Electroconvulsive therapy (ECT) is an effective therapeutic intervention in the elderly patients with major depression, especially those with psychosis, suicidality, catatonia, nutritional compromise, and resistance to medications. Response rates can be as high as 80%. We present an extensive review of the relevant literature, provide a description of the ECT program at Virginia Commonwealth University in Richmond, Virginia, USA, and present results of our experience with ECT in fifty elderly patients. The treatments were safe, well tolerated, and produced high response rates, variably between 68% and 84%. Patients in the long-term maintenance ECT program continue to show sustained benefits from ECT.

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Electroconvulsive therapy (ECT) is one of the treatment modalities in psychiatry that has stood the test of time for years. ECT has been used in various psychiatric conditions in the elderly. Comorbid medical conditions and cognitive deficits have been the prime concerns in this population. The indications and contraindications of use of ECT in the elderly population are same as that in an adult. ECT has also been found to be effective in patients with Parkinson's disease and dementia. Pre-ECT evaluation and cognitive evaluation prior and during ECT are inevitable. The determination of right technique, dose, frequency, and assessment of side effects are prerequisites to the usage of ECT in elderly. Owing to risk of cognitive side effects, right unilateral ECT is preferred. In carefully selected indications, ECT may be a superior management modality than pharmacotherapy.

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Electroconvulsive therapy (ECT) has been found to be a rapid and effective treatment strategy for psychiatric and neurological conditions in the elderly, but the administration of ECT in the elderly can be challenging due to a high risk of adverse events. The increased risk can be attributed to a declined physiological reserve, the presence of physical comorbidities, and the use of multiple drugs, which interact with the electrical stimulus and the anesthetic medications used during the ECT procedure. The selection of appropriate induction agents and muscle relaxants should be guided by patient's clinical status and the psychotropic drugs being used. Modifications in the doses of psychotropic drugs also need to be carried out before ECT to reduce cardiovascular and neurological side effects. Modification in the conduct of anesthesia can also aid in augmenting seizures and in preventing common side effects of ECT. A vital step in preventing adverse events in the elderly is carrying out a thorough pre.ECT evaluation. Despite these challenges, ECT can be carried out safely in elderly patients with severe comorbidities, provided clinical ECT, and anesthetic parameters are adequately optimized.

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Mild cognitive impairment (MCI) is recognized as a target for early intervention in elderly with high risk for dementia due to Alzheimer's disease (AD) and other related disorders. Transcranial direct current stimulation (tDCS) is reemerging as a novel method of noninvasive brain stimulation in various neuropsychiatric disorders including MCI and dementia based on the potential clinical applications of its utility in modulating neuroplasticity. In this article, we review the neurobiology of aging, AD, and MCI from the perspective of tDCS and summarize the findings from studies applying tDCS in MCI to improve cognitive function. Studies on therapeutic application of tDCS to improve cognitive function in MCI and other related disorders have shown mixed results. Limited studies available in this topic suggest a potential role for tDCS in MCI. Low risk for adverse effects, lower cost, and the possibility of self-administered home-based intervention are important advantages that encourage further research in this field. There is a need for more evidence from large systematic randomized controlled trials regarding the efficacy of tDCS in MCI. Standardization of stimulation protocols, evaluation of long-term outcome with the possibility of maintenance tDCS, and efficacy of combined intervention of tDCS and cognitive training are important areas for future research in this area.

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Patients with bipolar disorder (BD) can have a range of comorbid psychiatric disorders, and clinical studies have reported BD to be a putative risk factor for the development of dementia. In this case report, we present a case of a 62-year-old female, who had been suffering from BD since early adulthood, developed symptoms of dementia at the age of 60 years, which led to diagnostic issues at the time of relapse of BD. At the time of presentation, she had a depressive relapse with catatonic symptoms and was managed with electroconvulsive therapy during the acute phase, and lithium was used for maintenance treatment.

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There is limited literature on catatonia as a presenting manifestation of dementia. Further, whenever catatonia occurs in patients with dementia, it often responds to lorazepam. There is limited literature on use of electroconvulsive therapy for management of catatonia among patients with dementia. In this report, we present a case of catatonia occurring during dementia of Lewy body which did not respond to lorazepam but responded to use of electroconvulsive therapy.

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Background: Elderly depression is a fairly common and often difficult to treat condition. Elderly patients also often have comorbid medical conditions that preclude the use of other somatic treatment modalities. Repetitive transcranial magnetic stimulation (rTMS) is a treatment methodology that is approved to be used in depression and is supposed to have fewer side-effects. This paper describes the experience of a recently started rTMS service in a tertiary hospital in North India with referred elderly patients suffering from depression. Methods: Results of rTMS therapy administered to 7 elderly patients who were referred during this period are described. Results: Only one patient with bipolar depression perceived significant benefit from rTMS. Three patients complained of mild and transient side-effects, and one patient discontinued treatment due to his medical condition (unrelated to rTMS). Conclusions: rTMS seems to be safe and well-tolerated in this population. However, further experience is needed before commenting definitely on effectiveness of this treatment modality.

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Repetitive transcranial magnetic stimulation (rTMS) has been used widely in adult patients with depression and resistant auditory hallucinations. There is a paucity of data for rTMS use in geriatric patients for these indications. Recent research has revealed newer avenues for the use of rTMS in clinical geriatric psychiatry practice which includes mild cognitive impairment and dementia. rTMS is also being looked at as an effective treatment when combined with cognitive training in the management of Alzheimer's disease. The present review discusses the various uses of rTMS in geriatric psychiatry. This paper analyzes the various studies done with rTMS in older patients in various indications and the safety and efficacy of the procedure are also evaluated. The need for further studies in this area using larger samples is also mentioned.

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Introduction: Electroconvulsive therapy (ECT) is frequently used treatment procedure, and is utilized more often for severe, treatment-resistant, or refractory psychiatric disorders. However, published data on the use of ECT is limited, more so for special population like older adults. Aim: The aim of the study was to explore the clinical, demographic, and diagnostic profiles of older adults, and the parameters of ECT treatment, in a tertiary care Geriatric Mental Health set up. Materials and Methods: Approval to review the case notes was obtained from the Institutional Ethical Committee. The individuals were aged 60 years and above and had received ECT between January 2014 and May 2017. The relevant details pertaining to the aims of the study were recorded in a spreadsheet. Results: Twenty-five courses (absolute number = 191) of ECT were given to 21 patients (mean age = 67.44 ± 9.8 years) with mean of 7.64 ± 3.6 ECT per patient. Majority of the patients belonged to age group 60–69 years, and were male (81%). Depression was the most common diagnosis for giving ECT (43%) in these individuals, and poor response to pharmacological treatment (81%) was the most common indication. The mean duration of the seizure elicited was 28.8 ± 13.2 s, and a therapeutic response was seen in 86% of cases. No major complications were noted during ECT treatment. Conclusion: When used judiciously and with trained staff, ECT is an effective and relatively safe mode of treatment even in older adults.

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Patients with schizophrenia may sometimes have refractory symptoms that do not respond to medical treatments. One such symptom commonly seen in schizophrenia is refractory and distressing auditory hallucinations that do not respond to medication and psychotherapy. Transcranial direct current stimulation (tDCS) has been used successfully in adult patients in the management of refractory auditory hallucinations in schizophrenia. We report here a case of severe distressing refractory auditory hallucinations in a 66-year-old male with schizophrenia that responded to once daily tDCS which was then continued over a 3-month period. More than 80% improvement was reported in a month of treatment which was then continued over 3 months to yield 95% improvement. The patient had a better quality of life and relief from a distressing symptom. No side effects were noted due to the tDCS treatment. This case report supports the view that tDCS is an effective treatment for resistant and refractory auditory hallucinations in geriatric patients with schizophrenia.

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Various drugs have been used in the management of behavioral and psychotic symptoms including aggression and agitation in dementia. However, the risk of side effects and sedation limits the use of higher doses of many agents. Electroconvulsive therapy (ECT) has been used in the management of behavioral symptoms related to dementia although sparingly and rare. We report the case of a 75.year.old male patient with moderate Alzheimer's dementia and severe agitated behavior and aggression which failed to respond to pharmacological treatment and whom we treated using seven ECT sessions with success. Significant clinical improvement was noted and no cognitive decline or worsening of the dementia in any form was reported. The patient was followed up 6 months post the ECT sessions. This case report demonstrates the safety and efficacy ECT use patients with Alzheimer's dementia when behavioral problems and aggression or agitation fail to respond to medications.

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Introduction: The number of elder patients with severe psychiatric illnesses other than depression is increasing. Electroconvulsive therapy (ECT) has a special role in the treatment of late-life depression and other psychiatric conditions in the elderly. Using ECTs in the elderly could be difficult. In an Indian setting, ECT in the geriatric population is used as last resort of treatment which is in contrast to Western countries. There is dearth of data available for the use of ECT in the elderly in India. Methodology: Retrospective data review was carried out to identify patients 55 years or older who had received ECT from January 2014 to June 2016 in tertiary care teaching hospital in a metropolitan city in India. Results: A total of 304 ECTs were administered to 25 elderly aged >55 years with average of 12 ECTs per patient. Schizophrenia (56%) was the most common diagnosis among patients who were considered for ECT, and this was followed by major depression without psychotic features (24%) and major depression with psychotic features (8%). The most common indication to start ECT was nonresponsiveness to medications (92%). There was an increase in mean Mini-Mental State Examination (MMSE) scores from baseline (23.42) to the end of the sixth (24.60) and last ECT (24.60). Duration of current used during ECT had positive correlation with MMSE. Patients with comorbid medical illness (20%) received ECT without any complication. Conclusions: This study adds to scarce database on the use of ECT in old-age patients in India and adds to evidence that ECT is safe and effective treatment in old age with no negative impact on cognition.

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Background: Although electroconvulsive therapy (ECT) is a well-established treatment modality worldwide for elderly with severe psychiatric disorders, literature is sparse in India. Materials and Methods: A retrospective chart review of patients aged 60 years and above (n = 90) who received a course of ECTs between April 2003 and 2013 in National Institute of Mental Health and Neurosciences, Bengaluru, a tertiary care neuropsychiatric institute, was carried out. For each elderly person, the next consecutive nonelderly ECT patient was selected as a control (n = 85). Clinical, demographic, and ECT variables were compared. Results: Depression (n = 57; 63.3%) was the most common diagnosis for ECT among the elderly while schizophrenia (n = 28; 32.9%) was most common among controls (P < 0.01); suicidal ideas were the most common indication (n = 25; 28.4%) among the elderly while aggression was the most common indication among controls (n = 28; 33.3%) (P = 0.004). Elderly received more number of ECTs (mean [standard deviation (SD)] 8.0 [3.0] vs. 6.4 [2.8]; P ≤ 0.01), had higher seizure threshold (mean [SD] 135.3 [76.9] mc vs. 81.3 [54.2] mc; P < 0.01), and experienced lesser duration of motor seizures (mean [SD] 38.48 [9.72] s vs. 48.90 [14.66]; P < 0.01). Immediate post-ECT cognitive deficits were more in the elderly (n = 19; 21.6% vs. n = 7; 8.3%; P = 0.02). Case records showed no between-group differences both at the end of 3-month (P = 0.40) and 6-month (P = 0.50) follow-up for cognitive complaints. Mean (standard deviation) Clinical Global Impression-Improvement scores at the end of ECT course were 2.3 (0.9) versus 2.4 (0.8) (P = 0.5) among elderly and nonelderly, respectively. These scores were comparable at the end of 3 as well as 6 months' follow-up. Conclusions: This retrospective chart review showed ECT to be safe and effective for geriatric patients with severe psychiatric disorders including cognitive adverse effects. However, prospective studies would help to better establish cognitive adverse effects of ECT.

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Background: Electroconvulsive therapy (ECT) is an important modality of treatment for various psychiatric disorders in all age groups. The trends of use of ECT in the elderly population have not been studied despite wide variation in the utilization of this treatment modality. Aim: This study aimed to evaluate the trends in use of ECT in geriatric patients at a tertiary care center over a period of 9 years. Methodology: Data were extracted from the departmental registry for the period of 2008–2016 to evaluate the total number of new patients attending the psychiatric services, total number of new elderly (i.e., ≥60 years) patients attending the psychiatric services, total number of inpatients, total number of elderly inpatients, total number of patients who received ECT, and total number of elderly patients who received ECT. Results: During the period of 2008–2016, elderly formed from 4.6% to 19.11% of the total number of patients who received ECT. There was an upward trend in the proportion of elderly patients receiving ECT, with a nearly 10-fold rise in absolute number and doubling of the percentage of elderly patients among those receiving ECT. Over the years, there was an increase in use of ECT among elderly inpatients and use of ECT as an outpatient treatment for elderly. Conclusion: Over the years, there has been increase in the absolute number as well as proportion of elderly patients receiving ECT. There is a significant increase in the use of ECT among elderly at the outpatient basis.

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