Tolerability and Efficacy of Bi-temporal Electroconvulsive Therapy in Elderly Patients with Severe Mental Illness

Abstract

Background: Electroconvulsive therapy (ECT) has been an effective treatment option available for elderly patients with severe mental illness; however, there are concerns related to its tolerability. Unilateral ECT has fewer cognitive adverse effects compared to bilateral ECT while efficacy with bilateral ECT is better. Aim: To evaluate the tolerability and efficacy of Bi-temporal ECT in elderly patients (>60 years) with severe mental illness in a general hospital set-up. Methodology: The study was a prospective, observational study conducted in SDM College of Medical Sciences and Hospital, Dharwad with a sample size of 15 elderly patients aged above 60 years with severe mental illness. Participants were screened for psychiatric symptoms with Mini-International Neuropsychiatric Interview and assessed for severity of symptoms with Hamilton Depression Rating Scale, Young Mania Rating Scale, and Positive and Negative Syndrome Scale. Cognitive functioning was assessed by Hindi Mental Status Examination Scale and effectiveness was assessed using global functioning by Global Assessment of Functioning (GAF) Scale. Assessment was done before giving ECT and 4 weeks at follow-up. The study period was from January 2019 to December 2019. Results and Conclusions: The median age of the elderly was 61 years. Majority (66.7%) were diagnosed with mood disorder and 33.3% of the patients were diagnosed with paranoid schizophrenia. Around 47% had comorbid hypertension and 33.3% had diabetes mellitus. All the patients in the study sample received thrice weekly bi-temporal ECT in the range of 2–8 with median of 5. Significant reduction in symptomatology was observed, on comparing the scores before and after ECT with improvement in overall functioning assessed by GAF Scale. There was no decline in cognitive functioning test, although there was an improvement in the Hindi version of mini mental status examination scores at 4 weeks after discharge. By the above observations, we concluded that the use of bi-temporal ECT in elderly patients with severe mental illness was found to be safe and effective in treating.