Section - Quick Takes

05. A Systematic Review of Modified Electroconvulsive Therapy (ECT) to Treat Delirium

Published on December 1, 2022 Certification expiration date: December 1, 2028

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Reviewing 40 cases, the authors conclude there is insufficient literature to support ECT as a clinical treatment for delirium.
By contrast, use of ECT for the treatment of malignant catatonia has substantial support.

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Text version

Listen to this: “Of 1200 records screened, 10 studies met inclusion criteria, 6 case reports, 3 case series and 1 quasi-experimental study.” What are we looking at here? Electroconvulsive therapy (ECT) for delirium? It seems like a wild idea, but boy, if this worked, it would have such broad applicability. Notice we’re not talking here about ECT for depression or catatonia. This is ECT for delirium. Frankly, I’d never heard of this. Well, it turns out the last review on this topic was in 1994, just after I finished my residency. So, let’s see if there’s any support for this idea at all in these case reports and quasi-experimental study.

Hi! Jim Phelps here for the Psychopharmacology Institute. This is exciting. I mean, think about all those patients in the general hospital with delirium. How common is it? Among hospitalized elders, about 20%. Postsurgical patients, there’s a big range, 13%–50%.

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Learning Objectives:

After completing this activity, the learner will be able to:

Assess the efficacy of lamotrigine and lithium compared with lithium alone for the treatment of rapid cycling bipolar disorder.
Evaluate the results of a randomized trial of microdosed psilocybin using a wide array of outcome measures, including EEG and cognitive testing.
Compare the efficacy and adverse effects of various atypical antipsychotics as adjuncts to antidepressants in the treatment of major depressive disorder.
Compare the findings of a large Finnish cohort study with previous Cochrane meta-analyses regarding the value of adjunctive mood stabilizers relative to outcomes with antipsychotic monotherapy for patients with schizophrenia spectrum disorders.
Examine evidence for the use of electroconvulsive therapy in patients with markedly altered mental status.

Original Release Date: December 1, 2022

Review and Re-release Date: December 1, 2025

Expiration Date: December 1, 2028

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

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Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.