Severe Postictal Confusion After Electroconvulsive Therapy: A Retrospective Study.

Area of Science:

• Neurology
• Psychiatry
• Clinical Pharmacology

Background:

• Severe postictal confusion (sPIC) is a significant adverse effect of electroconvulsive therapy (ECT).
• The prevalence and predictors of sPIC remain poorly understood.
• Understanding sPIC is crucial for patient safety during ECT.

Purpose of the Study:

• To determine the prevalence of severe postictal confusion (sPIC) in electroconvulsive therapy (ECT) patients.
• To identify potential demographic, clinical, and treatment-related risk factors for sPIC.
• To explore the development of a predictive model for sPIC.

Main Methods:

• Retrospective chart review of 295 ECT patients.
• Data collection included demographic, clinical, and treatment characteristics.
• Univariate and multivariate logistic regression analyses were performed to identify risk factors and develop predictive models, with split-sample validation.

Main Results:

• The prevalence of sPIC was 25.1% (74 out of 295 patients).
• Patients with sPIC showed trends towards male sex, history of cerebrovascular incidents, no selective serotonin reuptake inhibitor use, higher succinylcholine dosage, and flumazenil pretreatment.
• Multivariate analysis did not yield a significant predictive model for sPIC in the holdout dataset.

Conclusions:

• Severe postictal confusion (sPIC) occurs in approximately 25% of electroconvulsive therapy (ECT) patients.
• While certain factors like male sex and cerebrovascular history were associated, they did not lead to a robust predictive model.
• Further research is needed to identify reliable predictors and develop strategies to mitigate sPIC.