Reference no: EM133602014

Question

A 26-year-old white male was admitted after being transferred from the outpatient evaluation service with severe homicidal and suicidal ideation. Admitting diagnoses was severe major depressive disorder with psychotic features. The patient uses cannabis weekly. pharmacologic treatment was initiated and suicide precautions were instituted. After a thorough neuropsychological , personality, and behavioral psychologic evaluation, the risks and benefits of ECT were reviewed. Due to the severity of the psychotic episode and the patient's delusional state, it was determined that ECT was warranted. Extensive efforts were made to secure informaed consent from the patinet, and a course of single seizure unilateral ECT was begun. ECT was administered three times per week, and the course of therapy was completed in a three-week period. on the fourth treatment of ECT, postictal observation was notable for cardiac arrhythmia, which subsided without sequelae. Otherwise, the patient tolerated the therapy well and responded quickly with resolution of the psychotic features and overall improvement in the acute phase of his depressive disorder. Suicide precautions could be lifted after the fifth treatment with ECT. After establishing adequate therapeutic levels of lithium, the patient was discharged to be managed as outpatient. Discharge Diagnosis: Sever major.