Case Report

Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient

Yvette Nel, Craig A. Bracken
South African Journal of Psychiatry | Vol 29 | a1944 | DOI: https://doi.org/10.4102/sajpsychiatry.v29i0.1944 | © 2023 Yvette Nel, Craig A. Bracken | This work is licensed under CC Attribution 4.0
Submitted: 03 June 2022 | Published: 31 January 2023

About the author(s)

Yvette Nel, Department of Psychiatry, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
Craig A. Bracken, Department of Psychiatry, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa

Abstract

Introduction: The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia.

Patient presentation: This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previous psychotherapeutic interventions.

Management and outcome: We describe the course of management of this patient with ECT, following poor initial clinical response to ECT with propofol induction, the subsequent use of ketamine as an anaesthetic induction agent for ECT, with associated improvement in seizure quality, and good overall clinical response to ECT demonstrated thereafter.

Conclusion and contributions: This case report suggests that ketamine may be a viable induction agent for ECT in this clinical setting.


Keywords

ECT; case report; Ketamine; HIV; catatonia

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