Magazine article Clinical Psychiatry News

ECT May Quell Dementia-Associated Agitation

Magazine article Clinical Psychiatry News

ECT May Quell Dementia-Associated Agitation

Article excerpt


ORLANDO -- Electroconvulsive therapy was safe and effective for treatment of refractory agitation in patients with dementia, including those with multiple medical comorbidities, in the largest case series reported to date.

"This was true at least in the short term. Long term, there are no data," Dr. Yilang Tang noted at the annual meeting of the American Association for Geriatric Psychiatry.

He presented a chart review of the 38 patients with dementia who received ECT for agitation at Emory University's Wesley Woods Geriatric Hospital in Atlanta during 2012.

On admission, patients were on an average of six psychotropic medications, including two or more antipsychotic agents in half of cases. The subjects averaged 6.2 Axis III diagnoses. Patients received a mean of 10.2 and median of 6 ECT treatments. The ECT was performed initially with right unilateral electrode placement in 35 of 38 patients; however, 6 patients were switched to biffontal placement after four to six sessions because of poor response.

The mean baseline total Pittsburgh Agitation Scale score was 9.2. At discharge, after an average length of stay of 26 days, all patients demonstrated a significant reduction in their agitation score, with a median 8-point drop from baseline. Two patients had transient increases in their agitation score, from 7 points to 11 in one case and from 3 points to 7 in the other, but they improved with maintenance ECT after their acute course of therapy. In addition, patients went from an average of six psychotropic medications at admission to five at discharge, according to Dr. Tang, a psychiatric resident at Emory University in Atlanta.

Most patients were discharged after four-six ECT sessions, although seven patients received more than 12 treatments, mostly delivered as outpatient maintenance therapy.

One patient experienced transient ECT-related delirium. Yet no major treatment-related medical complications occurred, even though 7 patients had coronary artery disease, 24 were hypertensive, 3 had a history of stroke, and 3 patients had heart failure.

Only 2 of 38 patients were readmitted within 1 year after discharge, 1 of whom got another course of ECT. Although the possibility of readmission at other facilities can't be ruled out, it seems unlikely that this occurred often, since patients' surrogates were pleased with the post-ECT clinical improvement, Dr. …

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