title: Speed of recovery from disorientation may predict the treatment outcome of electroconvulsive therapy (ECT) in elderly patients with major depression.
abstract: BACKGROUND
  No study has previously investigated whether the speed of recovery from disorientation in the post-ictal period may predict the short-term treatment outcome of electroconvulsive therapy (ECT).
  
  
  METHODS
  This longitudinal cohort study included 57 elderly patients with unipolar or bipolar major depression, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed weekly during the ECT course using the 17-item Hamilton Rating Scale for Depression (HRSD17). The post-ictal reorientation time (PRT) was assessed at the first and third treatments.
  
  
  RESULTS
  Longer PRTs at the first and third treatments predicted a more rapid decline and a lower end-point in continuous HRSD17 scores (p=0.002 and 0.019, respectively). None of the patients who recovered from disorientation in less than 5 min met the remission criterion, defined as an HRSD17 score of 7 or less. A greater increment in stimulus dosage from the first to the third ECT session rendered a smaller relative decline in PRT (p<0.001).
  
  
  CONCLUSIONS
  The limited number of subjects may reduce the generalizability of the findings.
  
  
  CONCLUSIONS
  The speed of recovery from disorientation at the first and third sessions seems to be a predictor of the treatment outcome of formula-based ECT, at least in elderly patients with major depression. It remains to be clarified how the PRT may be utilized to guide stimulus dosing.
authors.affiliation: Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: tormagne.bjolseth@diakonsyk.no.
authors.forename: Tor
authors.initials: T
authors.lastname: Magne Bjølseth
authors.affiliation: Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Engedal
authors.affiliation: Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway.
authors.forename: Jūratė
authors.initials: J
authors.lastname: Šaltytė Benth
authors.affiliation: Department of Emergency Mental Health Services, Oslo University Hospital, Ullevål, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Bergsholm
authors.affiliation: Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Gro
authors.initials: G
authors.lastname: Strømnes Dybedal
authors.affiliation: Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Torfinn
authors.initials: T
authors.lastname: Lødøen Gaarden
authors.affiliation: Department of Research and Development in Mental Health, Akershus University Hospital, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Tanum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D003221:Confusion / Q000453:epidemiology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
keywords: Electroconvulsive therapy; Major depression; Old age; Post-ictal reorientation time; Treatment outcome predictor