ECT and Delirium: Literature Review and a Pediatric Case Report

There is limited information available regarding delirium that may occur during the course of electroconvulsive therapy (ECT) in pediatric patients (< 18 years). The aim of this paper is to describe ECT-associated delirium, suspected risk factors, and screening tools that may help in its identification and management. We present a case involving a 15 y.o. African American male who developed ECT-associated delirium during the treatment of catatonia.

Three subtypes of delirium associated with ECT have been described. First, postictal delirium which occurs immediately following ECT and may last up to 1 h; second, post ECT or agitated delirium occurring upon emergence from anesthesia, and interictal delirium which is a prolonged period of disorientation following ECT or it may appear de novo separately from the postictal disorientation period. ECT-associated delirium as a side effect of ECT has been described exclusively in adults. Limited evidence in published literature suggests that predisposing factors may include catatonia, developmental disorders, cerebral vascular disease, parkinson's disease, dementia, bi-temporal electrode placement, high stimulus intensity, and/or prolonged seizures. Patients receiving ECT should be routinely screened for delirium, and if present, for worsening of catatonia with/without NMS throughout their treatment. Patients who develop delirium during ECT should be evaluated for potential underlying etiologies including contributing pharmacological strategies. Clear and consistent definitions of ECT-associated delirium are necessary to improve outcomes.