Delayed Onset and Prolonged ECT-Related Delirium

Abstract

Electroconvulsive therapy (ECT) is effective in the treatment of depression. Delayed post-ECT delirium is rare but can occur in a small subset of patients with risk factors and in most cases resolves with the use of psychotropic medications. We report a unique presentation of a patient who developed a delayed post-ECT delirium with fecal incontinence that commenced 24 hours after the administration of ECT. The condition resolved spontaneously after 48 hours without the use of psychotropic medications.

Electroconvulsive Therapy and Risk of Dementia—A Nationwide Cohort Study in Taiwan

“…Other studies presented that ECT-related deaths were either very low or none at all ( 5 – 7 ). The ECT cohort with prolonged seizures ( 39 , 40 ), post-ECT in-hospital delirium ( 41 ), and MACE's ( 9 ), were complications of ECT. Our study found that these prolonged seizures in-hospital, post-ECT in-hospital delirium, and acute stroke were associated with an increased risk of dementia for the ECT cohort.…”

Patient with Prolonged Psychosis after Electroconvulsive Therapy

“…One case described a 41-yearold woman with depression who developed a delayed-onset delirium after her third ECT session. 1 In this case, her confusional state resolved spontaneously within 48 hours. No antipsychotics were necessary.…”

“…Multiple theories describing variations on neurotransmitters causing changes in pituitary hormones and increased neural plasticity or synaptogenesis 1,9 have been developed to explain the mechanism by which ECT works. The monoamine neurotransmitter theory postulates that ECT alters dopamine, serotonin, and adrenergic transmitters by augmenting receptor sensitivity or neurotransmitter availability.…”

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

“…Electroconvulsive therapy (ECT) is a safe and efficacious treatment modality that has been utilized since 1938 to treat several psychiatric conditions including severe depression, bipolar disorder, schizophrenia, and catatonia [ 1 , 2 ]. ECT can produce minor adverse effects such as headache, myalgia, and nausea [ 3 , 4 ]. However, one of the more concerning adverse effects often seen with ECT is cognitive impairment.…”

“…However, one of the more concerning adverse effects often seen with ECT is cognitive impairment. ECT-induced cognitive impairment includes transient delirium, anterograde amnesia (i.e., difficulty retaining new information), and retrograde amnesia (i.e., impaired recall of memories formed prior to ECT) [ 3 – 5 ]. Post-ECT delirium can occur in up to 36% of patients receiving ECT [ 6 – 8 ].…”