J Neuropsychiatry Clin Neurosci 20:379-380, August 2008
© 2008 American Neuropsychiatric Association
ECT Treatment for Two Cases of Dementia-Related Pathological Yelling
To the Editor: Current guidelines support the use of ECT in individuals with mood disorders unresponsive to pharmacologic treatments.1 Recently, ECT has been identified as an effective intervention for medication refractory verbal and physical agitation in patients with dementia, developmental disability, and traumatic brain injury.2,3 Behavioral dyscontrol presenting as verbal agitation (inappropriate vocalizations or chronic hollering unexplained by other causes) is a common and troublesome dementia-related condition and is difficult to manage in a long-term care setting.4 Among patients demonstrating extensive episodes of verbal agitation secondary to dementia or other underlying illnesses (namely major depression or bipolar mania), the primary intervention after the failure of nonpharmacological measures is the judicious use of evidence-based medications.5 ECT use is generally reserved for refractory circumstances or when medications are poorly tolerated.6 We report two cases of successful use of ECT for patients with dementia who demonstrated severe verbal agitation and presented no known previous history of major depressive or mood disorders.
Ms. A is an 88-year-old woman with no previous psychiatric admissions and a 6-year history of probable Alzheimer’s disease dementia and Parkinson’s disease. She was transferred to the medical psychiatry unit from a nursing home...read the whole letter