Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
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Electroconvulsive Therapy for Psychiatric Disorders in Elderly Adults

노년기 정신장애의 전기경련치료

  • Joo, Eun-Jeong (Department of Neuropsychiatry, School of Medicine, Eulji University) ;
  • Kim, Hee Cheol (Department of Psychiatry, Keimyung University Dongsan Hospital) ;
  • Kang, Ung Gu (Department of Psychiatry, Seoul National University Hospital) ;
  • Lee, Nam Young (Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital) ;
  • Park, Seung Hyun (Daedong Hospital) ;
  • Kim, Jung Min (St. Andrew's Hospital) ;
  • Kim, Yong Sik (Department of Psychiatry, Nowon Eulji Medical Center, Eulji University) ;
  • Chung, In Won (Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital)
  • 주은정 (을지대학교 의과대학 정신건강의학교실) ;
  • 김희철 (계명대학교동산병원 정신건강의학과) ;
  • 강웅구 (서울대학교병원 정신건강의학과) ;
  • 이남영 (동국대학교 일산병원 정신건강의학과) ;
  • 박승현 (대동병원) ;
  • 김정민 (성안드레아병원) ;
  • 김용식 (노원을지대학교병원 정신건강의학과) ;
  • 정인원 (동국대학교 일산병원 정신건강의학과)
  • Received : 2020.09.09
  • Accepted : 2020.09.29
  • Published : 2020.10.31
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Abstract

Electroconvulsive therapy (ECT) is indicated for various mental disorders (e.g., major depressive disorder, schizophrenia, and bipolar disorder) and the behavioral and psychological symptoms of dementia in elderly patients. Furthermore, ECT is a useful first-line treatment in emergency and crisis situations such as suicide risk, violent behavior, catatonia, and food refusal, which are more frequent in elderly patients. ECT is also effective in the treatment of the motor symptoms of neurological disorders, such as Parkinson's disease and Huntington's disease. Due to the high risk of various physical diseases, the comorbid physical conditions of elderly patients should be individually controlled to optimize ECT treatment. Compared to young adults, in elderly patients the seizure threshold is higher, the seizure duration is shorter, and the anesthetic dose is lower. On the contrary, the response rate in the elderly is both faster and higher. Considering potential cognitive decline and the prevention of further deterioration of cognitive function in elderly patients, in the absence of significant comorbidities, twice weekly sessions and right unilateral electrode placement with a lower seizure threshold and less cognitive effect are preferred to bilateral electrode placement, which has a high risk of adverse cognitive effects. After an acute course of ECT, continuation and maintenance of ECT, combined with prescription of therapeutic drugs, may prevent possible relapse or recurrence of mental disorders. In conclusion, ECT can be used to treat mental disorders in elderly adults, with safety and effectiveness comparable to that in young adults.

Keywords

Acknowledgement

본 연구는 보건복지부의 재원으로 정신건강 R&D사업 지원에 의하여 이루어진 것임(과제고유번호: HL19C-0051-000020).

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