Is Electroconvulsive Therapy Safe for Patient with Very Low BMI? A Case Report

ECT in a Patient with Low BMI
Vol. 11 No. 1 : 2016 (83-86)

LOO JL LOO JL
FARAH DEENA AS FARAH DEENA AS
HATTA S HATTA S

Abstract
A case of rapid stabilization using electroconvulsive therapy (ECT) for a major depressive disordered (MDD) patient with life-threatening low body mass index (BMI) is reported. This case report focuses on a 55-year-old Malay housewife with underlying hyperthyroidism in a euthyroid state who presented with MDD with mood congruent psychotic features, which were precipitated by the death of her husband. Her BMI was only 11 kg/m2 due to severe anorexia, and she was highly suicidal. Peripheral total parenteral nutrition was started and ECT was commenced for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout admission. The patient was discharged at BMI of 13 kg/m2 with good appetite. ECT was safe for very low BMI MDD patient.
Keywords : anorexia, electroconvulsive therapy, major depressive disorder, rapid stabilization, very low bmi,
Abstrak
Laporan kes ini mengetengahkan kaedah penstablian terapi elektrokonvulsif (ECT) yang cepat bagi pesakit kemurungan major (MDD) yang mempunyai indeks jisim berat badan (BMI) tersangat rendah. Kami melaporkan seorang suri rumah wanita berumur 55 tahun dengan masalah penyakit hipertiroid yang berada di dalam status eutiroid mengalami masalah kemurungan major dengan ciri khusus psikosis kongruen akibat daripada kematian suami pesakit. Paras BMI beliau hanyalah pada tahap 11 kg/m2 disebabkan oleh anoreksia dan pesakit berkenderungan untuk membunuh diri. Preskripsi pemberian nutrisi secara parenteral sepenuhnya diberi dan rawatan ECT telah dilaksanakan untuk rawatan penyakit kemurungan secara penstabilan yang cepat di samping rawatan oral menggunakan ubat escitalopram 15 mg setiap malam. Penyembuhan sepenuhnya tercapai selepas rawatan terapi sebanyak sembilan kali ECT dan berat badan naik secara sihat di dalam wad. Pesakit telah dilepaskan pada tahap BMI sebanyak 13 kg/m2 dengan selera makan yang baik. Secara kesimpulannya, rawatan ECT adalah selamat untuk pesakit kemurungan major yang mempunyai paras indeks jisim berat badan sangat rendah.
Kata Kunci : anoreksia, kemurungan major, paras jisim indeks badan rendah, penstabilan cepat, terapi elektrokonvulsif,

Correspondance Address
Hatta Sidi, Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91456142 Fax: +603-91456681 Email: hattasidi@hotmail.com