Electroconvulsive Therapy Under Mechanical Ventilation for Catatonia-associated Respiratory Failure
Shotaro Fujiwara1, Tomoko Nagao2, Mari Inami1
1Departments of Psychiatry.
The Journal of ECT
|December 9, 2025
Summary
Electroconvulsive therapy (ECT) effectively treats catatonia, even with respiratory complications. This case highlights coordinating mechanical ventilation with ECT for safe, successful treatment in severe catatonia.
Area of Science:
- Psychiatry
- Neurology
- Critical Care Medicine
Background:
- Catatonia is a severe neuropsychiatric syndrome often requiring intensive treatment.
- Comorbidities like pneumonia can complicate the administration of electroconvulsive therapy (ECT).
- Clozapine discontinuation can precipitate severe catatonia, as seen in a patient with schizophrenia.
Purpose of the Study:
- To report a case of successful electroconvulsive therapy (ECT) administration in a catatonic patient with severe respiratory compromise.
- To emphasize the role of multidisciplinary collaboration in managing complex catatonia cases.
- To highlight the utility of spontaneous awakening trials (SAT) in assessing readiness for ECT in ventilated patients.
Main Methods:
- A case report of a male patient in his 30s with schizophrenia and severe catatonia following clozapine withdrawal.
- Management involved mechanical ventilation, continuous sedation, and high-dose benzodiazepines.
- Electroconvulsive therapy (ECT) was initiated and administered while the patient was under mechanical ventilation, guided by multidisciplinary team discussions and spontaneous awakening trials (SAT).
Main Results:
- The patient experienced significant improvement in catatonic symptoms after two ECT sessions, allowing for extubation.
- Successful spontaneous awakening trials (SAT) confirmed the resolution of catatonia, enabling further treatment.
- The patient was discharged without recurrence of catatonia or medical complications after a total of six ECT sessions.
Conclusions:
- Electroconvulsive therapy (ECT) can be safely and effectively administered to catatonic patients requiring mechanical ventilation.
- Multidisciplinary collaboration is crucial for coordinating complex medical treatments, including mechanical ventilation and ECT.
- Spontaneous awakening trials (SAT) are valuable for determining the optimal timing and necessity of ECT in ventilated catatonic patients.
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