Successful ect treatment of a treatment resistant manic bipolar patient with intracra- nial mass and pulmonary embolism history: Case

Abstract

Electroconvulsive therapy (ECT) is an effective and safe treatment method used in many psychiatric disorders. The efficacy and safety of ECT in the presence of an intracranial mass is controversial. The presence of a space-occupying mass was a contraindication to ECT until the 1980s. With the changes in ECT protocols over time and its application to more patients, positive data on the safety of ECT in intracranial masses have begun to accumulate. Available data suggest that ECT can be safe-ly used in patients with benign, small, and otherwise clinically insignificant tumors. A history of pulmonary embolism (PE) accompanying a psychiatric disorder may cause clinicians to avoid ECT. There are some concerns regarding the use of ECT in patients with a history of PE as there is little evidence for the safety of the implemen-tation of ECT. Although there is limited evidence regard-ing the safety of ECT in the presence of comorbidities, ECT can be successfully implemented where there is no response to other treatments with the necessary consul-tations and close follow-up, without delaying the treat-ment. In this article, a case who had been followed up with a bipolar affective disorder diagnosis, was hospita-lized for manic episode, who had comorbidities such as intracranial tumor and PE history, who did not benefit from psychotropic treatments and who responded sig-nificantly to nine sessions of ECT without any complica-tions is presented. The case presented here is, as far as is known, the first report where comorbidities such as intracranial tumor and pulmonary embolism history, which may cause clinicians to hesitate to implement ECT, co-exist.