%0 Journal Article
%T Delayed Onset and Prolonged ECT-Related Delirium
%A Sameer Hassamal
%A Ananda Pandurangi
%A Vasu Venkatachalam
%A James Levenson
%J Case Reports in Psychiatry
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/840425
%X Electroconvulsive therapy (ECT) is effective in the treatment of depression. Delayed post-ECT delirium is rare but can occur in a small subset of patients with risk factors and in most cases resolves with the use of psychotropic medications. We report a unique presentation of a patient who developed a delayed post-ECT delirium with fecal incontinence that commenced 24 hours after the administration of ECT. The condition resolved spontaneously after 48 hours without the use of psychotropic medications. 1. Introduction ECT is an important treatment for severe depression including medication refractory depressive symptoms, mania, schizophrenia, and catatonia [1]. However, in the United States, ECT is most commonly used for the treatment of unipolar depression after multiple trials of psychotropic medications have failed to achieve either an adequate response or remission [2]. Although the exact mechanism of action is unknown, a variety of theories postulate that ECT increases monoamine neurotransmitter availability, induces a release of hypothalamic or pituitary hormones, and increases neurogenesis or synaptogenesis [3¨C5]. ECT has also been shown to have anticonvulsant properties [6]. Cardiovascular complications are the most common causes of morbidity and mortality following ECT [7, 8]. Other complications include headaches, muscle pain, fatigue, and nausea [9, 10]. Anterograde and retrograde amnesia are common ECT-related cognitive complaints [8]. Typically, anterograde amnesia resolves within a few weeks whereas retrograde amnesia is more persistent [8]. Both types of amnesia are more common with bilateral stimulation, high-intensity electrical dosage, and sinus waveform stimulus [11¨C13]. Mild confusion is reported in about 40% of cases; however, delirium is common following the first seizure or in those with predisposing brain pathology such as white matter lesions [9, 14, 15]. Additionally, patients taking lithium or dopaminergic medications concurrently with ECT are at an increased risk of delirium [16]. We present the case of a highly functional 41-year-old Caucasian woman who developed a severe and prolonged ECT-related delirium. 2. Case Presentation Ms. XX, a 41-year-old Caucasian woman with no known medical illnesses was diagnosed with unipolar major depressive disorder at the age of 27 years. The current episode was her 3rd, lasted over 4 months, and had only partially responded to psychotropic medications including the combination of lithium carbonate 300£¿mg twice a day, mirtazapine 15£¿mg daily, and venlafaxine XR 450£¿mg daily. Ms. XX had also
%U http://www.hindawi.com/journals/crips/2013/840425/