Torrico Tyler, Shaheen Shahzeb, Weinstein David, Padhy Ranjit, Salam Md Towhid
Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
Department of Psychiatry, Kern Medical, Bakersfield, CA, USA.
J Med Access. 2023 Dec 22;7:27550834231220504. doi: 10.1177/27550834231220504. eCollection 2023 Jan-Dec.
Catatonia is a psychomotor syndrome resulting from an underlying psychiatric or medical disorder commonly observed in inpatient psychiatric units. While benzodiazepines and electroconvulsive therapy (ECT) are effective treatment options, the unavailability of ECT in many community psychiatric hospitals in the United States negatively affects patient outcomes. We present a 25-year-old African American male with a psychiatric diagnosis of schizophrenia complicated by malignant catatonia who was admitted to a community psychiatric hospital. He required intensive medical stabilization with supportive management, and transfer requests to ECT-equipped hospitals were initiated. While awaiting transfer for 148 days, the patient's symptoms did not fully remit with lorazepam (even with 36 mg daily in divided doses) and other psychotropic medication trials, including antipsychotics and mood stabilizers. After nearly 5 months of inpatient stay, he was successfully transferred, received ECT treatment, and experienced rapid resolution of catatonia. After discharge, to obtain three monthly sessions of maintenance ECT, he had 5-h one-way ground transportation arranged to an out-of-county ECT-equipped facility. There was no relapse in catatonia by the 2-year follow-up. This report highlights a significant healthcare disparity when attempting to manage severe catatonia within community hospital settings without access to ECT in the United States. Alternative treatments, including antipsychotics, had minimal impact on symptoms and possibly increased morbidity in this case while awaiting ECT. Treatment at our designated safety net hospital still required referral to 14 ECT-equipped hospitals before successful transfer. This case highlights the urgent need for ECT availability in more community hospitals to treat patients with refractory psychiatric conditions, including catatonia. ECT is an essential psychiatric treatment that, for certain conditions, has no appropriate alternatives. We propose that access to ECT be considered in the determination of safety net hospital systems, with improved ability to transfer patients who are suffering from treatable life-threatening mental health conditions.
紧张症是一种精神运动综合征，由潜在的精神或医学疾病引起，常见于住院精神科病房。虽然苯二氮䓬类药物和电休克疗法（ECT）是有效的治疗选择，但美国许多社区精神病医院无法提供ECT，这对患者的治疗结果产生了负面影响。我们报告了一名25岁的非裔美国男性，他被诊断为精神分裂症并发恶性紧张症，入住了一家社区精神病医院。他需要强化医疗稳定和支持性管理，并启动了转至配备ECT医院的请求。在等待转院的148天里，患者的症状并未因劳拉西泮（即使每日分剂量服用36毫克）以及包括抗精神病药物和心境稳定剂在内的其他精神药物试验而完全缓解。经过近5个月的住院治疗后，他成功转院，接受了ECT治疗，紧张症迅速得到缓解。出院后，为了每月接受三次维持性ECT治疗，他安排了5小时的单程陆路交通前往县外一家配备ECT的机构。在2年的随访中，紧张症没有复发。本报告强调了在美国社区医院环境中试图管理严重紧张症而无法获得ECT时存在的重大医疗差距。在这种情况下，包括抗精神病药物在内的替代治疗对症状的影响极小，并且在等待ECT期间可能增加发病率。在我们指定的安全网医院进行治疗时，仍需转诊至14家配备ECT的医院才能成功转院。该病例突出表明，迫切需要更多社区医院能够提供ECT，以治疗包括紧张症在内的难治性精神疾病患者。ECT是一种重要的精神科治疗方法，对于某些病症而言，没有合适的替代方法。我们建议在确定安全网医院系统时考虑提供ECT的能力，提高转运患有可治疗的危及生命的精神健康状况患者的能力。
