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Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy

Authors Ittasakul P, Jarernrat P, Tor PC

Received 14 September 2020

Accepted for publication 19 October 2020

Published 2 February 2021 Volume 2021:17 Pages 283—289


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Yuping Ning

Pichai Ittasakul,1 Phathamon Jarernrat,1 Phern-Chern Tor2

1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Mood and Anxiety, Institute of Mental Health, Singapore

Correspondence: Pichai Ittasakul
Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
Tel +662-2011478
Fax +662-200-3277

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

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