Delayed onset and prolonged interictal delirium following electroconvulsive therapy

Abstract

Electroconvulsive therapy is safe and effective in the treatment of depression in older individuals. Minor cognitive side effects of electroconvulsive therapy include acute postictal confusion and reversible short-term memory deficits. However, interictal delirium is uncommon in absence of risk factors. Herein, we report the case a depressed male patient without any known risk factors who developed interictal delirium 2 days after his sixth electroconvulsive therapy session. Interictal delirium improved with treatment within 1 week.

Delayed Onset and Prolonged ECT-Related Delirium

“…Both of these cases described this presentation as a delirium [17, 18]. An interictal delirium usually occurs after a prolonged period of disorientation following ECT or can even occur independently of the post-ictal state [18, 19]. The most common risk factors are older age, subcortical and basal ganglia lesions, heart disease, Parkinson's disease, and Alzheimer's disease [20, 21].…”

“…Two other subtypes of delirium after ECT have been described. The most common subtype is an acute post-ictal disorientation characterized by a confusional state immediately after ECT typically self-resolving in an hour [18, 22]. The third is a post-ECT delirium highlighted by hyperactivity that usually begins a few minutes after the seizure induced by ECT [17, 18, 23].…”

“…The most common subtype is an acute post-ictal disorientation characterized by a confusional state immediately after ECT typically self-resolving in an hour [18, 22]. The third is a post-ECT delirium highlighted by hyperactivity that usually begins a few minutes after the seizure induced by ECT [17, 18, 23]. Most post-ECT delirium cases last less than an hour, tend to occur during the initial ECT treatments especially in those switched from unilateral to bilateral treatment, and usually resolve spontaneously or after the administration of diazepam, midazolam, barbituratesm, or droperidol [16, 18, 24].…”

“…The third is a post-ECT delirium highlighted by hyperactivity that usually begins a few minutes after the seizure induced by ECT [17, 18, 23]. Most post-ECT delirium cases last less than an hour, tend to occur during the initial ECT treatments especially in those switched from unilateral to bilateral treatment, and usually resolve spontaneously or after the administration of diazepam, midazolam, barbituratesm, or droperidol [16, 18, 24]. Our patient's presentation did not fit the above scenarios.…”

Patient with Prolonged Psychosis after Electroconvulsive Therapy

“…The other case described a 50-year-old man with depression who developed delirium 2 days after his sixth ECT session. 8 His symptoms lasted longer, showing improvement after 1 week with administration of haloperidol, lorazepam, and donepezil. The cause of his symptoms was not clear, as he did not have any risk factors or cortical abnormalities; bilateral electrode placement and older age were thought to have contributed to his condition.…”