P0321 - Electroconvulsivotherapy in the elderly, indications, risks and side-effects

Abstract

Introduction:

Major depression is one of the most prevalent diagnoses in the elderly and represents an important cause of morbidity and mortality in this group. There exists evidence that electroconvulsive therapy (ECT) is particularly efficient and safe in the elderly patient.

Methods:

Bibliographic review on Pubmed, Medline and Textbooks of Psychiatry

Results:

The use of ECT in the psychogeriatric patient has indication in episodes of major depression, mania, schizophrenia and other psychotic disorders, and also when there exists concomitant neurological (affective disorders in dementia, Parkinson´s disease, and post stroke depression). or other mental syndromes (catatonia or delirium secondary to various medical conditions).

Because the geriatric population suffers multiple organic comorbidities, the following risk factors require evaluation: history of head trauma, focal or general neurological complaints (recent stroke, intracranial tumour, hypertension or aneurysm), angina, congestive heart failure, bone fractures, osteoporosis, spinal disease and oesophageal reflux.

The following adverse effects have been described: cardiac ischemia, arrhythmia (tachycardia and bradycardia), hypertension, pneumonia secondary to aspiration of gastric contents, musculoskeletal and dental injury, increase of intraocular pressure, post ictal confusion and disorientation, impaired retrograde and anterograde memory.

Conclusion:

The indication, risks factors and possible adverse effects of ECT should be carefully evaluated in the elderly patient.