The Use of ECT in the Elderly—Looking Beyond Depression

Chatham, Anthony; Shafi, Hadia; Hermida, Adriana P.

doi:10.1007/s11920-022-01353-0

Cited by 12 publications

(12 citation statements)

References 93 publications

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“…[200][201][202][203] Electroconvulsive therapy (ECT) was shown to improve depression, psychosis, and motor symptoms in patients with PD, although the motor improvement was short-lasting. 204,205 Dementia with Lewy Bodies. Patients with DLB are highly sensitive to antipsychotic parkinsonian side effects and may experience motor symptom exacerbation.…”

Section: Management Of Psychotic Symptoms In Neurodegenerative Diseasesmentioning

confidence: 99%

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Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

Seritan

2023

J Geriatr Psychiatry Neurol

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Background: Approximately 15% of older adults may experience psychotic phenomena. Primary psychiatric disorders that manifest with psychosis (delusions, hallucinations, and disorganized thought or behavior) account for less than half. Up to 60% of late-life psychotic symptoms are due to systemic medical or neurological conditions, particularly neurodegenerative diseases. A thorough medical workup including laboratory tests, additional procedures if indicated, and neuroimaging studies is recommended. This narrative review summarizes current evidence regarding the epidemiology and phenomenology of psychotic symptoms encountered as part of the neurodegenerative disease continuum (including prodromal and manifest stages). Results: Prodromes are constellations of symptoms that precede the onset of overt neurodegenerative syndromes. Prodromal psychotic features, particularly delusions, have been associated with an increased likelihood of receiving a neurodegenerative disease diagnosis within several years. Prompt prodrome recognition is crucial for early intervention. The management of psychosis associated with neurodegenerative diseases includes behavioral and somatic strategies, although evidence is scarce and mostly limited to case reports, case series, or expert consensus guidelines, with few randomized controlled trials. Conclusion: The complexity of psychotic manifestations warrants management by interprofessional teams that provide coordinated, integrated care.

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Section: Management Of Psychotic Symptoms In Neurodegenerative Diseasesmentioning

confidence: 99%

“…212 ECT has also been tried for patients with DLB, but benefits are less robust compared to PD. 204,213 Behavioral Variant Frontotemporal Dementia. Studies suggest a dopaminergic deficit in bvFTD.…”

Section: Management Of Psychotic Symptoms In Neurodegenerative Diseasesmentioning

confidence: 99%

Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

Seritan

2023

J Geriatr Psychiatry Neurol

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“…Electroconvulsive therapy (ECT) is a potential therapeutic option in such patients 10 because it can lead to a significant improvement in depressive symptoms that are treatment refractory. 11 However, ECT results in neurophysiologic alterations to heart rate and blood pressure 10,12 due to the parasympathetic and sympathetic surge that occur during ECT. These hemodynamic changes are transient, but quite significant, 10 and therefore, special considerations must be made for patients with cardiac disease.…”

Section: Electroconvulsive Therapy and Cardiovascular Physiologymentioning

confidence: 99%

Electroconvulsive Therapy in Heart Transplant Patients

Ketcham

Glass

Hermida

2023

J ECT

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Patients with heart disease are at an increased risk of depression. Electroconvulsive therapy (ECT) is a highly effective treatment for severe depressive episodes. However, ECT may increase the risk for adverse outcomes in certain patients because of changes in blood pressure and heart rate secondary to an initial parasympathetic surge followed by a sympathetic surge and peripheral catecholamine release. In post–cardiac transplant patients, these acute hemodynamic changes on a denervated heart may bring clinical challenges. The available data on ECT in heart transplant patients are limited. The authors of this article present a summary of the available literature relating to ECT in heart transplant patients. The authors performed a literature search of 6 online databases yielding 6 English-language case reports of ECT in cardiac transplant patients. All patients experienced changes in hemodynamic variables during and immediately after ECT, ranging from moderate decrease in blood pressure to extreme hypertension. The cases did not report any serious cardiac complications during the course of ECT. In the 5 patients whose psychiatric responses to treatment were detailed, all had improvement in their depressive symptoms. Electroconvulsive therapy may be considered for severe cases of depression in patients with a history of cardiac transplant, but the potential benefit of ECT needs to be weighed against risks. In the limited number of cases reported in the literature, ECT seems to have been relatively safe and effective.

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“…Electroconvulsive therapy (ECT) is an effective and safe medical treatment used to treat a variety of psychiatric disorders if administered properly, 1 although it can be accompanied by adverse effects, one of which is postictal agitation (PIA). Postictal agitation is a complication that occurs in 7% to 10% of ECT patients 2 . It is a temporary condition with symptoms that include disorientation, motor restlessness, behavioral manifestations, and poor response to verbal commands 3 .…”

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confidence: 99%

“…Postictal agitation is a complication that occurs in 7% to 10% of ECT patients. 2 It is a temporary condition with symptoms that include disorientation, motor restlessness, behavioral manifestations, and poor response to verbal commands. 3 It can be associated with patient falls, combativeness, and removal of intravenous (IV) lines with potential significant risk to the safety of the patient and to health care professionals, 4 making identification and evaluation of adequate management strategies essential.…”

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confidence: 99%

Acute and Prophylactic Management of Postictal Agitation in Electroconvulsive Therapy

Sterina

Gregory²,

Hermida

2022

J ECT

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Postictal agitation (PIA) is a common adverse effect of electroconvulsive therapy (ECT), a treatment used for a variety of psychiatric disorders. Because of risk of harm to patients and health providers when patients develop PIA, its acute management and prophylaxis are of vital importance for ECT practitioners. This article describes PIA risk factors, as well as practical steps to manage this ECT complication. Nonpharmacologic patient safety interventions are critical components of PIA management. Benzodiazepines, antipsychotics, and additional anesthetic doses are discussed as acute treatment interventions. Prophylactic pharmacologic choices described include antipsychotics, postseizure anesthetics, and dexmedetomidine. Exploratory choices such as melatonin and intranasal formulations of sedatives are also discussed. This review suggests that common medication like olanzapine and propofol are cost-effective considerations to decrease PIA incidence and/or severity after ECT. In addition, dexmedetomidine presents a management alternative for treatment-resistant PIA. This literature review outlines treatment choices while suggesting future directions for considering effective treatments of postictal agitation in clinical settings.

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The Use of ECT in the Elderly—Looking Beyond Depression

Cited by 12 publications

References 93 publications

Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review

Electroconvulsive Therapy in Heart Transplant Patients

Acute and Prophylactic Management of Postictal Agitation in Electroconvulsive Therapy

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