Discussion:
To our knowledge, only fourteen case reports have been published
concerning catatonia with OCD manifestation (Blacker, 1966;
Duarte-Batista et al., 2020; D’Urso et al., 2012; Elia et al., 2005;
Eryılmaz et al., 2014; Fontenelle et al., 2007; Hermesh et al., 1989;
Jagadheesan et al., 2002; Jaimes-Albornoz et al., 2021; Makhinson et
al., 2012; Mukai et al., 2011; Nikjoo et al., 2022; SACHDEVA et al.,
2015), among which only four articles have shown ECT efficacy for
recurrent catatonia (D’Urso et al., 2012; Eryılmaz et al., 2014;
Jagadheesan et al., 2002; Makhinson et al., 2012). A study by D’Urso et
al. showed successful treatment of catatonia and OCD whereas,
Duarte-Batista et al. in their study depicted transient improvement of
catatonia, eventually requiring Deep Brain Stimulation (Duarte-Batista
et al., 2020; D’Urso et al., 2012). In our study, we present effective
management of recurrent catatonia using ECT. However, despite the use of
antidepressants and ERP therapy, OCD was not successfully treated. In a
meta-analysis conducted by Pluijms et al., the efficacy of ECT for major
depression improved significantly with an adjuvant antidepressant
(Pluijms et al., 2021). Additionally, our patient displayed depressive
symptoms; she described signs and symptoms consistent with a major
depressive disorder diagnosis after ECT and an SSRI helped her recover
from catatonia. It was noted that in the past 13 years, there have been
three instances of recovery from catatonia followed by closely spaced
episodes of depression and OCD. In her first two episodes, depression
persisted for 6–8 months while OCD persisted for 1-4 weeks. However,
this pattern of depression followed by OCD appeared to be reversed in
her most recent episode of catatonia, where the depression persisted for
2 weeks and OCD for 7 weeks.
The following table summarizes the treatment interventions and outcomes
of individual cases: