Electroconvulsive Therapy for Life‐Threatening Refractory Hypoactive Delirium in an 87‐Year‐Old Patient: A Case Report
- 1Service of Old-Age Psychiatry Department of Psychiatry Lausanne University Hospital (CHUV) University of Lausanne Prilly Switzerland unil.ch
- 2Geriatrics Unit Department of Internal Medicine Lausanne University Hospital (CHUV) University of Lausanne Lausanne Switzerland unil.ch
Abstract
Delirium is a frequent and serious neuropsychiatric syndrome in older inpatients and is associated with severe negative outcomes. Hypoactive delirium is often underdiagnosed and may become life‐threatening when accompanied by sustained refusal of oral intake. Evidence for pharmacological treatment of persistent or refractory delirium remains limited, and the role of electroconvulsive therapy (ECT) is poorly defined. We report an 87‐year‐old woman with both schizoaffective and major neurocognitive disorder who developed refractory hypoactive delirium in the context of multiple medical precipitants. Despite systematic identification and treatment of precipitants, correction of metabolic disturbances, and optimization of psychotropic medication, she continued to exhibit marked psychomotor inhibition and refusal of food and fluids, leading to clinically significant dehydration and electrolyte abnormalities. Given imminent medical risk and refractoriness to standard management, ECT was initiated twice weekly after multidisciplinary evaluation. Clinical improvement was observed after the first session, with resolution of delirium features and restoration of oral intake after three sessions, without periprocedural complications. This case suggests that carefully monitored ECT may be considered as a rescue intervention in cases of life‐threatening refractory hypoactive delirium and underscores the need for clearer escalation guidance and higher‐quality evidence.
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BibTeX
@article{perrin2026electroconvulsive,
title = {{Electroconvulsive Therapy for Life‐Threatening Refractory Hypoactive Delirium in an 87‐Year‐Old Patient: A Case Report}},
author = {Henri Perrin and Joao de Sousa and Patrizia d’Amelio and Pierre Vandel and Armin von Gunten and Kevin Swierkosz-Lenart and Beatriz Pozuelo Moyano},
journal = {Case Reports in Psychiatry},
year = {2026},
month = oct,
doi = {10.1155/crps/9267185},
url = {https://doi.org/10.1155/crps/9267185},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Electroconvulsive Therapy for Life‐Threatening Refractory Hypoactive Delirium in an 87‐Year‐Old Patient: A Case Report
AU - Henri Perrin
AU - Joao de Sousa
AU - Patrizia d’Amelio
AU - Pierre Vandel
AU - Armin von Gunten
AU - Kevin Swierkosz-Lenart
AU - Beatriz Pozuelo Moyano
PY - 2026
DA - 2026/10/30
JO - Case Reports in Psychiatry
DO - 10.1155/crps/9267185
UR - https://doi.org/10.1155/crps/9267185
AB - Delirium is a frequent and serious neuropsychiatric syndrome in older inpatients and is associated with severe negative outcomes. Hypoactive delirium is often underdiagnosed and may become life‐threatening when accompanied by sustained refusal of oral intake. Evidence for pharmacological treatment of persistent or refractory delirium remains limited, and the role of electroconvulsive therapy (ECT) is poorly defined. We report an 87‐year‐old woman with both schizoaffective and major neurocognitive disorder who developed refractory hypoactive delirium in the context of multiple medical precipitants. Despite systematic identification and treatment of precipitants, correction of metabolic disturbances, and optimization of psychotropic medication, she continued to exhibit marked psychomotor inhibition and refusal of food and fluids, leading to clinically significant dehydration and electrolyte abnormalities. Given imminent medical risk and refractoriness to standard management, ECT was initiated twice weekly after multidisciplinary evaluation. Clinical improvement was observed after the first session, with resolution of delirium features and restoration of oral intake after three sessions, without periprocedural complications. This case suggests that carefully monitored ECT may be considered as a rescue intervention in cases of life‐threatening refractory hypoactive delirium and underscores the need for clearer escalation guidance and higher‐quality evidence.
SN - 2090-682X
SN - 2090-6838
ER -