Electroconvulsive Therapy In Elderly Patients Research Articles

Tolerability and Efficacy of Bi-temporal Electroconvulsive Therapy in Elderly Patients with Severe Mental Illness

Background: Electroconvulsive therapy (ECT) has been an effective treatment option available for elderly patients with severe mental illness; however, there are concerns related to its tolerability. Unilateral ECT has fewer cognitive adverse effects compared to bilateral ECT while efficacy with bilateral ECT is better. Aim: To evaluate the tolerability and efficacy of Bi-temporal ECT in elderly patients (>60 years) with severe mental illness in a general hospital set-up. Methodology: The study was a prospective, observational study conducted in SDM College of Medical Sciences and Hospital, Dharwad with a sample size of 15 elderly patients aged above 60 years with severe mental illness. Participants were screened for psychiatric symptoms with Mini-International Neuropsychiatric Interview and assessed for severity of symptoms with Hamilton Depression Rating Scale, Young Mania Rating Scale, and Positive and Negative Syndrome Scale. Cognitive functioning was assessed by Hindi Mental Status Examination Scale and effectiveness was assessed using global functioning by Global Assessment of Functioning (GAF) Scale. Assessment was done before giving ECT and 4 weeks at follow-up. The study period was from January 2019 to December 2019. Results and Conclusions: The median age of the elderly was 61 years. Majority (66.7%) were diagnosed with mood disorder and 33.3% of the patients were diagnosed with paranoid schizophrenia. Around 47% had comorbid hypertension and 33.3% had diabetes mellitus. All the patients in the study sample received thrice weekly bi-temporal ECT in the range of 2–8 with median of 5. Significant reduction in symptomatology was observed, on comparing the scores before and after ECT with improvement in overall functioning assessed by GAF Scale. There was no decline in cognitive functioning test, although there was an improvement in the Hindi version of mini mental status examination scores at 4 weeks after discharge. By the above observations, we concluded that the use of bi-temporal ECT in elderly patients with severe mental illness was found to be safe and effective in treating.

Response to electroconvulsive therapy in elderly patients with late-onset bipolar disorder: The impact of cerebral small vessel disease.

Cerebral Small Vessel Disease (CSVD) is a chronic, progressive vascular disorder that confers increased vulnerability to psychiatric syndromes, including late-life mood disorders. In this study, we investigated the impact of CSVD on electroconvulsive therapy (ECT) outcomes in patients with late-onset bipolar disorder (BD). A sample of 54 non-demented elderly patients (≥60years) with late-onset BD and treatment-resistant major depression, mixed state, or catatonia who underwent bilateral ECT were included in this naturalistic observational study. A diagnosis of CSVD was established based on brain neuroimaging performed before ECT. All patients were evaluated before and after ECT using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression scale (CGI). Of the total sample, 19 patients were diagnosed with CSVD (35.2%). No significant differences were observed at baseline between patients with and without CSVD. Overall, a response was obtained in 66%-68.5% of patients, with remission in 56.2%. No significant differences in ECT outcomes were found between those with and without CSVD, and both groups exhibited substantial improvements in symptom severity following ECT. The outcome of ECT in late-onset BD was not influenced by the presence of CSVD. This finding aligns with previous research on unipolar depression. Accordingly, ECT should be considered for elderly patients with late-onset BD, regardless of the presence of CSVD.

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations.

Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited. We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT. A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary to ictal hypertensive surge during treatment with ECT. Risk factors such as history of hypertension, age of the patient, extent of the ictal surge in blood pressure, efficacy of prophylactic treatment to control surge in blood pressure and characteristics of cerebral aneurysm each elevated the risk of complication in these cases. We reviewed safety measures based on the evidence from the current literature available. ECT is safe in elderly patients with cerebral aneurysms provided appropriate safety measures are employed. Screening for cerebral aneurysms in high risk patients, effective prevention and management of blood pressure elevation acutely during ECT is the best practice to avoid adverse outcomes.

Electroconvulsive therapy awareness as approach for psychology students

Electroconvulsive therapy (ECT) generated many controversies over time. The clinical literature establishing the efficacy of ECT is among the most solid for any medical treatment, and has been extensively reviewed; however, both practitioners and patients seem to be still reluctant on this issue. In the following review we are aiming at raising the level of awareness among the interested parties regarding ECT. Epidemiological evidence shows that there are a growing number of cases in which ECT has a great benefit, among the most notable being pharmacological resistant depressive disorder, bipolar disorder, schizophrenia, catatonia and others. Current guidelines seem to be overly-prudent regarding ECT indications, in spite of a growing body of research attesting to its importance. Side effects of ECT range from somatic to cognitive and, with a careful prior examination, most are acute and can be managed in a few minutes. An exception to this is the cognitive impairment, which can last from a few hours to a few weeks and presents a reason to reconsider ECT in elderly patients with an important preexisting cognitive impairment.

ECT FOR THE TREATMENT OF SOMATIC SYMPTOM DISORDER AND UNINTENTIONAL WEIGHT LOSS IN OLDER ADULTS: 2 CASE REPORTS

Introduction Somatoform disorders occur in up to 13% of those over age 65 and symptoms often cause significant impairment and disability (Hilderink et al. 2013; Leong et al. 2015). Unintentional weight loss in the elderly is also common and associated with increased morbidity and mortality (Hajek et al. 2017; McMinn et al. 2011). Studies show that depression is often comorbid with both somatoform disorders and unintentional weight loss in the elderly (Leong et al. 2015; Thompson and Morris 1991). Electroconvulsive therapy (ECT) is an effective treatment for severe depression, especially in older adults. However, there is limited of evidence regarding the use of ECT in elderly patients for the treatment of somatic symptom disorders (with predominant GI symptoms) or unintentional weight loss. Three case reports have been documented of women in their seventh decade of life with functional GI symptoms that responded to ECT (Cooper 2016; Cybulska 1997; Dols et al. 2012). Leong et?al reported a case series of 28 patients with somatic symptoms disorder who were successfully treated with ECT, examining the primary endpoint of improvement in somatic symptoms. However, only 2 of these cases included functional GI symptoms, and neither of the patients were over the age of 50 (Leong et al. 2015). Methods We report 2 cases of patients over age 65 who were psychiatrically hospitalized for co-morbid depressive symptoms, somatic symptom disorder (with predominant GI symptoms), and unintentional weight loss. Due to inability to tolerate medications and severity of depressive and somatic symptoms, both received an acute course of ECT. Results Both patients had gastrointestinal medical history (dumping syndrome, gastroparesis, irritable bowel syndrome), but extensive medical workup did not account for the severity of somatic symptoms, most notably nausea, or weight loss at the time of psychiatric admission. Both patients had diagnoses of major depressive episodes with PHQ-9 scores in the moderate range on admission (14 and 15). Both patients completed a full acute course of bitemporal ECT and reported subjective improvement in their somatic symptoms, appetite, and depressive symptoms (PQH-9 scores 0 and 1 respectively) following the course of ECT. Both also objectively gained a weight from time of admission to long-term follow-up without subsequent ECT treatment. Patient A's BMI on admission was 17.1 and increased to 23.81 at 8 month follow-up. Patient B's BMI on admission was 25.6 and increased to 29.17 at 7 month follow-up. In these two cases, ECT was well tolerated with reported side effects of mild headache, body aches, and mild to moderate memory loss. Of note, both patients had a rapid and robust response to ECT with remission of depressive symptoms and significant improvement in gastrointestinal symptoms after 5 bitemporal treatments. Conclusions Due to the higher rate of co-morbid medical conditions that could potentially contribute to somatic symptoms, it can be more challenging to diagnose somatic symptoms disorder in older adults (Wijeratne et al. 2003). When older adults present with somatic symptoms that are not fully explained by medical pathology, somatic symptom disorder should be considered and appropriate treatment initiated. Given the adverse outcomes and higher mortality in elderly individuals with unexplained weight loss, timely treatment is imperative. This case report suggests that ECT may be a well-tolerated and highly effective treatment for elderly patients with medically unexplained gastrointestinal disorders/somatic symptom disorder and significant weight loss with comorbid depression. This research was funded by: Not Applicable

Analysis of elderly patients treated with electroconvulsive therapy and complication rates: a single center experience

Objective: Electroconvulsive therapy (ECT) is an effective treatment method used in many psychiatric disorders, primarily in mood and psychotic disorders. ECT is also effective and safe for geriatric depression. This study aimed to analyze elderly patients treated with ECT in bipolar disorder, major depressive disorder and psychotic disorder diagnostic groups. Methods: In this study, we retrospectively reviewed 58 geriatric patients over 60 years old who were treated with ECT between January 2014 and December 2017. Patients’ sociodemographic data, preliminary American Society of Anesthesiologists physical status assessments (ASA) scores and Clinical Global Impression (CGI), Hamilton Depression Rating Scale (HAMD), Young Mania Rating Scale (YMRS), Positive and Negative Symptom (PANSS) Scales before and after ECT were analyzed. Results: CGI, HAMD, YMRS and PANSS scores have significantly decreased after ECT. According to preoperative anesthesia consultations of the patients, 62.1% (n=36) were assessed to be in ASA 2 risk group and 34.5% (n=20) in ASA 3 risk group. One patient in the ASA 2 risk group and four patients in ASA 3 group had to discontinue treatment due to cardiovascular instability. These patients were administered medical treatment. There were no other mortalities or severe complications. Conclusion: This data shows that there were no mortalities or severe complications in elderly patients and supports the effectiveness and safety of ECT in elderly patients with bipolar disorder, major depressive disorder and psychotic disorder.

Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression

BackgroundNo prior study has investigated whether impairment of specific cognitive functions at baseline may predict the short-term treatment outcome of electroconvulsive therapy (ECT) in elderly non-demented patients with major depression (MD). MethodsThis longitudinal cohort study included 65 elderly patients with unipolar or bipolar MD, aged 60–85 years, treated with formula-based ECT. Treatment outcome was assessed using the 17-item Hamilton Rating Scale for Depression (HRSD17). Cognitive function at baseline was assessed using nine neuropsychological tests or subtests measuring information processing speed, verbal learning and memory, and aspects of executive function. ResultsA poorer performance on the word reading task of the Color Word Interference Test rendered higher odds of achieving remission during the ECT course (p=0.021). Remission was defined as an HRSD17 score of 7 or less. There were no other significant associations between the treatment outcome of ECT and cognitive performance parameters assessed at baseline. LimitationsThe limited number of subjects may have reduced the generalizability of the findings. Multiple statistical tests increase the risk for making a type I error. ConclusionsHow well patients perform on neuropsychological tests at baseline is most likely not a predictor of, or otherwise not significantly associated with the treatment outcome of formula-based ECT in elderly patients with MD.

Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

Background: Electroconvulsive therapy (ECT) is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years) had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26%) showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

Prevention of Relapse With Maintenance Electroconvulsive Therapy in Elderly Patients With Major Depressive Episode

To evaluate the effectiveness and safety of maintenance electroconvulsive therapy (mECT) in elderly patients with treatment-resistant Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode. Seven elderly patients with treatment-resistant major depressive episode were treated with a complete ECT cycle. Thereafter, they received one monthly ECT session as maintenance for 1 year. Response to treatment was defined as at least a 50% drop from baseline on the Hamilton Depression Rating Scale (HamD) and remission as not meeting criteria for major depression, a HamD score of 7 or less, and Clinical Global Impressions-Severity of Illness score of 1. We compared their response with the response of 7 elderly patients with treatment-resistant major depression who were treated with a full cycle of ECT but did not receive mECT (non-mECT). We compared the 2 groups for the number of relapses or recurrences of major depressive episodes after remission was achieved; a relapse or a recurrence occurred when HamD scores were 14 or higher, or when Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision major depressive episode criteria were met, or when Clinical Global Impressions-Severity of Illness score was 3 or higher and increased by at least 2 points from response/remission. The mECT group (4 women and 3 men; mean age, 73 years) had significantly less mean relapses/recurrences (0 vs 1.57) and hospitalizations (0 vs 1) and received less drug treatment than the nonMECT group (similar for age and sex composition) during the 12-month follow-up period. All patients with mECT improved during treatment and did not relapse. Maintenance ECT protected elderly patients from recurrent depressive episodes from relapsing/recurring more than standard ECT.

QT Dispersion and Rate-Corrected QT Dispersion During Electroconvulsive Therapy in Elderly Patients

Electroconvulsive therapy (ECT) induces increase of QT dispersion (QTD) and the rate-corrected QTD (QTcD), which are associated with increased risk of ventricular arrhythmias and cardiovascular mortality. The effects of electrical stimulus during ECT on QTD and QTcD in elderly patients are of considerable interest. The purpose of this study was to clarify the differential effects of electrical stimulus caused by ECT on interbeat interval, QT interval, the rate-corrected QT (QTc) interval, QTD, and the QTcD under propofol anesthesia between younger and elderly patients with major depression. Twenty younger psychiatric patients (aged 30-40 years) and 20 elderly patients (aged 65-75 years) scheduled for ECT were studied under propofol anesthesia. A 12-lead electrocardiogram was monitored to measure parameters. Muscle paralysis was achieved by administering 1-mg/kg succinylcholine intravenously, and the efficacy of ECT was determined by the tourniquet technique. The mean arterial pressure in the elderly was significantly higher than that of the younger patients from immediately to 2 minutes after electrical stimulus. The interbeat interval in the elderly was significantly lower than that of the younger patients from immediately to 1 minute after electrical stimulus. There was no statistically significant difference in the QT interval between the groups. The baseline value of QTc interval was higher than the normal limits, and the QTc interval in the elderly was significantly lower than that of the younger patients from immediately to 1 minute after electrical stimulus. The baseline value of QTD was higher than the normal limits, and the QTD in the elderly was significantly higher than that of the younger patients from immediately to 7 minutes after electrical stimulus. The baseline value of QTcD was higher than the normal limits, and the QTcD in the elderly was significantly higher than that of the younger patients from immediately to 7 minutes after electrical stimulus. The QTc interval, QTD, and QTcD may be higher than the normal limits before anesthesia in patients with major depression. The QTD and QTcD in the elderly, which are associated with increased risks of ventricular arrhythmias, are higher than those of the younger patients after electrical stimulus during ECT. Electrical stimulus may induce further increased risks of cardiac events in elderly patients.

Successful Electroconvulsive Therapy in a 95-Year-Old Man With a Cardiac Pacemaker—a Case Report

In old-old patients with major depressive disorder, electroconvulsive therapy (ECT) is relatively safe and more effective than pharmacotherapy. 1 Manly DT Oakley SP Bloch RM Electroconvulsive therapy in old-old patients. Am J Geriatr Psychiatry. 2000; 8: 232-236 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar , 2 Tharyan P The evidence for electroconvulsive therapy (ECT) in the treatment of severe late-life depression. ECT for depressed elderly: what is the evidence and is the evidence enough?. Int Psychogeriatr. 2007; 19: 19-35 Crossref PubMed Scopus (4) Google Scholar , 3 Burd J Kettl P Incidence of asystole in electroconvulsive therapy in elderly patients. Am J Geriatr Psychiatry. 1998; 6: 203-211 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar , 4 Salzman C Wong E Wright BC Drug and ECT treatment of depression in the elderly, 1996–2001: a literature review. Biol Psychiatry. 2002; 52: 265-284 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar ECT provokes unique hemodynamic changes. 5 Saito S Anesthesia management for electroconvulsive therapy: hemodynamic and respiratory management. J Anesth. 2005; 19: 142-149 Crossref PubMed Scopus (60) Google Scholar It has been applied successfully in pacemaker patients. During ECT, a pacemaker may be inhibited because of oversensing of ECT-induced myopotentials. This may result in asystole. However, studies have shown that the risks of pacemaker malfunction or cardiac complications during ECT are relatively small. 6 Dolenc TJ Barnes RD Hayes DL Rasmussen KG Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004; 27: 1257-1263 Crossref PubMed Scopus (49) Google Scholar , 7 Giltay EJ Kho KH Keijzer LTM Leijenaar M van Schaick HW Blansjaar BA Electroconvulsive therapy (ECT) in a patient with a dual-chamber sensing, VDDR pacemaker. J ECT. 2005; 21: 35-38 Crossref PubMed Scopus (14) Google Scholar , 8 Suzuki K Takamatsu K Takano T Tanabe Y Matsuoka H Should we convert demand mode to fixed mode when electroconvulsive therapy is administered to patients with pacemakers?. J ECT. 2009; 25: 76 Crossref PubMed Scopus (3) Google Scholar Regarding old-old patients, we found only one report of successful ECT in two patients older than 90 years with DDD and DDDR pacemakers. 6 Dolenc TJ Barnes RD Hayes DL Rasmussen KG Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004; 27: 1257-1263 Crossref PubMed Scopus (49) Google Scholar We present a 95-year-old patient with a VVIR pacemaker.

Seizure Thresholds in Elderly Patients Treated with Electroconvulsive Therapy for Major Depressive Disorder: A Review

Objective: Electroconvulsive therapy (ECT) is effective and generally safe in depression. Its effectiveness and side effects are suggested to be related to the electrical stimulus administered relative to the seizure threshold. Since aging seems to raise the seizure threshold in ECT, we reviewed the literature for evidence correlating advanced age and seizure threshold, and for hypotheses explaining why seizure thresholds might raise with age. Methods: Pubmed, PsychINFO, three standard works on ECT, and cross-references were searched for studies investigating seizure thresholds and/or associated factors in elderly depressed patients. Results: A total of 406 possibly relevant articles were found, of which 27 studies could be included. One very recently published study was included afterwards because of its significance. Aging was moderately associated with a raised initial seizure threshold with correlation coefficients ranging from 0.30 to 0.64 (p < 0.05). Also, seizure thresholds in elderly patients were more likely to raise during the ECT course. Reported hypotheses for these clinical phenomena include a decrease of neuroexcitability, changes in morphologic and functional characteristics of the brain, somatic comorbidity, and concomitant medication use. Conclusion: To optimize ECT in elderly patients, hypotheses and suggestions for further research are proposed regarding the moderate correlation between advanced age and initial seizure threshold and the rise in seizure threshold during the ECT course. Keywords: Aging, electroconvulsive therapy, review, seizure threshold

P2-433: The emergence of cognitive deficits and dementia in depressive geriatric in-patients after ECT

Electroconvulsive therapy (ECT), an effective treatment for refractory depression, may cause transient or persistent cognitive impairment. We studied the course of cognitive performance and affective symptoms after ECT in elderly patients with and without pre-existing cognitive deficits. Consecutive 42 geriatric patients with refractory depressive episodes was studied before ECT. The cognitive performance of all was rated with the Mini-Mental-State examination (MMSE) before, during and after the course of ECT. The affective symtoms were rated with Hamilton Depressions Scale 24 (HAMD 24) before, during and after finishing ECT. Most of the patients underwent a cranial MRI in the last 12 months before, which was specifically examined for signs of neurodegeneration or cerebrovascular disease or both by an experienced neuroradiologist. Recurrent depression was present in 28 (66.7%), 11 (26.2%) had a first depressive episode. Schizoaffective disorder was diagnosed in 3 (7.1%) participiants and bipolar-I-disorder in 1 (2.4%) according to ICD-10. The mean age was 73.1 (range 89/65) years (women 73.4 [89.3/65.3], men 71,1 [81.6/62.6]).Co-existing dementia prior to ECT was diagnosed in 10 (23.8%) patients, mild cognitive imparment (MCI) in 7 (16.7%). Advanced vascular or neurodegenerative disease was found in 50% of patients. The affective symtoms were rated with Hamilton Depressions Scale 24 (HAMD 24) before, during and after finishing ECT. All patients achieved complete or partial remission of affective symptoms in HAMD 24. During ECT-treatment, patients with dementia or MCI showed more distinctive cognitive deficits than geriatric participiants without preexisting cognitive deficits in rating MMSE. In patients with cerebrovascular lesions, neurodegeneration or both in cranial MRI transient cognitive impairments were induced faster than in patients without cerebral changes. About 75% of these patients had not achieved baseline levels in cognitive functioning 8 weeks after finishing treatment. In 1/3 MCI or dementia were diagnosed in follow-up. Geriatric patients without cognitive impairment before treatment and no or only mild neuroimaging findings achieved full cognitive functioning during follow-up. Our results show that ECT is effective in refractory geriatric depression. Severe cognitive side-effects occur mainly in patients with pre-diagnosed cognitive impairment or MRI signs of neurodegenerative or vascular disease.

Efficacy of Electroconvulsive Therapy in the Treatment of Nondepressed Psychiatric Illness in Elderly Patients: A Review of the Literature

Electroconvulsive therapy (ECT) is well established as a safe and effective treatment for several psychiatric disorders. Responsiveness to ECT does not abate with age, and data indicate that the use of ECT in the treatment of psychiatric disorders in the elderly persons has increased in recent decades. Special consideration must be given to the baseline cognitive abilities of an elderly patient prior to treatment with ECT. Much of the literature on the use of ECT in the elderly persons has focused on the treatment of mood disorders, whereas less research has been devoted to its use in the treatment of other psychiatric conditions. Although depressive syndromes remain the most common indication for ECT in the elderly persons, clinicians treating elderly patients should remain aware of the safety and efficacy of this treatment modality with other psychiatric disorders. This review examines the literature on the use of ECT in elderly patients with some common neuropsychiatric disorders including catatonia, bipolar mania, schizophrenia, dementia with behavioral disturbance, and Parkinson's disease.

Electroconvulsive Therapy in Patients with Cardiac Pacemakers

There are few contraindications to electroconvulsive therapy and it is generally well tolerated. However, electroconvulsive therapy in elderly patients with cardiac pacemakers in situ theoretically presents an increased risk of complications. We undertook a retrospective audit of all patients who received anaesthesia for electroconvulsive therapy between January 1999 and September 2005. There were ten patients who had cardiac pacemakers in situ. They underwent a total of 147 electroconvulsive therapy treatments. In 146 out of the 147 treatments, the anaesthesia proceeded uneventfully. The findings suggest that provision of anaesthesia and electroconvulsive therapy in patients with cardiac pacemakers, including rate-responsive pacemakers, is a safe undertaking, with no extra precautions being needed except for routine ECG monitoring.

A protocol for administration of electroconvulsive therapy in elderly patients with fractures

A protocol for administration of electroconvulsive therapy in elderly patients with fractures

A protocol for administration of electroconvulsive therapy in elderly patients with fractures

INTRODUCTION: Electroconvulsive therapy (ECT) is an important treatment for depressive illness in the elderly. METHOD: We describe a brief protocol, divided into three phases, for the administration of ECT to elderly patients with fractures. CONCLUSION: In conclusion, we suggest that elderly patients with fractures should not be denied this potentially life saving treatment. Used with caution ECT is both safe and effective in patients with fractures. (Int J Psych Clin Pract 2000; 4:101-104)

ECT in Elderly Patients With Schizophrenia

Five female patients with chronic schizophrenia and schizoaffective disorder received electroconvulsive therapy (ECT). Patients were 58 to 74 years old when ECT began. Three patients followed the acute course of ECT with a course of maintenance ECT. Four patients were considered treatment-resistant to medication. One patient objected to any use of medication and opted for ECT when she became psychotic. Four patients received concurrent antipsychotic medication during and after the course of ECT. All five patients experienced improvement in their psychosis.

ECT in Elderly Patients With Schizophrenia

Five female patients with chronic schizophrenia and schizoaffective disorder received electroconvulsive therapy (ECT). Patients were 58 to 74 years old when ECT began. Three patients followed the acute course of ECT with a course of maintenance ECT. Four patients were considered treatment-resistant to medication. One patient objected to any use of medication and opted for ECT when she became psychotic. Four patients received concurrent antipsychotic medication during and after the course of ECT. All five patients experienced improvement in their psychosis. Five female patients with chronic schizophrenia and schizoaffective disorder received electroconvulsive therapy (ECT). Patients were 58 to 74 years old when ECT began. Three patients followed the acute course of ECT with a course of maintenance ECT. Four patients were considered treatment-resistant to medication. One patient objected to any use of medication and opted for ECT when she became psychotic. Four patients received concurrent antipsychotic medication during and after the course of ECT. All five patients experienced improvement in their psychosis.

Incidence of Asystole in Electroconvulsive Therapy in Elderly Patients

The authors prospectively investigated the incidence of asystole (absence of heartbeat for 5 seconds) in elderly patients receiving electroconvulsive therapy (ECT) at a university-based geriatric psychiatry unit. In all, 65.8% of patients experienced asystole at some time during their course of ECT. Those who experienced asystole were significantly younger (average age, 72.2) than those without asystole (average age, 77.0; P = 0.026) and were also less likely to have cardiac rhythm disturbances on electrocardiogram (P = 0.024). Medical history, history of cardiac disease, electrode placement, energy level, and number of ECT treatments did not predict asystole. Asystole is a common side effect of ECT in elderly patients. It was not associated with any untoward outcome. The fact that "old-old" patients and those with cardiac disease are less likely to experience asystole than younger, healthier patients is reassuring to practitioners of ECT.