ABSTRACT
Postictal delirium is an acute confusional state occurring during the immediate postictal phase in patients receiving electroconvulsive therapy that is characterized by motor agitation, disorientation, clouded consciousness, repetitive stereotyped movements, and poor response to commands. A schizophrenic patient with severe and recurrent postictal delirium is described. The possible role of the clozapine-electroconvulsive therapy combination in the occurrence of postictal delirium is discussed. Several management strategies were tried, with various degrees of success. Propofol proved to be effective in preventing agitation when used as induction agent or when administered at seizure end. However, propofol could not prevent a delirious state when only administered after the first signs of motor restlessness had emerged.
Subject(s)
Anesthetics, Intravenous/administration & dosage , Antipsychotic Agents/therapeutic use , Delirium/drug therapy , Electroconvulsive Therapy , Propofol/administration & dosage , Schizophrenia/therapy , Adult , Clozapine/therapeutic use , Combined Modality Therapy , Delirium/etiology , Humans , MaleSubject(s)
Anesthetics, Intravenous/therapeutic use , Bipolar Disorder/therapy , Electroconvulsive Therapy/methods , Piperidines/therapeutic use , Seizures/etiology , Drug Resistance , Drug Therapy, Combination , Female , Humans , Methohexital/therapeutic use , Middle Aged , Remifentanil , Treatment OutcomeSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Bipolar Disorder/therapy , Electroconvulsive Therapy/adverse effects , Seizures/etiology , Sulfonamides/adverse effects , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Female , Humans , Seizures/physiopathology , Sulfonamides/therapeutic useABSTRACT
The Ehlers-Danlos syndrome is an inheritable disorder caused by genetic defects of collagen. Hyperextensibility and fragility of the skin, joint hyperlaxity, and generalized fragility of the connective tissues, involving the hollow organs and arteries, are the cardinal features of this syndrome. Low bone density has also been reported. Theoretically, these patients can have an increased risk of rupture of blood vessels and of bone fractures. A patient with a schizo-affective disorder and Ehlers-Danlos Type I who received bifrontal ECT for a depressive episode is described. Even without specific measures to lower blood pressure, a course of ECT was finished without any complication.
