catatonia was first described by kahlbaum in 1874 , as a brain disorder , which has cyclic , alternating and progressive course . over the years , understanding about catatonia has increased and it is now well - known that besides the primary psychiatric disorders , catatonia is associated with many neurological and medical disorders . catatonia in adolescents has been reported to be associated with affective , psychotic , autistic , developmental , drug induced and medical conditions . further , as in adults , catatonia in children and adolescents also responds to benzodiazepines and electroconvulsive therapy ( ect ) . however , the literature on the use of ect in adolescents with catatonia is limited . in this case report , we present a case of catatonic schizophrenia , treated with ect and review the literature on the use of ect in adolescent catatonia . a 16-year - old single girl presented with an insidious onset illness of 3 year duration . for the initial 1 year , the symptoms were characterized by fearfulness , anxiety , derealization and poor academic performance . during the 2 and 3 years of symptomatic phase , she developed additional symptoms of social withdrawal , poor initiative , irritability , muttering and gesturing in air , suspiciousness , delusions of reference and persecution and delusion of misidentification , poor self - care and stopped studying . about a month prior to presentation to our center , her speech output started reducing , she had perseveration and later became mute , had marked psychomotor retardation , ambitendency , active and passive negativism , posturing and refusal to eat . she was taken to a psychiatrist for her symptoms and was given intravenous lorazepam up to 8 mg / day along with risperidone up to 4 mg / day , but did not show any improvement . following this , there was no history suggestive of other delusions , hallucinations in any other modality , made phenomenon , somatic passivity , delusional perception , depressive symptoms , manic symptoms , head injury , fits , loss of consciousness , fever , substance use and thyroid dysfunction . patient was found to have immobility , posturing , withdrawal , gegenhalten , mutism , negativism , staring and drooling of saliva . her bush - francis catatonia rating scale ( bfcrs ) score was 20 . in view of her symptomatology , she was admitted to the in - patient unit of the hospital . on investigation , hemogram , liver function test , renal function test , serum electrolytes , thyroid function test , ultrasound abdomen , computerized tomography of brain , x - ray chest ( posterior anterior view ) and electrocardiogram did not reveal any abnormality . on the basis of the history and mental status examination , a diagnosis of catatonic schizophrenia was considered . she was initially treated with injection lorazepam 4 mg every 6 h for initial 24 h along with tablet olanzapine 7.5 mg / day but did not show any improvement . following this , her parents were educated about the electroconvulsive therapy procedure and the indications for the same in patient . attempt was also made to take patient 's assent before initiating ects , but could not be done considering her condition . she was administered nine ects ( details shown in table-1 ) over the period of 3 weeks and dose of olanzapine was increased to 15 mg / day . with this treatment , gradually she showed improvement in all her symptoms . as her clinical condition improved , her assent was sought for subsequent ects . during this period , assessment for memory impairment was also undertaken following each ect , but patient did not have any subjective complaints or objective signs of memory impairment . by her ninth ect , her bfcrs score came down from 20 to 2 and following this , no more ects were given in view of a plateau of clinical response . on mental status examination , she only had blunted affect with no other active psychopathology at the end of the course of ect . it is recommended that catatonia should be managed with high doses of benzodiazepines ( i.e. , lorazepam or other benzodiazepines ) or ect , in addition to the treatment of underlying medical and psychiatric disorder with specific treatment . however , the literature with regard to the use of ect in adolescents is limited . in a review of the published literature from 1985 to 2009 , the authors located 31 reports , which described 59 cases of catatonia in children and adolescents treated with ect . majority of the patients described in the literature who were treated with ect were males ( 57% ) . the age range of patients varied from 6 to 19 years with only three patients less than 11 years of age . most of the cases were diagnosed with mood disorders ( 47.5% ) and this was followed by schizophrenia ( 27.1% ) , pervasive developmental disorder ( 13.5% ) , organic catatonia ( 5% ) , psychotic disorders other than schizophrenia ( 5% ) and one case ( 1.7% ) each of idiopathic catatonia and familial catatonia with seizures . in terms of response to ect , the data suggested that 45 patients ( 76.27% ) had a favorable response , 3 ( 5% ) cases had a partial response and in one case there was no response to ect . the authors cautioned that while interpreting the efficacy data it is important to remember that there may a potential bias for reporting only those cases , which show improvement with ect . in another review , authors noted that bilateral ( bitemporal or bifrontal ) ect has better efficacy than the unilateral ect . further , it is suggested that if a patient responds partially to lorazepam it should be used concurrently with ect for a better outcome in the acute management of catatonia . we carried out a search in pubmed and could locate 10 reports of use of ect in adolescents with catatonia published after the review of consoli et al . eight out of the 10 reports , described 11 cases in which ect was used in adolescents for treatment of catatonia in patients with varied clinical conditions [ table 2 ] . one case series described the use of maintenance ect in three children with autism , in which ect had led to resolution of acute symptoms of catatonia . in the retrospective study from our center , which described the use of ect in adolescents , out of the 25 patients , 17 had catatonic symptoms and the response rate in patients with catatonia was 91.6% . the present case adds to the limited data , which is available and shows that use of ect can be life - saving in adolescents with severe mental disorders . case reports / case series of use of electroconvulsive therapy in adolescents published after consoli et al . review from the above review , it can be concluded that ect is an effective treatment for management of catatonia in adolescents . in view of the same , rather than banning the use of ect in adolescents , it would be better to leave the decision to use and not to use ect in adolescents in the hands of the clinicians .