Safe Administration of ECT in a Suicidal Patient with a Space-Occupying Astrocytoma

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Benjamin Casola

Augusta University, Augusta

: Int J Ment Health Psychiatry

Abstract

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Electroconvulsive therapy (ECT) can be lifesaving for patients suffering from treatment-resistant psychiatric conditions, especially acute suicidality or depression. However, space-occupying lesions pose risks associated with ECT use due in part to seizure-induced escalations in blood pressure with corresponding increases in cerebral blood flow and possibly intracranial pressure, subsequently increasing the risk of brain herniation. Here, we present the case of a patient with a left medial temporal lobe astrocytoma, worsening epileptic seizures, and nonepileptic seizures who underwent ECT for major depressive disorder and suicidality. The patient had improvement of depressive symptoms, resolution of suicidality, and brief cessation of nonepileptic seizures. Brief anterograde amnesia contributed to the termination of treatment. This case adds to the growing literature about the feasibility of ECT treatment in cerebral lesions prone to changes in intracranial pressure, such as the usually cystic astrocytomas.

Biography

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Benjamin Andrew Casola is a 28-year-old psychiatry resident in Augusta, Georgia. He published a poster with the GPPA in 2019 and was recently published in the JECT for a case report. He has published three works of poetry and short stories "Winterbrook", "Tesoro", and "Ex Tenebris". He also won the Bruce Dearing Award in poetry for his work in the "The Healing Muse". He will continue publishing while working to become a holistic child psychiatrist.