Factors Associated With Delirium Following Electroconvulsive Therapy: A Systematic Review.

Factors Associated With Delirium Following Electroconvulsive Therapy: A Systematic Review.

Publication date: Dec 01, 2019

Delirium following electroconvulsive therapy (ECT) has been a clinical challenge, which, however, has not been investigated through a systematic literature review. The objective of this study was to systematically synthesize available evidence regarding factors associated with post-ECT delirium.

We conducted a systematic literature search for any type of original investigations that reported risk factors of post-ECT delirium, using PubMed.

The literature search identified 43 relevant articles. One study found an association between catatonic feature and increased risk of postictal delirium. Five studies reported that the presence of cerebrovascular disease, Parkinson disease, or dementia was related to higher incidence of post-ECT delirium. Incidence of post-ECT course delirium was increased with bitemporal stimulation (3 studies). One study showed that ultrabrief pulse ECT reduced reorientation time following seizure compared with brief pulse ECT. High stimulus intensity resulted in more prolonged reorientation time after ECT than lower stimulus intensity (2 studies). Longer seizure length was significantly associated with post-ECT delirium in 1 study. Eight studies that examined postictal delirium in association with medications used, including lithium, did not show any consistent finding in their relationships. Four studies showed decreased incidence of postictal delirium in those receiving dexmedetomidine.

Limited evidence suggests that catatonic feature, cerebrovascular disease, Parkinson disease, dementia, bitemporal electrode placement, high stimulus intensity, or longer seizure length are associated with an increased risk of post-ECT delirium. Moreover, dexmedetomidine and ultrabrief pulse ECT seem to have preventive effects of post-ECT delirium.

Tsujii, T., Uchida, T., Suzuki, T., Mimura, M., Hirano, J., and Uchida, H. Factors Associated With Delirium Following Electroconvulsive Therapy: A Systematic Review. 23121. 2019 J ECT (35):4.

Concepts Keywords
Bitemporal Reorientation seizure
Catatonic Postictal delirium
Cerebrovascular Disease Risk postictal delirium
Delirium Incidence postictal delirium
Dementia Review Delirium
ECT Therapy Electroconvulsive therapy
Electroconvulsive Therapy Psychiatry
Electrode Medicine
Incidence Clinical medicine
Lithium Psychiatric diagnosis
Parkinson Disease RTT
PubMed Cognitive disorders
Seizure Intensive care medicine
Stimulus Electroconvulsive therapy
Systematic Review Treatment of depression
Epileptic seizure


Type Source Name
disease MESH Delirium
disease MESH risk factors
disease MESH cerebrovascular disease
disease MESH Parkinson disease
pathway KEGG Parkinson disease
disease MESH dementia
drug DRUGBANK Dexmedetomidine


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