Joshua L. Cohen, PhD, My-Hanh Thi Vu, MD, Mirza Adam Beg, BS, Soumya Sivaraman, MD, Badari Birur, MD

ABSTRACT

Somatic delusions occur in a variety of psychiatric disorders including schizophrenia, major depressive disorder, and bipolar disorder. Somatization is associated with lower quality of life and greater risk for suicide. Treatment of somatic delusions is extremely challenging. Here we report an interesting case of severe somatic delusions in a 48-year-old African-American female with a long history of treatment resistant schizoaffective disorder, with multiple somatic complaints surrounding constipation, pregnancy, jaw pain, body aches, vaginal itch, malodorous urine, and neck pain, despite normal clinical examinations and negative medical work up. Additionally, she endorsed persistent auditory and visual hallucinations. Her symptoms remained resistant to several trials of psychotropic medications, including clozapine. Chart review of past hospitalizations revealed significant improvement with Electroconvulsive Therapy (ECT), so the team decided to perform a course of six bi-temporal ECT treatments administered over two weeks. Stimulation was applied at a current of 800mA for 4.5s, with a pulse width of 1ms and frequency of 60 Hz. This case illustrates the successful use of ECT in treating prominent somatic delusions in a patient with treatment- resistant schizoaffective disorder.