Risk Factors for Postictal Delirium in Geriatric Patients Undergoing Electroconvulsive Therapy: The Role of Lithium and Quetiapine.

Abstract

Background: Postictal delirium (PID) is a significant and often underrecognized adverse effect associated with electroconvulsive therapy (ECT) in geriatric patients. Despite its clinical relevance, the specific risk factors contributing to the development of PID in this vulnerable population remain inadequately understood, which may affect treatment outcomes and patient safety.

Methods: In this retrospective study, we analyzed data from 168 elderly patients who underwent ECT between 2009 and 2020 at a general hospital in China. Univariate analyses of sociodemographic and clinical characteristics were performed to identify variables for inclusion in a logistic regression model. Multiple binary logistic regression analysis was performed to determine the relationship between these variables and PID occurrence.

Results: The incidence of PID was 20.8% (35/168) among the study cohort. Univariate analysis revealed statistically significant differences between PID and non-PID groups for lithium (χ ² = 6.67, p = 0.010), quetiapine (χ ² = 4.36, p = 0.037), number of ECT sessions (U = 3065.50, p = 0.003), and response rate (χ ² = 12.86, p < 0.001). Logistic regression analysis demonstrated that lithium (odds ratio (OR) = 5.128; p = 0.009) and quetiapine (OR = 2.562; p = 0.024) were significantly associated with PID.

Conclusion: Our findings indicate that lithium and quetiapine use significantly increase the risk of developing PID, underscoring the need for clinical vigilance. Careful consideration of these medications when planning ECT treatment is recommended to minimize the risk of postictal complications and optimize therapeutic outcomes.