{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:54:44Z","timestamp":1789844084272,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019573","name":"Amsterdam University Medical Centers","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019573","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cognitive side effects, such as memory loss, associated with electroconvulsive therapy (ECT) have been extensively studied. However, knowledge about (sub)acute confusional states during ECT is limited, particularly in older adults with depression. Their incidence, recurrence, and co\u2010occurrence remain unclear. This study aimed to describe the incidence, recurrence, co\u2010occurrence, and clinical course of various subtypes of confusional states during ECT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were derived from the \u2018Rivastigmine for ECT\u2010induced Cognitive Adverse effects in Late\u2010Life depression\u2019 (RECALL) prospective cohort study, involving 145 older adults (\u2265\u200955\u2009years) with a major depressive episode receiving ECT. We assessed different subtypes of confusional states: postictal and interictal delirium (PID and IID), postictal agitation (PIA), prolonged time to reorientation (TRO), and subacute general cognitive decline (Mini Mental State Examination decline \u2265\u20094 points) throughout the ECT course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over half of the older adults (55.9%) experienced at least one subtype of confusional state during their ECT course. The most prevalent subtypes were PIA (29.5%) and prolonged TRO (28.3%), while postictal (5.9%) and interictal delirium (4.2%) were less common. Recurrence rates varied, with interictal delirium (66.7%) and prolonged TRO (50.0%) showing the highest rates compared to postictal delirium (12.5%). Notably, 18.0% of older adults experienced more than one subtype of confusional state during their ECT course, and these states could emerge at any time during the ECT course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first study to comprehensively examine the clinical course of various subtypes of confusional states during ECT in older adults with depression Our findings reveal that confusional states are highly prevalent, heterogeneous, and may emerge at any time during the ECT course. Notably, since the instruments used were not designed to measure (subtypes of) confusional states during ECT, further research into the differentiation of (sub)acute confusional states is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>EudraCT 2014\u2010003385\u201024<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13803","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T19:29:07Z","timestamp":1742326147000},"page":"125-133","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Confusional States During Electroconvulsive Therapy for Late\u2010Life Depression: A Prospective Cohort Study"],"prefix":"10.1111","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5974-4424","authenticated-orcid":false,"given":"Thomas C.","family":"Feenstra","sequence":"first","affiliation":[{"name":"GGZ Centraal Mental Health Care  Amersfoort the Netherlands"},{"name":"Amsterdam Public Health Research Institute Mental Health Program  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Denayer","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Psychiatric Center KU Leuven Academic Center for ECT and Neuromodulation (AcCENT)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristof","family":"Vansteelandt","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Psychiatric Center KU Leuven Academic Center for ECT and Neuromodulation (AcCENT)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmien","family":"Obbels","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Psychiatric Center KU Leuven Academic Center for ECT and Neuromodulation (AcCENT)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaat","family":"Hebbrecht","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Psychiatric Center KU Leuven Academic Center for ECT and Neuromodulation (AcCENT)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liese","family":"Van den Eynde","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Psychiatric Center KU Leuven Academic Center for ECT and Neuromodulation (AcCENT)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shauni","family":"Verspecht","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, University Psychiatric Center KU Leuven Academic Center for ECT and Neuromodulation (AcCENT)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esm\u00e9e","family":"Verwijk","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology Amsterdam UMC  Amsterdam the Netherlands"},{"name":"Department of Psychology, Brain and Cognition University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"van Exel","sequence":"additional","affiliation":[{"name":"Amsterdam Public Health Research Institute Mental Health Program  Amsterdam the Netherlands"},{"name":"GGZ InGeest Mental Health Care  Amsterdam the Netherlands"},{"name":"Department of Psychiatry Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Mood, Anxiety, Psychosis, Sleep and Stress Program Amsterdam Neuroscience  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9856-6920","authenticated-orcid":false,"given":"Rob M.","family":"Kok","sequence":"additional","affiliation":[{"name":"Parnassia Psychiatric Institute  The Hague the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Bouckaert","sequence":"additional","affiliation":[{"name":"Department of Geriatric Psychiatry, KU Leuven University Psychiatric Center KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton C. M.","family":"Vergouwen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Medical Psychology OLVG Hospital  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriano","family":"van der Loo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Medical Psychology OLVG Hospital  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aartjan T. 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The Netherlands: Richtlijnendatabase (2021)."},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2022.953686","article-title":"Rivastigmine for ECT\u2010Induced Cognitive Adverse Effects in Late Life Depression (RECALL Study): A Multicenter, Randomized, Double Blind, Placebo\u2010Controlled, Cross\u2010Over Trial in Patients With Depression Aged 55\u2009Years or Older: Rationale, Objectives and Methods","volume":"13","author":"Henstra M. 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