Patient with IPAH and Malignant Catatonia Successfully Treated with Electroconvulsive Therapy: a Case Report

Patient with IPAH and Malignant Catatonia Successfully Treated with Electroconvulsive Therapy: a Case Report

A 23-year-old woman with idiopathic pulmonary arterial hypertension (IPAH) was successfully treated for malignant catatonia with electroconvulsive therapy (ECT) in what may be the first case of its kind.

Her story is described in a recent study titled “A case of malignant catatonia with idiopathic pulmonary arterial hypertension treated by electroconvulsive therapy,” published in the journal BMC Psychiatry. She was treated at the Tokyo Medical and Dental University in Tokyo, Japan.

The young woman was diagnosed with IPAH when she was 8 years old, and her disease progressed despite treatment. At the age of 12, she started to receive continuous infusions of epoprostenol, which helps dilate narrowed blood vessels. When she was 16, she was diagnosed with diabetes and started treatment with insulin injections. The epoprostenol treatment was effective for a while, but when she reached the age 23 her IPAH worsened.

The patient’s complex medical history also included psychiatric illness. She was hospitalized at the age of 20 and 21 because of attempted suicide, and was treated with antidepressants and antipsychotic medication for psychotic depression. Later, her diagnosis was changed to schizophrenia.

When she was 23 she stopped taking her psychiatric medication as prescribed. Her symptoms of schizophrenia gradually worsened, and she was hospitalized in the psychiatric ward.

Despite medical treatment, she developed malignant catatonia, a a state characterized by psychosis, autonomic instability, mutism, and extreme exhaustion. The condition usually develops as a severe consequence of psychiatric illness such as schizophrenia, bipolar disorder, or depression.

Patients with IPAH who undergo anesthesia and surgery are known to have a high risk of death. Therefore, doctors have to be very careful when administering medication or therapies that could affect the patients’ circulatory system.

But malignant catatonia is also a life-threatening condition and requires proper care, as it can severely impair physical movement and might lead to cardiovascular instability, respiratory failure, coma, and often death if left untreated. ECT — electroconvulsive therapy — is the most effective treatment for the condition, and often offers fast relief.

Due to the patients’ cardiovascular instability associated with catatonia, ECT was initiated after obtaining informed consent from her family. The most serious complication of ECT is pulmonary hypertensive crisis, so a pediatric cardiologist and a medical engineer carefully observed her status during all ECT sessions.

The team reported that her heart frequency increased during the treatment sessions, but her blood pressure was kept within the expected range. Her symptoms of malignant catatonia, such as a fast heartbeat, high blood pressure, fluctuating blood-sugar levels, and fever, were gradually relieved and reached normal ranges after nine ECT sessions.

Following the completion of 14 ECT sessions, her mental health returned to a normal status, and she left the hospital 93 days after arriving. She was followed up on an outpatient basis and remained stable with medication.

Based on this case report, the authors concluded that “ECT is an acceptable option for the treatment of medication-refractory psychiatric disturbances in patients with IPAH, provided careful management is assured to prevent or address complications.”


  1. Cheryl Prax says:

    You are blind to the fact that you have destroyed this woman’s life with your drugs and electroshock.
    Electroshock gives temporary brain damaged euphoria followed by a return of depression but with permanent brain damage.
    Your torture contimues

  2. Pamela Spiro Wagner says:

    This is a very serious misrepresentation. This patient’s catatonia “score” was steeply declining before ECT was ever administered, as you would note if you read the case and looked st the graphs provided. Furthermore, she was in fact not truly catatonic at all. She exhibited autonomic instability and tachycardia but no stupor, and in my view the very fact that she had been intubated by force and shocked into grand mal seizures against her will would be quite enough to induce an autonomic reaction and tachycardia. This is shameless abuse of power and nothing less than brutality!

  3. Deirdre Oliver says:

    What is “Malignant Catatonia”? Historically “Catatonia’ was never a diagnosis in its own right. It was a category of schizophrenia,i.e. “catatonic schizophrenia” with very specific features. When and where I studied (1969 -72 in a 1000 bed hospital in a 3000 bed psychiatric compound)) it had not been seen for over 10 years. It was thought to have been a withdrawal/ dissociative state associated with the dreadful conditions found in the old mental hospitals and since the improvements of the 1950s and 60s it was never seen.
    Is this another yet diagnosis manufactured to explain away mismanagement, mistreatment and abuse, similar to the made up “dissociative dementia”, an invented term supported by zero literature produced by Harold Sackheim in defense of a court action by a seriously cognitively damaged plaintive. The man lost. (Colin Ross (email Sept. 2013 – incident 2006)
    It seems that people so distressed by their treatment that they withdraw are now labelled “catatonic” and are fodder for the SHOCK machine. Yet another example of doctors having to DO something when doing nothing might have prevented the problem in the first place and almost certainly would prevent it getting worse. This poor young woman now has brain damage along with all her other problems and of course when she realises and gets distressed again, they’ll say, “see it worked in the past so we’ll do it AGAIN!” God help her!

    • Thank you, Deirdre Oliver, for pointing out that “catatonia” is frequently misapplied, and likely was so here. In any event, I have never been convinced that ECT “treats” catatonia, whether such symptoms arise from so-called schizophrenia, depression or medication overdose and/or hospital abuses or gross mismanagement. Oh, indeed, the person may seem to recover, apparently concomitant to the electroconvulsive “treatments” and grand mal seizures induced in her brain, but in my experience, this is likely more due the mechanics of sheer terror than to any ECT “response.”

      I was also appalled that a 23-year old woman was repeatedly treated as a pediatric “case” and after a suicide attempt given “anti-psychotic drugs”, well before she was diagnosed as “psychotic” (or so it appears reading the case report.)

  4. Deirdre Oliver says:

    In fact ECT doesn’t “treat” anything. It superimposes a series of traumatic brain injuries (TBIs) over whatever condition the individual has. The results are those of an acute Organic Brain Syndrome and may include a transient mild euphoria (also found following seizures), emotional blunting, apathy, memory disturbance and mood changes. In fact for a fuller view of the acute and long term consequences of ECT, check out TBI and ABS. There are also likely to be EEG abnormalities for a short period, but these may be protracted and/or permanent. Like so many psychiatric interventions that treatment CAUSES abnormalities where none existed prior.
    Remember: a TBI occurs when an external force disrupts normal brain function – ECT is an external force (450 volts pulsing for 8 seconds) that causes a seizure and coma, both serious disruptions of normal brain function – therefore ECT causes a TBI every time. This is an indisputable FACT. Psychiatrists admit that memory loss is `common’ and, “the most common symptom of brain injury is loss of old memory and difficulty forming new memories. (Brain Foundation) This cannot be blamed on depression as it is found in ALL ECT recipients, regardless of diagnosis.

  5. Christopher James Dubey says:

    I lived through forced ECT as a young adult from 2005-2006 at the Institute of Living in Hartford, Connecticut. You can find some of my articles online. What doctors perceived is not what I experienced. They kept saying any bad perception of ECT was due to some old movie, even when I screamed. ECT survivors have made multiple attempts at legal actions over the years. One has been pursuing a class action for some time. I myself got a bill started in Connecticut in 2013, sponsored by two politicians, with widespread support. We may try again soon. I was glad to record the names of the abusers, ahem “doctors,” who hurt me, for the public record. I hope to take part in at least one of these legal actions against the device manufacturers, FDA, or prescribers. I know many people hurt by ECT, even some who initially thought it was a “miracle” or a “life-saver.” The harm isn’t always immediately apparent. ECT is a medically accepted form of traumatic brain injury. It “works” by similar means as lobotomy, which the media and the medical profession were enamored with not so long ago in history.

Leave a Comment

Your email address will not be published. Required fields are marked *