as parkinsonism, dementia and stroke. ECT has proven to be efficacious even when these conditions are present. During the next decade, research studies should focus on the use of ECT as a synergistic therapy, to enhance other biological and psychological treatments, and prevent symptom relapse and recurrence.

Successful electroconvulsive therapy in major depression with fluvoxamine-induced bruxism

A 61-year-old patient with major depression and selective serotonin reuptake inhibitor-induced bruxism was successfully treated with a course of bilateral electroconvulsive therapy. Both the depressive symptoms and bruxism completely remitted after six treatments. Possible mechanisms of this effect are discussed.

Classification and treatment of tardive syndromes

BACKGROUND

Tardive syndromes are a group of delayed-onset abnormal involuntary movement disorders induced by a dopamine receptor blocking agent. There are several phenomenologically distinct types of TS.

REVIEW SUMMARY

The term tardive dyskinesia has been used to refer to the TS that presents with rapid, repetitive, stereotypic movements mostly involving the oral, buccal, and lingual areas. Tardive dystonia can be focal, segmental, or generalized. It commonly affects the face and neck followed by the arms and trunk. It usually results in retrocollis when it involves the neck and trunk arching backwards when it involves the trunk. Tardive akathisia is characterized by a feeling of inner restlessness and jitteriness with an inability to sit or stand still. Other tardive syndromes include tardive tics, myoclonus, tremor, and withdrawal-emergent syndrome. It remains unclear whether tardive parkinsonism truly exists. The only way to prevent TS is to avoid its etiologic agents. Chronic use of dopamine receptor blocking agents should be limited as much as possible to patients with chronic psychoses. In general, for mild TS, reducing the neuroleptic dose, switching to an atypical agent, or discontinuing antipsychotic treatment altogether in the hope of facilitating remission is recommended. For moderate to severe TS, tetrabenazine or reserpine may be the most effective agent. Neuroleptics should be resumed to treat TD in the absence of active psychosis only as a last resort for persistent, disabling, and treatment-resistant TD.

CONCLUSIONS

The severity of the TS and the absolute need for antipsychotic therapy often dictate the treatment approach for this disorder.

Electroconvulsive therapy-responsive depression in a patient with progressive supranuclear palsy

We report the case of a 68-year-old woman with progressive supranuclear palsy whose depression was successfully treated with electroconvulsive therapy. She tolerated the treatments well and showed neither improvement nor decline in the neurologic symptoms of her illness.