Table 2 Acute course of L’s electroconvulsive therapy
From: Case report on Cotard’s syndrome (CS) in a patient with schizophrenia: a rare case from Malaysia
Session | Stimulus dosage | Seizure activity | Electroencephalography reading | Recommendations | Outcome of electroconvulsive therapy |
|---|---|---|---|---|---|
1 | 4% | No seizures | No EEG reading | L still believed that her body was decaying. However, she was able to consume 2-3 spoonsful of rice by herself. Suicidal thoughts were still profound . | |
8% | No seizures | No EEG reading | To increase the percentage to 16% for the next ECT | ||
2 | 16% | No seizures | No EEG reading | L’s belief of her body decaying was reduced. Her food intake was increased from 2-3 spoonsful of rice to half a plate “My organs are starting to function and I feel my body is healing.” | |
32% | Flickering of toes | Spike activity poorly defined with slow irregular waves (subthreshold EEG) | |||
48% | Flickering of toes | Subthreshold EEG | To increase the percentage to 56% for the next ECT | ||
3 | 56% | Flickering of muscles in lower limbs | Subthreshold EEG | Without prompting, L was able to finish a whole plate of rice by herself. | |
64% | Generalized tonic clonic movement of the upper and lower limbs for 19 s | EEG showed suprathreshold symmetrical waves for 27 s | To maintain the same percentage for the next ECT | ||
4 | 64% | Generalized tonic clonic movement of the upper and lower limbs for 15 s | EEG showed suprathreshold symmetrical waves for 21 s | To maintain the same percentage for the next ECT | In addition to food intake, L’s self-care had also improved. She was able bathe and use the toilet. Her beliefs progressed from decaying body to her internal organs functioning well, her body felt warm and “there is blood circulation coming back to my body.” After this round of ECT, subjective feelings of suicidal thoughts had markedly decreased |
5 | 64% | Generalized tonic clonic movement of the upper and lower limbs for 14 s | EEG showed supra-threshold symmetrical waves for 17 s | To maintain the same percentage for the next ECT | L appeared more cheerful, happy and reactive to surroundings. She believed her organs had returned to full functionality. Decreased suicidal thought was sustained |
6 | 64% | Flickering of muscles in upper and lower limbs | Subthreshold EEG | L’s appetite had significantly improved. “I feel alive, I am alive. My organs are fully functioning now. I am not suicidal anymore.” After this round of ECT—no persecutory delusion(s), no nihilistic delusions. Activities of daily living improved. She was no longer suicidal | |
75% | Generalized tonic clonic movement of the upper and lower limbs for 15 s | EEG showed supra-threshold symmetrical waves for 20 s | This is the last ECT session. L completed 6 sessions of acute course of ECT |