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A 42-year-old woman who has been diagnosed with psychotic depression is discussing treatment options with her psychiatrist. She is very reluctant to take medication because of fear that she will make her chemical imbalance even worse. She is also looking for something that is going to have a faster effect. The doctor discusses the possibility of electroconvulsive treatment. What is the most common complication of this treatment?
A. Cerebral edema
B. Hypotensive crisis
C. Memory impairment
D. Oneiroid state
E. Status epilepticus
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all correct
The correct answer is C. The greatest concern regarding ECT is memory loss, which is usually short term, but occurs in 75% of the patient population. Follow-up data after the full course of treatment indicate that almost all patients are back at their baseline cognitively after 6 months.
The risk of cerebral edema (choice A) is significantly increased in patients with space occupying lesions in the CNS. Otherwise, it is not the most common side effect.
Hypotensive crisis (choice B) may occur in the event of brief postictal bradycardia. Usually, hypertension occurs, and some patients may need to be pretreated with antihypertensives.
An oneiroid state (choice D) is a dreamlike state seen mostly in schizophrenic patients, who look perplexed. It can also be seen in medical and neurological conditions. The patient is not fully oriented to time and place, and is usually having hallucinations.
Status epilepticus (choice E) can occur during the induction of seizures and is managed with additional doses of anesthetic, however, it is not most common complication.
