老年期抑郁症电休克治疗期间的意识模糊状态：一项前瞻性队列研究
Confusional States During Electroconvulsive Therapy for Late-Life Depression: A Prospective Cohort Study.
作者信息
Feenstra Thomas C, Denayer Nathalie, Vansteelandt Kristof, Obbels Jasmien, Hebbrecht Kaat, Van den Eynde Liese, Verspecht Shauni, Verwijk Esmée, van Exel Eric, Kok Rob M, Bouckaert Filip, Vergouwen Anton C M, van der Loo Adriano, Beekman Aartjan T F, Sienaert Pascal, Rhebergen Didi
机构信息
GGZ Centraal Mental Health Care, Amersfoort, the Netherlands.
Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, the Netherlands.
出版信息
Acta Psychiatr Scand. 2025 Aug;152(2):125-133. doi: 10.1111/acps.13803. Epub 2025 Mar 18.
INTRODUCTION
Cognitive side effects, such as memory loss, associated with electroconvulsive therapy (ECT) have been extensively studied. However, knowledge about (sub)acute confusional states during ECT is limited, particularly in older adults with depression. Their incidence, recurrence, and co-occurrence remain unclear. This study aimed to describe the incidence, recurrence, co-occurrence, and clinical course of various subtypes of confusional states during ECT.
METHODS
Data were derived from the 'Rivastigmine for ECT-induced Cognitive Adverse effects in Late-Life depression' (RECALL) prospective cohort study, involving 145 older adults (≥ 55 years) with a major depressive episode receiving ECT. We assessed different subtypes of confusional states: postictal and interictal delirium (PID and IID), postictal agitation (PIA), prolonged time to reorientation (TRO), and subacute general cognitive decline (Mini Mental State Examination decline ≥ 4 points) throughout the ECT course.
RESULTS
Over half of the older adults (55.9%) experienced at least one subtype of confusional state during their ECT course. The most prevalent subtypes were PIA (29.5%) and prolonged TRO (28.3%), while postictal (5.9%) and interictal delirium (4.2%) were less common. Recurrence rates varied, with interictal delirium (66.7%) and prolonged TRO (50.0%) showing the highest rates compared to postictal delirium (12.5%). Notably, 18.0% of older adults experienced more than one subtype of confusional state during their ECT course, and these states could emerge at any time during the ECT course.
CONCLUSION
This is the first study to comprehensively examine the clinical course of various subtypes of confusional states during ECT in older adults with depression Our findings reveal that confusional states are highly prevalent, heterogeneous, and may emerge at any time during the ECT course. Notably, since the instruments used were not designed to measure (subtypes of) confusional states during ECT, further research into the differentiation of (sub)acute confusional states is warranted.
TRIAL REGISTRATION
EudraCT 2014-003385-24.
引言
与电休克治疗（ECT）相关的认知副作用，如记忆丧失，已得到广泛研究。然而，关于ECT期间（亚）急性意识模糊状态的知识有限，尤其是在患有抑郁症的老年人中。其发病率、复发率和共现情况仍不清楚。本研究旨在描述ECT期间意识模糊状态各亚型的发病率、复发率、共现情况及临床过程。
方法
数据来源于“卡巴拉汀用于ECT诱导的老年抑郁症认知不良反应”（RECALL）前瞻性队列研究，该研究纳入了145名患有重度抑郁发作且接受ECT治疗的老年人（≥55岁）。我们评估了意识模糊状态的不同亚型：发作后和发作期间谵妄（PID和IID）、发作后激越（PIA）、重新定向时间延长（TRO）以及整个ECT疗程中的亚急性总体认知衰退（简易精神状态检查表下降≥4分）。
结果
超过一半的老年人（55.9%）在ECT疗程中经历了至少一种意识模糊状态亚型。最常见的亚型是PIA（29.5%）和TRO延长（28.3%），而发作后谵妄（5.9%）和发作期间谵妄（4.2%）则较少见。复发率各不相同，发作期间谵妄（66.7%）和TRO延长（50.0%）的复发率高于发作后谵妄（12.5%）。值得注意的是，18.0%的老年人在ECT疗程中经历了不止一种意识模糊状态亚型，且这些状态可能在ECT疗程中的任何时间出现。
结论
这是第一项全面研究患有抑郁症的老年人在ECT期间意识模糊状态各亚型临床过程的研究。我们的研究结果表明，意识模糊状态非常普遍、具有异质性，且可能在ECT疗程中的任何时间出现。值得注意的是，由于所使用的工具并非设计用于测量ECT期间的（意识模糊状态）亚型，因此有必要对（亚）急性意识模糊状态的鉴别进行进一步研究。
试验注册
EudraCT 2014 - 003385 - 24。
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