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Electroconvulsive Therapy Induced Hyperammonemia and Delirium: a Case Report
Pin-Hsin Lee, M.D.; Kuo-Tung Chiang, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E46-E47. doi:10.1176/appi.neuropsych.13050105
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The authors report no financial relationships with commercial interests.

From the Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, No. 60, Xinmin Road, Beitou District, Taipei City 112, Taiwan (PHL, KTC).

Send correspondence to Dr. Chiang; e-mail: cocca0805@yahoo.com.tw

Copyright © 2014 by the American Psychiatric Association

Received May 13, 2013; Revised May 16, 2013; Accepted May 16, 2014.


To the Editor: ECT is an effective, safe, and tolerable treatment for psychiatric disorders, including depression, schizophrenia, and bipolar disorders. It is also applied to medication-resistant psychiatric disorders. However, somatic and cognitive side effects such as headache, nausea, memory disturbances, and delirium are commonly reported after ECT.1,2 The most worrisome cognitive side effect is potentially life-threatening delirium, which may become the limitation of ECT. Postictal delirium usually resolves rapidly, but prolonged delirium sometimes occurs and may last from hours to several days.3 Structural, metabolic, endocrine disturbances, and medications may cause prolonged delirium.3 Hyperammonemia, which causes an acute onset of impaired consciousness, lethargy, and focal neurological signs or symptoms, is also one important condition to be monitored.35

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Electroconvulsive therapy induced hyperammonemia and delirium: a case report. J Neuropsychiatry Clin Neurosci 2014;26(2):E46-7.