title: Predictors of electroconvulsive therapy postictal delirium.
abstract: BACKGROUND
  Postictal delirium is a common adverse effect of electroconvulsive therapy (ECT) and can be dangerous to both patient and staff caring for them in the postanesthesia care unit. However, little is known about predictors of postictal delirium.
  
  
  OBJECTIVE
  The aim of this study was to identify predictors of postictal delirium. We hypothesized that both patient and ECT treatment variables might influence the likelihood of postictal delirium.
  
  
  METHODS
  We prospectively monitored postictal delirium in the postanesthesia care unit using the Confusion Assessment Method for the Intensive Care Unit after the first ECT treatment of 96 consecutive patients. Patient and treatment variables were extracted retrospectively by chart review. A multiple logistic regression model was developed to assess the effect of these variables on the likelihood of developing delirium.
  
  
  RESULTS
  Seizure length was found to be a statistically significant predictor of postictal delirium after adjusting for other covariates (p = 0.003). No other variables were predictive.
  
  
  CONCLUSIONS
  A long ECT seizure increases the likelihood of delirium in the postanesthesia care unit at the first treatment. This finding suggests that postanesthesia care unit staff may benefit from knowledge about seizure length for predicting postictal delirium and anticipating the best management of post-ECT patients.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: imreti@jhmi.edu.
authors.forename: Irving M
authors.initials: IM
authors.lastname: Reti
authors.affiliation: Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Podlisky
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: April
authors.initials: A
authors.lastname: Sharp
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Walker
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Neufeld
authors.affiliation: College of Nursing, Rutgers University, Newark, NJ, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hayat
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000628:therapy*; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis / Q000209:etiology*; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000628:therapy*; D012307:Risk Factors; D012640:Seizures; D013997:Time Factors