Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy

Abstract

Objective To investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT). Methods We conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables. Results Prevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m 2 vs 24.1 ± 5.2 kg/m 2 , t = −2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83–0.99, p < 0.035). Conclusion PIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.

The Role of Acetylcholinesterase Inhibitors in the Treatment of Prolonged Postelectroconvulsive Therapy Delirium

“…Associated cognitive impairment, however, can at times serve as a deterrent to initiate treatment or may result in early termination of treatment. ECT postictal delirium is one of the distinct cognitive side effects of ECT with variable incidence rates ranging from 5 to 36% [ 10 – 13 ]. It can present as agitated delirium on emergence from anesthesia [ 14 ].…”

“…In addition to the prolonged confusion, features of hypomania have been described in adults over age 75 and have been noted to spontaneously resolve within 2 weeks of cessation of treatment [ 16 ]. Risk factors associated with postictal delirium include the presence of concomitant catatonia; presence of cerebrovascular disease, Parkinson's disease (PD), or dementia; bitemporal stimulation; high stimulus intensity; longer seizure length; use of dexmedetomidine or etomidate; higher body mass index (BMI); concomitant use of high-dose quetiapine; and the lack of use of antidepressants [ 10 , 11 , 13 , 17 , 18 ]. Age has been described as a risk factor for acute postictal disorientation, more specifically time to reorientation [ 19 ].…”

Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study

“…Unfortunately, ECT is associated with cognitive side-effects which hamper more broad application and successful treatment ( 1 ). About one third of patients may experience postictal confusion immediately after the ECT-sessions, which may cause discomfort and even premature termination of this potentially beneficial treatment ( 2 ). A quarter of ECT-patients show a significant decrease in cognitive functioning 1 week after cessation of the ECT-course ( 3 ).…”

Severe Postictal Confusion After Electroconvulsive Therapy

“…Most often, these symptoms are mild. However, severe postictal confusion (sPIC) occurs in 16% to 39.9% of ECT patients 4–6 . Severe postictal confusion may lead to injuries in the patient and surroundings, making this a very stressful event, not only for patients but also for family and health care professionals involved.…”

“…However, severe postictal confusion (sPIC) occurs in 16% to 39.9% of ECT patients. [4][5][6] Severe postictal confusion may lead to injuries in the patient and surroundings, making this a very stressful event, not only for patients but also for family and health care professionals involved. After experiencing sPIC, most patients experience feelings of shame and/or anticipation fear for future ECT sessions, which sometimes leads to prematurely discontinuation of the ECT course.…”