the burden on the families of the patients is not only emotional , but also a financial one . some of these patients , with affective symptoms and more schizophreniform symptoms as part of the primary diagnostic entity , may be helped by electroconvulsive treatment ( ect ) . this was already shown in a paper penetrating the medical records of the first series of patients treated by meduna in budapest , albeit with camphor . rabheru and persad reviewed the literature on continuation and maintenance electroconvulsive therapy in different patient groups in 1997 . the efficacy of maintenance ect has recently been shown in a study of major depression . they concluded that both continuation and maintenance electroconvulsive therapy were efficacious , safe , well tolerated , and also cost - effective for patients with major psychiatric disorders with depression . the procedure in itself is deemed extremely safe according to nuttal et al . who studied 2279 patients given 17,394 ect treatments . no deaths were observed , and only transient cardiac complications ( arrhythmias and one cardiac arrest ) in 9 patients . the adverse effects of ect are related to the anaesthesia , which today is very short and practically without any danger of mortality . headache and nausea occur in some patients , and transient memory impairment is usual during the time of a series of ects . the indications for ect around the world differ , although the main indication is severe depression , uni- or bipolar or as part of other mental illnesses . . thus it would be of interest to report on the treatment of a patient with severe mental illness , purportedly diagnosed as schizophrenia , given ect for more than seven years . we describe a patient with severe symptoms from the age of 20 . his illness started during military service in 1973 . the military doctor observed that he suddenly one day was sitting under military training staring , answering only yes or no . he was referred to the psychiatric asylum on chlorpromazine 50 mg twice daily . in the asylum his illness was described as catatonic episodes or a parkinsonistic crisis . shortly after arrival he had a general seizure and later minor seizures . after one week he responded to other people and after three weeks he was sent home on 4 mg haloperidol . for 12 years he lived a fairly normal life with work and non - resident contact with a psychiatrist . stay he had taken contact with hare krishna groups , giving him a state of incoherent speech and agitation . this time he was treated with the following medication : haloperidol 40 mg , levomepromazin 300 mg , perfenazin 32 mg and orfenadrin 200 mg per die . in 1995 he probably had neuroleptic malignant syndrome ( nms ) and was treated in a somatic department . 2006 he had several grand mal seizures and a new serious episode of nms . after this episode ect was started and already at the 6th treatment he was deemed to be normal . maintenance ect was not started and after some months he was again referred to the hospital and was in need of 10 ect treatments before he remitted . 2007 he started with regular ect at two weeks intervals , later the intervals have changed and before the latest referral he was on ect once weekly . he recently dropped out of the regular , scheduled ect for three weeks and he relapsed with involuntary movements and incoherent speech . a lorazapam challenging test with only 1 mg orally was given because the department did not have injectables . he was put on lorazepam 1 mg thrice daily and ect could again be given after two days . when asked about his memory he had no complaints after all these years with ect . ect is performed in dedicated rooms in the acute psychiatric department with an anaesthesiologist and anaesthetic nurse present . two eeg leads and pulse oxymeter readings are registered together with ecg and the calculated output from the thymatron device . most of his treatments have been as a non - resident patient coming to the hospital only for the sessions . the treatments have been given with right unilateral stimulating electrode placement with 90 - 100% stimulation level . ect is performed in dedicated rooms in the acute psychiatric department with an anaesthesiologist and anaesthetic nurse present . two eeg leads and pulse oxymeter readings are registered together with ecg and the calculated output from the thymatron device . most of his treatments have been as a non - resident patient coming to the hospital only for the sessions . the treatments have been given with right unilateral stimulating electrode placement with 90 - 100% stimulation level . the present case demonstrates the importance of a thorough clinical diagnosis in patients with changing stupor and mutism , florid megalomanic and muscular symptoms . the seizures as observed already by karl ludwig kahlbaum after 1863 may be a signal of the disease of catatonia in an early stage . the use of lorazepam is both a diagnostic tool and a treatment supplement besides ect when the patient suffers from catatonia . treatment with ect over many years may influence memory and cognition , but the severity differs greatly . his definite improvement would be a positive input in the vivid on - going discussion by lay people and psychologist / psychiatrists on cognitive deficits after ect . it is still disputed in the literature , less among clinicians , whether ect as a maintenance option is effective . the nice guidelines ( national institute of clinical excellence , technology appraisal 59 ) from 2003 are negative , but their conclusion is based on mostly retrospective reports , and not the following study . in a prospective , controlled study swoboda et al . studied a group of patients ( n=42 ) with affective or schizoaffective disorder . frequent maintenance ect , as in our patient , may keep the incumbent out of hospital . the nice guidelines conclusion may thus be irrelevant in these special patients as mentioned in the most recent textbook on ect . and in a case as the present , with catatonia , evidence for the positive effect of ect with or without the use of lorazepam is forthcoming . the outcome years after a series of ect may in many cases not be very different from other short - term treatment options as pharmacotherapy and/or psychotherapy for depressions . helping patients develop skills to cope with lifea and are necessary would be a task for other health professionals than those administering the treatment . in a small follow up study after ect some patients committed suicide long time after the end of the series . the patients had serious problems with coping in life as assessed by the sense of coherence test of antonovsky . long - term maintenance treatment may thus contribute to a lower mortality rate in severely depressed patients . the present patient finally got a proper diagnosis after experiencing nms twice and thus forcing his clinicians to offer him ect .
some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions . 
 we present a patient who at the age of 19 developed several schizophrenia - suspect symptoms . 
 soon inexplicable general seizures where observed . 
 he was treated with antipsychotics , but had two bouts of malignant neuroleptic syndrome . 
 electroconvulsive therapy ( ect ) gave some symptom relief and he continued on maintenance ect for years with weekly intervals . 
 interruption of this treatment pattern rapidly increased symptom load . 
 after seven years a lorazepam provocation test was performed as he had a new relapse after 3 weeks without ect . in the ensuing hours 
 his aggressiveness and nonsense speaking rapidly diminished . 
 kahlbaums observation of seizures as part of a catatonia was not understood in this case . 
 the publication of the new dsm - v diagnosis of catatonia may hopefully reduce the probability of treating a patient for schizophrenia for years without access to a more targeted medication and ect plan .