老年患者接受电休克治疗后发作后谵妄的危险因素：锂盐和喹硫平的作用。
Risk Factors for Postictal Delirium in Geriatric Patients Undergoing Electroconvulsive Therapy: The Role of Lithium and Quetiapine.
作者信息
Wu Shiling, Li Kun, Long Jiang, Zhang Chenchen, Li Rui, Cheng Bochao, Cao Minne, Deng Wei
机构信息
Department of Physiotherapy, Shandong Daizhuang Hospital, 272051 Jining, Shandong, China.
Jining Key Laboratory of Neuromodulation, 272051 Jining, Shandong, China.
出版信息
Alpha Psychiatry. 2025 Jul 31;26(4):45431. doi: 10.31083/AP45431. eCollection 2025 Aug.
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 ( = 6.67, 0.010), quetiapine ( = 4.36, = 0.037), number of ECT sessions ( = 3065.50, = 0.003), and response rate ( = 12.86, 0.001). Logistic regression analysis demonstrated that lithium (odds ratio (OR) = 5.128; = 0.009) and quetiapine (OR = 2.562; = 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.
背景
发作后谵妄（PID）是老年患者接受电休克治疗（ECT）时出现的一种严重且常被忽视的不良反应。尽管其具有临床相关性，但导致该脆弱人群发生PID的具体危险因素仍未得到充分了解，这可能会影响治疗效果和患者安全。
方法
在这项回顾性研究中，我们分析了2009年至2020年期间在中国一家综合医院接受ECT治疗的168例老年患者的数据。对社会人口统计学和临床特征进行单因素分析，以确定纳入逻辑回归模型的变量。进行多因素二元逻辑回归分析，以确定这些变量与PID发生之间的关系。
结果
研究队列中PID的发生率为20.8%（35/168）。单因素分析显示，PID组和非PID组在使用锂盐（χ² = 6.67，P = 0.010）、喹硫平（χ² = 4.36，P = 0.037）、ECT治疗次数（χ² = 3065.50，P = 0.003）和缓解率（χ² = 12.86，P = 0.001）方面存在统计学显著差异。逻辑回归分析表明，锂盐（比值比（OR） = 5.128；P = 0.009）和喹硫平（OR = 2.562；P = 0.024）与PID显著相关。
结论
我们的研究结果表明，使用锂盐和喹硫平会显著增加发生PID的风险，强调了临床警惕的必要性。建议在计划ECT治疗时仔细考虑这些药物，以尽量降低发作后并发症的风险并优化治疗效果。
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