Ausra Bagdonaite1, Valentinas Mačiulis1, 2, Jūratė Lengvenienė1, Aldona Šiurkutė1, 2, Gintaras Naujokas3, Sandra Simkunaite1
1Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania
2Vilnius University Medical Faculty Psychiatric Clinic, Vilnius, Lithuania
3Private Limited Company Žemaitijos Mental Health Center, Telšiai, Lithuania
Purpose: We present three successful clinical cases which illustrate the difficulties of treatment when severe resistance psychoses had developed.Treatment with various combinations of antipsychotics was ineffective; response to treatment was achieved when ECT was added. All three patients had positive synaptic anti-GAD antibodies and in one case, had low positive channel antibodies (Anti – VGKC) in blood. Antineuronal antibodies were negative.
Method: Clinical cases.
Clinic: All three patients were in severe psychotic state with prominent catatonic symptoms, in which fluctations persisted for more than a year. Two of them (man, age 23 and women, age 31) were ill with paranoid schizophrenia. Former psychotic episodes were treated with antipsychotic combinations, and partial remission in both was achieved. One of them had concomitant diagnose of epilepsy, which established during current psychotic episode. The third one (woman, age 34) was ill with organic catatonia, epilepsy and moderate mental retardation. She was treated with dexametazone unsuccessfully. The EEG showed the epileptic activity. Both were treated with lamotrigine up to 300 mg/d. To each of the patients through inpatient treatment (which lasted 1 – 1.5 years) was administered 46 – 77 acute and maintenance ECT. Interruption of the procedures longer than week resulted in a return of catatonic symptoms.
Results: All patients were discharged significantly improved: catatonia disappeared, only mild psychotic symptoms persisted.
Conclusions: a number of factors determine treatment resistance: genetic factors, medical comorbidities, brain structure and functionalities etc. We cannot speculate with only three cases, but our results show, that autoimmune damage might be the cause of treatment resistance. It is known that spontaneous remissions might also occur, but in our cases, a good outcome was achieved after long term treatment with ECT. That is why we claim, that the ECT is effective in cases when resistance to treatment is determined by channelopathies.