Discussion:
To our knowledge, only fourteen case reports have been published concerning catatonia with OCD manifestation (Blacker, 1966; Duarte-Batista et al., 2020; D’Urso et al., 2012; Elia et al., 2005; Eryılmaz et al., 2014; Fontenelle et al., 2007; Hermesh et al., 1989; Jagadheesan et al., 2002; Jaimes-Albornoz et al., 2021; Makhinson et al., 2012; Mukai et al., 2011; Nikjoo et al., 2022; SACHDEVA et al., 2015), among which only four articles have shown ECT efficacy for recurrent catatonia (D’Urso et al., 2012; Eryılmaz et al., 2014; Jagadheesan et al., 2002; Makhinson et al., 2012). A study by D’Urso et al. showed successful treatment of catatonia and OCD whereas, Duarte-Batista et al. in their study depicted transient improvement of catatonia, eventually requiring Deep Brain Stimulation (Duarte-Batista et al., 2020; D’Urso et al., 2012). In our study, we present effective management of recurrent catatonia using ECT. However, despite the use of antidepressants and ERP therapy, OCD was not successfully treated. In a meta-analysis conducted by Pluijms et al., the efficacy of ECT for major depression improved significantly with an adjuvant antidepressant (Pluijms et al., 2021). Additionally, our patient displayed depressive symptoms; she described signs and symptoms consistent with a major depressive disorder diagnosis after ECT and an SSRI helped her recover from catatonia. It was noted that in the past 13 years, there have been three instances of recovery from catatonia followed by closely spaced episodes of depression and OCD. In her first two episodes, depression persisted for 6–8 months while OCD persisted for 1-4 weeks. However, this pattern of depression followed by OCD appeared to be reversed in her most recent episode of catatonia, where the depression persisted for 2 weeks and OCD for 7 weeks.
The following table summarizes the treatment interventions and outcomes of individual cases: