Major depressive episode with psychotic symptoms and difficulty to access electroconvulsive therapy resulting in prolonged hospitalization: a case report
DOI:
https://doi.org/10.37497/JMRReview.v2i1.30Keywords:
Psychiatry, Major Depressive Disorder, Psychosis, Psychotic Depression, Electroconvulsive TherapyAbstract
Aim: To report a case of a patient with severe depressive episode and psychotic symptoms that, that due to difficulty in accessing ECT, led to prolonged hospitalization of the patient.
Method: This is a patient treated at the Psychiatry Service of the Hospital Universitário São Francisco na Providência de Deus – HUSF, located in the city of Bragança Paulista – SP, Brazil.
Case Report: It was a male patient, 57 years old, retired, with symptoms of social isolation, anhedonia, weight loss and intense decrease in fluid intake. He had mixed delirium, inappetence and sleep disorders, being referred to a specialized Hospital after worsening with the initial treatment. Due to her prolonged hospitalization and poor response to treatment (initially with citalopram, levomepromazine and quetiapine), the psychiatry team requested her transfer to a Hospital with ECT, but without success. During hospitalization, the therapeutic regimen was changed to a combination of venlafaxine and quetiapine, the latter being subsequently replaced by risperidone. There was gradual improvement of the condition, with weight gain and discharge after 53 days. In the post-discharge follow-up, the condition was stable and the medication was regularly used, with full return of functionality.
Conclusion: If available, ECT can be a great tool for the treatment of severe depressive episodes, especially with associated psychotic symptoms, mainly in patients with resistance to pharmacological treatments. Its use tends to reduce the length of hospital stay and restore quality of life to patients. The case presented in this paper is a specific example of how the absence of ECT caused an increase in the hospitalization time of a patient with psychotic depression, affecting his routine and quality of life, in addition to generating costs resulting from the provoked hospitalization.
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