Effectiveness of Electroconvulsive Therapy in the Remission of Malignant Catatonia Associated With Schizophrenia: A Case Report

TL;DR

This case report shows how electroconvulsive therapy successfully treated a rare and severe mental condition called malignant catatonia in a schizophrenia patient.

Contribution

The report highlights ECT's effectiveness in treating malignant catatonia within Brazil's public health system.

Findings

The patient showed complete remission of malignant catatonia after 10 ECT sessions.

The patient remained stable for 16 months post-treatment with no recurrence of psychiatric decompensation.

ECT was administered in a public hospital affiliated with Brazil's Unified Health System.

Abstract

Despite the robust body of evidence supporting the efficacy and safety of electroconvulsive therapy (ECT) in the treatment of severe psychiatric disorders, this procedure remains at the center of social debate, often influenced by historical prejudice. Such misconceptions have contributed to restricted access, which typically occurs either through costly private practice or in large academic centers within the public health system. Among the clinical conditions for which ECT is considered a first‐line treatment, malignant catatonia stands out—a rare and potentially fatal syndrome characterized by psychomotor disturbances and severe autonomic instability. If not treated promptly, its mortality rate may reach up to 50%. This case report describes the successful treatment of malignant catatonia in a patient with schizophrenia, in whom ECT sessions were administered intermittently and without a subsequent maintenance phase during inpatient care at a specialized psychiatric hospital affiliated with the Unified Health System in the state of São Paulo, Brazil. After 10 sessions, there was complete remission of the catatonic state, followed by hospital discharge for outpatient follow‐up. After 16 months, the patient maintained psychiatric stability, medication adherence, and partial independence in daily activities, with no new episodes of psychiatric decompensation. The case underscores the effectiveness of ECT in achieving remission of a rare and potentially life‐threatening disorder.

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