Postictal Confusion in ECT: Retrospective Study from Thailand

Out on PubMed, from investigators in Thailand, is this study:

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy.

Ittasakul P, Jarernrat P, Tor PC.Neuropsychiatr Dis Treat. 2021 Feb 2;17:283-289. doi: 10.2147/NDT.S281961. eCollection 2021.PMID: 33564234 

The abstract is copied below:

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/m2 vs 24.1 ± 5.2 kg/m2, 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.

Keywords: Thai patients; agitation; body mass index; BMI; electroconvulsive therapy; ECT; postictal confusion; PIC.

The pdf is here.

And from the text:

In our study, PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, nonresponse to verbal command following ECT within an hour in post-anesthetic care unit (PACU) and intravenous benzodiazepine (diazepam 5–20 mg or midazolam 2.5–5 mg) was necessary to manage disturbed behavior. 

...Of the 79 patients, 29 (36.7%) developed PIC at one or more sessions during the ECT course while 63.3% (50/79) had no PIC. In 912 ECT sessions, the occurrence of PIC was 86 times (9.4%, 86/912).

...Among 29 patients who developed PIC 37.9% (11/29) had only one PIC, 24.1% (7/29) had two PIC, 13.8% (4/29) had three PIC, 13.8% (4/29) had four PIC, 3.4% (1/29) had seven PIC, 3.4% (1/29) had eight PIC, and 3.4% (1/29) had eighteen PIC during the ECT course.

This retrospective study adds little to the evidence base about postictal confusion (PIC). While it is somewhat useful to document that heavier patients are at higher risk, this is a common sense finding, based on the obvious greater difficulty in managing the airway during the procedure. Only two patients induced with propofol had PIC. It would have been helpful to at least have a review in the discussion of how to best manage such patients and prophylax against the occurrence of PIC.
Not really worth reading more than the abstract, IMO.

Comments

Post a Comment

Popular posts from this blog

ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Image
Out on PubMed, from investigators in the US, is this study: Ketamine versus  ECT   for Nonpsychotic Treatment-Resistant Major Depression. Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Online ahead of print. PMID:  37224232 The abstract is copied below: Background:  Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. Methods:  We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression . Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 rat
Read more

RUL ECT vs Low Amplitude Seizure Therapy (LAP-ST)

Image
Out on PubMed, from the team in Augusta, Georgia, is this study: Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST). Youssef NA, McCall WV, Ravilla D, McCloud L, Rosenquist PB. Brain Sci. 2020 Dec 13;10(12):E979. doi: 10.3390/brainsci10120979. PMID:  33322138 The pdf is here . And from the Introduction : In theory, LAP-ST can be helpful because of the direct effect of lower electric current, but the principal reason is that LAP-ST has a more focal electric field (EF) [ 34 , 35 ]. The current amplitude is the primary factor that drives the EF into brain regions located deeper in the brain and is responsible for cognition and memory such as the hippocampus and temporal lobe [ 33 , 35 ]. This extra focality of the EF can minimize or avoid high EF stimulation to the deeper hippocampal and temporal lobe regions [ 33 , 35 ]. Minimization of deeper stimulation by using LAP
Read more

ECT For Children at a University Hospital: New Study in JECT

Image
 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article: Use of   ECT   for Children With and Without Catatonia: A Single-Site Retrospective Analysis. Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print. PMID:  38265759 The abstract is copied below: Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation.
Read more