A case series of noncatatonic mutism with poor response to conventional treatment approach

Mutism is the absence or marked paucity of verbal output due to functional or organic causes. Selective mutism is commonly seen in children with anxiety disorder. In psychiatric literature, long-standing mutism is most commonly associated with catatonic syndrome in adults. Although less commonly reported, long-standing mutism has also been associated with noncatatonic schizophrenia and posits a treatment challenge. Here, we describe two cases of long-standing noncatatonic mutism secondary to Schneiderian first rank symptoms, which were poorly responsive to conventional antipsychotic treatment and had good response to the combination of antipsychotics and electroconvulsive therapy (ECT). ECT is an underutilized treatment modality in patients with schizophrenia and is usually limited to catatonic states. The case series, thus, highlights the need for the development of an evidence base for the use of ECT in patients with noncatatonic mutism.