Psychotic symptoms as a complication of electroconvulsive therapy – a case report

Abstract

We report a patient who experienced atypical symptoms in the course of electroconvulsive therapy (ECT). During ECT treatment patient experienced psychotic symptoms which should be differentiated with prolonged delirium and nonconvulsive status epilepticus. 46-year-old female was referred to hospital with a diagnosis of major depressive disorder with no psychotic features in the course of recurrent depression. Despite several changes of pharmacological treatment no improvement was achieved, therefore it was decided to initiate ECT. Physical and neurological examination revealed no deviations from the norm. The results of other tests (CT and EEG) were normal. 4 bilateral, bitemporal ECT procedures were performed. The course of each procedure was typical, the same doses of anesthetic medication and pulse dose was administered throughout all of the procedures. The duration of seizure was 32-40 s. Despite this mental symptoms observed during the course of the treatment differed from known to the authors from both their own experience and from literature. Delusions of reference, persecution, agitation, oneiric delusions and olfactory hallucinations which appeared after the 4th ECT session maintained for 14 days and resolved after treatment with olanzapine. To the best of our knowledge, this is the first report on delusions of reference and persecution, oneiric delusions and olfactory hallucinations associated with the course of ECT.

Visual hallucinations following electroconvulsive therapy for major depressive disorder

“…However, there have been reports of other psychotic symptoms associated with ECT. Antosik-Wójcińska and colleagues reported a case of ECT causing delusions of reference, persecution, agitation and olfactory hallucinations in a 46-year-old woman 9. These symptoms occurred after the fourth ECT treatment.…”

Electrolyte Disturbances Related to Sodium and Potassium and Electroconvulsive Therapy: A Systematic Review

“…While our review has highlighted the potential safety of ECT in patients with electrolyte disturbances, it is essential to acknowledge the factors associated with limiting its application. Elevated intracranial pressure is only one absolute contraindication of this treatment, while relative contraindications include acute somatic conditions [62]. However, as a medical procedure, ECT is not without potential adverse effects.…”