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Successful and Rapid Response to Electroconvulsive Therapy of a Patient With Obsessive Compulsive Disorder and an Incidental Cyst.

A 65-year-old, married woman was admitted to the inpatient psychiatry unit in April 2018 after an extended bout of depression, as well as symptoms of obsessive compulsive disorder (OCD) and anorexia. Her history was notable for a large intraparenchymal lateral ventricular cyst. Magnetic resonance imaging (hereinafter) showed a 6.3-cm cyst within the right lateral ventricle, with adjacent parietal hyperintensity thought to be secondary to periventricular edema. The neurosurgical opinion was that the cyst was nonobstructive and appeared stable. Furthermore, therewere no absolute contraindications to electroconvulsive therapy (ECT), although the treatment carried a significant risk of altered electrical patterns because of differences in density compared with the typical norm. The patient's treatment also was notable for chronic hyponatremia, which began 2 years ago (subsequent and not causative to her psychiatric issues) and was recorded as low as 124 (reference values = 136–144 mmol/L). At the time of admission, her sodium was 129; she received only one bolus of 750-mL normal saline during her admission. Sodiumvalueswere checked before each inpatient ECT treatment and remained stable between 130 and 132 mmol/L. Because of the intracranial abnormality, bilateral electrode placement approach was used to minimize potential adverse effects and potential cerebral mass effect. Thymatron spectrum was used with 0.25-ms Duke titration schedule. We used succinylcholine 60 mg for paralytic effects and methohexital 50 mg for anesthesia. Nitroglycerine was used 9 times, and labetolol twice, to control the hypertensive response over her first 12 treatments. Convulsive duration ranged from 39 to 102 (average, 52), whereas electroencephalogram