高齢期に悪性緊張病による呼吸障害を起こし，ECTが著効した1例

Respiratory Distress due to Elderly Malignant Catatonia Resolved with ECT

抄録

　緊張病性昏迷状態の際にはさまざまな身体症状が随伴することが知られているが，我々は高齢期に2度の悪性緊張病性昏迷による呼吸障害を伴った1例を経験した。いずれも全身状態の悪化が進行したため，modified-Electroconvulsive Therapy(m-ECT)をそれぞれ計12回，10回施行した。その結果，緊張病症状は改善され，それによる呼吸障害も改善した。緊張病により呼吸障害を起こした高齢者にもm-ECTは効果的でかつ安全に施行できる可能性が示唆された。

　Somatic symptoms accompanied by catatonic stupor are composed of symptoms directly coming from catatonia (e.g. tachycardia, lability of blood pressure, fever) and symptoms secondary to catatonia (e.g. malnutrition, pressure sores). Catatonia with severe direct somatic symptoms is called malignant catatonia (MC). We reported that a malignant catatonic woman with respiratory distress was treated successfully with ECT. The patient was a 79-year-old woman. At the age of 37, she exhibited delusions and hallucinations, which resolved with medication. At the age of 77, she was admitted to our hospital. She exhibited stupor, catalepsy, rigidity, high fever, sialorrhea, tachycardia and tachypnea. Her condition was diagnosed as MC. Twelve ECT sessions were given. After them, her symptoms resolved completely. Continuation medication consisted of quetiapine (QTP) 300mg, but after a year her symptoms became aggravated again, so she was admitted to our hospital. She exhibited negativism, delusions of persecution and lack of spontaneity. She was treated with QTP300mg, but her condition did not improve. For delusion, haloperidol (HPD) was given and her symptoms slightly improved. but she became mute and gradually became bedridden. HPD was stopped, but she exhibited stupor, rigidity and catalepsy. In addition, she was unable to expire air due to hypermyotonia around the mouth and exhibited hypoxia, hypercapnia, hypertension, and tachycardia. ECT sessions were given. After acute ECT, her symptoms resolved completely. Continuation medication consisted of QTP300mg and she has been in remission for a year. ECT is effective and safe for respiratory distress due to catatonia