Clinical and cerebral blood flow changes in catatonic patients treated with ECT $ Rodrigo Escobar a,e,Ã , Alejandro Rios b , Ivan D. Montoya c , Francisco Lopera f , Daele Ramos e , Carlos Carvajal e , Gustavo Constain e , Juan E. Gutierrez d , Sergio Vargas d , Claudia P. Herrera a a Psychiatric Inpatient Unit, Department of Psychiatry, Hospital San Vicente de Paul, University of Antioquia, Calle 64 #51 d, Medellin, Colombia b Nuclear Medicine Department, Santa Marõ Âa Clinic, Medellin, Colombia c National Faculty of Public Health, University of Antioquia, Medellin, Colombia d Center for Resonance and Images (CERI), Medellin, Colombia e Mental Hospital of Antioquia (HOMO), Medellin, Colombia f Department of Neurology, University of Antioquia, Medellin, Colombia Received 5 January 2000; accepted 6 September 2000 Abstract Objective: To determine changes in clinical manifestations and cerebral blood flow (CBF) before and after administration of ECT to patients with catatonia due to schizophrenia or mood disorders. Methods: A sample of nine patients who met DSM-IV criteria for catatonia was studied. Patients received between 5 and 15 sessions (thrice per week) of ECT. Severity of catatonia was measured with the Modified Rogers Scale (MRS). Changes in CBF were measured with a brain single positron emission computer tomography (SPECT) that was performed 1 week before the first ECT and 1 week after the last ECT. Results: Catatonia was due to schizophrenia in five patients and mood disorders in four patients. There were no significant clinical and brain SPECT differences between these two groups before treatment. Pre- vs. post-ECT comparisons showed significant reduction of catatonic symptoms in both groups. However, patients with mood disorders needed less ECT sessions and showed greater clinical improvement. Brain SPECT showed significant increase in CBF in parietal, temporal, and occipital regions in patients with mood disorder and no significant changes in patients with schizophrenia. Conclusions: These results support the efficacy of ECT for treatment of catatonic patients, especially secondary to mood disorders, which seem to be correlated with improvements in CBF. D 2001 Elsevier Science Inc. All rights reserved. Keywords: Catatonia; ECT; SPECT; Major depression; Schizophrenia; MRS Introduction the concept of catatonia was developed by Kahlbaum in 1874 [1], when he described the motor disorders of 26 patients with severe psychiatric illness. DSM-IV criteria include motor inactivity, stupor, negativism, mutism, stereotypical movements, mannerisms, grimaces, echolalia, or echopraxia [2]. ICD-10 criteria include stupor or mut- ism, excitement, catalepsy, negativism, rigidity, waxy flex- ibility, and automatic obedience [3]. Patients may present motor or psychological agitation [4±6]. The most common causes of catatonia are mood disorders or schizophrenia, although there are 16% of cases associated with organic disorders [7]. Clinical dif- ferentiation of underlying causes of catatonia is frequently difficult to establish. Treatments for catatonic patients may include benzodiacepines, neuroleptics, tricyclic antidepres- sants, muscle relaxants, and electroconvulsive therapy (ECT) [7±11]. Although ECT has been indicated for treatment of catatonia [12±19], there are case reports [20±22] and few prospective studies proving its efficacy [23]. One retrospective study showed that 93% of patients improved $ Study presented at the IV annual meeting of the Colombian Society of Biological Psychiatry, Medellin, May 31, 1997 and at the XX Congress of Latin American Psychiatric Association (APAL), La Habana, Cuba, October 21, 1998. * Corresponding author. Tel.: +57-4-263-4578; fax: +57-4-263-6809. E-mail address: rescobargiraldo@hotmail.com (R. Escobar). Journal of Psychosomatic Research 49 (2000) 423 ± 429 0022-3999/00/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII:S0022-3999(00)00190-2