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Hua T, Cooper JJ. Challenges to Electroconvulsive Therapy in Pediatric Catatonia: A Case Report. J ECT 2023; 39:e6-e8. [PMID: 37125964 DOI: 10.1097/yct.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Tammy Hua
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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2
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Lee B, Shin E, Song I, Chang B. Depression in Adolescence and Brain-Derived Neurotrophic Factor. Front Mol Neurosci 2022; 15:947192. [PMID: 35875661 PMCID: PMC9302599 DOI: 10.3389/fnmol.2022.947192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
The incidence of depression among adolescents has been rapidly increasing in recent years. Environmental and genetic factors have been identified as important risk factors for adolescent depression. However, the mechanisms underlying the development of adolescent depression that are triggered by these risk factors are not well understood. Clinical and preclinical studies have focused more on adult depression, and differences in depressive symptoms between adolescents and adults make it difficult to adequately diagnose and treat adolescent depression. Brain-derived neurotrophic factor (BDNF) is known to play a critical role in the pathophysiology of many psychiatric disorders, including depression. However, there are still few studies on adolescent depression. Therefore, in this review paper, the causes and treatment of adolescent depression and the function of BDNF are investigated.
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Catatonia with Psychosis in an 8-Year-Old Child: A Case Report and a Literature Review. Case Rep Psychiatry 2022; 2022:4124733. [PMID: 35371578 PMCID: PMC8975680 DOI: 10.1155/2022/4124733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objective We present a narrative review of pediatric catatonia and a case report illustrating the complexity of management of psychosis in a child with catatonia. Method The literature search used the text terms pediatric, catatonia, and antipsychotics and the search engines PubMed and EBSCO. All references from peer-reviewed journals were reviewed for treatment strategies specific to management in children who are also psychotic. Findings. This 8-year-old girl presented with psychotic symptoms which were initially treated with antipsychotics and evolved into life-threatening catatonia that was eventually stabilized with a total daily dose of 46 mg of lorazepam. Lower doses led to recurrence. Once catatonia improved, she tolerated combined benzodiazepine and antipsychotic treatment. Long-term maintenance over 5 years required maintenance treatment with both benzodiazepines and antipsychotics to prevent relapse. Conclusions The extraordinary doses of benzodiazepines found to be optimal for management of catatonia in this child led to improved alertness and orientation, without evident sedation. Catatonia did not recur with later management of psychosis using neuroleptics when added to lorazepam. The current literature on pediatric catatonia does not provide guidance on dose maintenance or when and if to rechallenge with antipsychotics.
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Pervasive Refusal Syndrome: Three Case Reports—Autism as a Predisposing Factor and Gentle Coercion to Shorten Duration of Disorder? Case Rep Psychiatry 2022; 2022:2258180. [PMID: 35371579 PMCID: PMC8967588 DOI: 10.1155/2022/2258180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pervasive refusal syndrome (PRS) is a severe child psychiatric syndrome not yet included in the international classification and mostly affecting girls aged 7-15 years. Hospital admission and severe loss of function extend for many months and years but most recover. Autism has been suggested as a predisposing factor but largely lacks support for typical cases of PRS. Treatment is not evidence-based and described as requiring a lengthy inpatient stay with a very gradual and sensitive rehabilitation program. Case Presentations. Three cases of pervasive refusal syndrome (PRS) in girls aged 9–16 years are presented to report autism as a predisposing factor and to discuss gentle coercion as part of the management strategy to speed up the lengthy recovery. The cases, which met the proposed criteria and typical background characteristics, were noted with the addition of undiagnosed autism in two cases. The duration of inpatient admission was 8–14 months. Disease duration was 15-36 months. An adequate but negative lorazepam trial to rule out catatonia was carried out. Treatment was in one case successfully expedited with gentle coercion within a transparent management plan. Rehabilitation was slower in PRS with comorbid autism; additionally, accommodations to school and living support needed to be put in place. Conclusions PRS is a useful clinical entity and best perceived as a primitive reaction to overwhelming stress rather than as catatonia. Autism might be another predisposing factor and needs to be assessed. A psychoeducational approach and a clear management plan support rehabilitation. A gentle coercion might hasten recovery.
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5
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Tamman AJF, Anand A, Mathew SJ. A comparison of the safety, feasibility, and tolerability of ECT and ketamine for treatment-resistant depression. Expert Opin Drug Saf 2022; 21:745-759. [PMID: 35253555 DOI: 10.1080/14740338.2022.2049754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Treatment-resistant depression (TRD) is a problematic and prevalent public health and societal concern. Although electroconvulsive therapy (ECT) is the gold standard TRD intervention, the treatment evokes apprehension due to public perceptions, feasibility, and tolerability. Despite significant medical advancements, few medications have been approved by the U.S. Food and Drug Administration for TRD. In 2019, intranasal esketamine, the S-isomer of racemic ketamine, was approved for TRD, garnering significant excitement about the potential for the drug to act as an alternative treatment to ECT. AREAS COVERED The goal of this narrative review is to compare the safety, efficacy, and tolerability of ketamine and ECT; clarify whether ketamine is a reasonable alternative to ECT; and to facilitate improved treatment assignment for TRD. Empirical quantitative and qualitative studies and national and international guidelines these treatments are reviewed. EXPERT OPINION : The field awaits the results of two ongoing large comparative effectiveness trials of ECT and IV ketamine for TRD, which should help guide clinicians and patients as to the relative risk and benefit of these interventions. Over the next five years we anticipate further innovations in neuromodulation and in drug development which broadly aim to develop more tolerable versions of ECT and ketamine, respectively.
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Affiliation(s)
- Amanda J F Tamman
- Department of Psychology, St. John's University, Queens, NY, USA.,Mood and Anxiety Disorders Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amit Anand
- Department of Psychiatry, Mass General Brigham, Harvard Medical School, Boston, MA, USA
| | - Sanjay J Mathew
- Michael E. Debakey VA Medical Center, Houston, TX, USA.,Mood and Anxiety Disorders Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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6
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in people with depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [DOI: 10.1002/14651858.cd015164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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7
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Adverse effects of electroconvulsive therapy. Hippokratia 2021. [DOI: 10.1002/14651858.cd014995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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8
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in bipolar disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd015172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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9
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Tanguturi YC, Hanzlik E, Pagano L, Cundiff AW, Graham TB, Fuchs DC. Anti-NMDAR Encephalitis: Multidisciplinary Development of a Clinical Practice Guideline. Hosp Pediatr 2021; 11:1295-1302. [PMID: 34642216 DOI: 10.1542/hpeds.2021-005882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yasas C Tanguturi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences
| | | | | | - Allyson Witters Cundiff
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences
| | | | - D Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Departments of Psychiatry and Behavioral Sciences and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Abstract
ABSTRACT The existence of pediatric applications of electroconvulsive therapy (ECT) in the 1940s in Italy has been neglected by international literature. However, 2 case reports by Ferdinando Accornero and Mario Anderson, both assistants of Ugo Cerletti at the Sapienza Clinic for Nervous and Mental Diseases, should be brought to the attention of historians of ECT. The work presented therein began in Rome in September 1940, approximately at the same time of the first reported ECT administration on a child in Bristol, United Kingdom. The 2 reports described applications on 19 children and adolescents during 3 different sessions (1940-1941, 1944-1947, and 1947-1949), with a 3-year-long interruption due to the circumstances of World War II. Unfortunately, this research appeared belatedly in 2 articles from 1948 and 1950, respectively, in an Italian journal with limited distribution, when more extensive research contributions on pediatric ECT had already received international exposure. The Italian reports may cast light on the progress made by the early generation of ECT researchers in the 1940s toward the refinement of ECT techniques and the subsequent identification of diagnostic indicators for ECT among children.
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Affiliation(s)
- Elisabetta Sirgiovanni
- From the Department of Molecular Medicine, Museum of the History of Medicine, Sapienza University of Rome, Rome, Italy
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11
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Døssing E, Pagsberg AK. Electroconvulsive Therapy in Children and Adolescents: A Systematic Review of Current Literature and Guidelines. J ECT 2021; 37:158-170. [PMID: 34424874 DOI: 10.1097/yct.0000000000000761] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACT There is a lack of studies regarding the efficacy of electroconvulsive therapy (ECT) in children and adolescents. In this study, we aimed to assess benefits and harms of ECT in children and adolescents with major psychiatric diseases. We conducted a systematic search in PubMed, EMBASE, and PsycINFO for peer-reviewed articles written in English regarding the use of ECT as treatment for major psychiatric diseases in children and adolescents. This study consists of 192 articles, mostly case studies (n = 50), reviews and overview articles (n = 52), and retrospective studies (n = 30). We present an overview of evidence for ECT in children and adolescents with mood disorders, catatonia, schizophrenia, intellectual disability, self-injurious behavior, and other indications. This article is also a summary of international guidelines regarding the use of ECT in children and adolescents. We evaluated the overall quality of evidence by using Grading of Recommendations, Assessment, Development and Evaluations and found the overall level of evidence to be of low quality. There are no absolute contra indications for ECT in children and adolescents. Fears regarding cognitive dysfunction have not been reproduced in studies. Electroconvulsive therapy should be considered in severe, treatment-resistant mood disorders, catatonia, and schizophrenia, especially in older adolescents. High-quality studies are warranted to assess the efficacy of ECT, especially in these potentially life-threatening diseases.
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Affiliation(s)
- Erik Døssing
- From the Child and Adolescent Mental Health Centre, Mental Health Services, Zealand Region, Roskilde
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12
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Clermont A, Loubriel D, Li E, Mitera D, Samuels S. Electroconvulsive therapy in an adolescent patient with catatonia: a case report. Neurocase 2021; 27:18-21. [PMID: 33297838 DOI: 10.1080/13554794.2020.1859545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Catatonia is characterized by motor and behavioral symptoms and can arise in a wide variety of medical and psychiatric conditions. We describe the case of a 16-year-old female with a history of anxiety and depression who presented with prominent symptoms of negativism, initially diagnosed as conversion disorder. She failed to respond to increasing doses of benzodiazepines; after over six weeks of hospitalization, she received electroconvulsive therapy (ECT), resulting in significant remission of symptoms. This case demonstrates the importance of prompt diagnosis and treatment of catatonia in adolescent patients, as well as the safety and efficacy of ECT in this population.Abbreviations: AACAP: American Academy of Child and Adolescent Psychiatry; BPAD: Bipolar affective disorder; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; ECT: Electroconvulsive therapy; NMDA: N-methyl-D-aspartate.
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Affiliation(s)
| | - Daphne Loubriel
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Erin Li
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Darlene Mitera
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Susan Samuels
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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13
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for depression. Hippokratia 2021. [DOI: 10.1002/14651858.cd013843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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14
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Gralewicz A, Świȩcicki Ł, Antosik-Wójcińska AZ, Konopko M, Kurkowska-Jastrzȩbska I, Sienkiewicz-Jarosz H, Szostakiewicz Ł, Remberk B. ECT in an Adolescent With Schizophrenia and Seizures: Case Report. Front Psychiatry 2021; 12:646466. [PMID: 34867497 PMCID: PMC8633535 DOI: 10.3389/fpsyt.2021.646466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Electroconvulsive therapy (ECT) has been recognized as an effective treatment option in catatonia, and for prolonged or severe affective episodes and schizophrenia. Response rates vary from 40 to 80% in adolescents. The procedure is safe if the required precautions are undertaken. Nonetheless, ECT remains a serious clinical challenge in patients with comorbid seizures. We present a case study of a 17-year-old female student suffering from schizophrenia who was scheduled for ECT due to prior treatment inefficacy. Seizures had occurred a few days before the first ECT session. Nevertheless, the patient received the ECT course, combined with clozapine at 125 mg/day, after neurological diagnosis and treatment modification because the illness became life-threatening. The patient's clinical outcome was satisfactory without any seriously adverse events and further improvements were observed in the mental state following long-term psychosocial treatment at our inpatient unit. A few months later, epilepsy was however diagnosed with probably coexistence of partial seizures and seizure-like events without EEG correlate. Administering ECT in patients with seizure comorbidity was also investigated based on previous research. Data on this is, however, extremely scarce and to the best of our knowledge, the safety and efficacy of using ECT in adolescents with schizophrenia and seizures has yet not to any great extent been discussed in the literature.
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Affiliation(s)
- Anna Gralewicz
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | - Łukasz Świȩcicki
- Second Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | | | - Magdalena Konopko
- First Neurology Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | | | | | - Łukasz Szostakiewicz
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
| | - Barbara Remberk
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology (IPiN), Warsaw, Poland
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15
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Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives. Neuropsychiatr Dis Treat 2020; 16:2191-2208. [PMID: 33061390 PMCID: PMC7526008 DOI: 10.2147/ndt.s231573] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Catatonia is a serious, common syndrome of motoric and behavioral dysfunction, which carries high morbidity and mortality. Electroconvulsive therapy (ECT) is the definitive treatment for catatonia, but access to ECT for the treatment of catatonia remains inappropriately limited. Catatonia is observable, detectable, and relevant to various medical specialties, but underdiagnosis impedes the delivery of appropriate treatment and heightens risk of serious complications including iatrogenesis. Current understanding of catatonia's pathophysiology links it to the current understanding of ECT's mechanism of action. Definitive catatonia care requires recognition of the syndrome, workup to identify and treat the underlying cause, and effective management including appropriate referral for ECT. Even when all of these conditions are met, and despite well-established data on the safety and efficacy of ECT, stigma surrounding ECT and legal restrictions for its use in catatonia are additional critical barriers. Addressing the underdiagnosis of catatonia and barriers to its treatment with ECT is vital to improving outcomes for patients. While no standardized protocols for treatment of catatonia with ECT exist, a large body of research guides evidence-based care and reveals where additional research is warranted. The authors conducted a review of the literature on ECT as a treatment for catatonia. Based on the review, the authors offer strategies and future directions for improving access to ECT for patients with catatonia, and propose an algorithm for the treatment of catatonia with ECT.
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Affiliation(s)
- Jenifer R Lloyd
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Eric R Silverman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Joseph L Kugler
- Department of Psychiatry, University of Texas-Dell Medical School, Austin, TX, USA
| | - Joseph J Cooper
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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16
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Stein ALS, Sacks SM, Roth JR, Habis M, Saltz SB, Chen C. Anesthetic Management During Electroconvulsive Therapy in Children. Anesth Analg 2020; 130:126-140. [DOI: 10.1213/ane.0000000000004337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Patton AC, Thörnblom E, Salonen Ros H, Bodén R. A case of bipolar disorder onset with subsequent catatonia in a 14-year-old boy treated successfully with electroconvulsive therapy. Nord J Psychiatry 2019; 73:497-500. [PMID: 31430220 DOI: 10.1080/08039488.2019.1655590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anna-Clara Patton
- Child and Adolescent Psychiatry, Uppsala University, Uppsala University Hospital , Uppsala , Sweden
| | - Elin Thörnblom
- Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Helena Salonen Ros
- Child and Adolescent Psychiatry, Uppsala University, Uppsala University Hospital, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Robert Bodén
- Department of Neuroscience, Uppsala University , Uppsala , Sweden
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18
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Safety of Electroconvulsive Therapy in 2 Very Young Pediatric Patients With Catatonia Related to Anti-N-methyl-D-aspartate Receptor Encephalitis. J ECT 2019; 35:216-217. [PMID: 30720552 DOI: 10.1097/yct.0000000000000575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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First known case of catatonia due to cyclosporine A-related neurotoxicity in a pediatric patient with steroid-resistant nephrotic syndrome. BMC Psychiatry 2019; 19:123. [PMID: 31014303 PMCID: PMC6480487 DOI: 10.1186/s12888-019-2107-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 04/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Catatonia is a neuropsychiatric syndrome characterized by diverse psychomotor abnormalities, including motor dysregulation and behavioral and affective disturbances. Once thought to occur primarily in the context of schizophrenia, recent data suggest most cases of catatonia develop in individuals with depressive or bipolar disorders. Moreover, catatonia may ensue in general medical and neurological conditions, as well as due to a variety of pharmaceuticals, drugs of abuse, and toxic agents. At one time considered rare in pediatric patients, evidence now suggests catatonia is both underrecognized and undertreated in this population, where it carries an elevated risk of morbidity and mortality. Here we present the case of a child with steroid-resistant nephrotic syndrome who developed catatonia due to cyclosporine A-related neurotoxicity. CASE PRESENTATION A 9-year-old African-American boy with no psychiatric history and a 9-month history of nephrotic syndrome due to focal segmental glomerulosclerosis was admitted to the local children's hospital for management of mutism, posturing, insomnia, gait abnormalities, and somatic delusions. Seven days prior to admission, his cyclosporine plasma concentration was elevated at 1224 ng/mL (therapeutic range: 100-200 ng/mL). Upon admission, cyclosporine was discontinued and psychiatry was consulted, diagnosing catatonia. The patient subsequently received propofol 80 mg IV resulting in a transient lysis of catatonia. Over a lengthy hospitalization, the patient's catatonia was initially treated with lorazepam, quetiapine being added later to target psychosis. All signs and symptoms of catatonia resolved, and the patient was eventually tapered off both lorazepam and quetiapine with no return of symptoms more than 6 months later. CONCLUSIONS To our knowledge, this case represents the first reported instance of cyclosporine A-induced catatonia in a patient with steroid-resistant nephrotic syndrome. It illustrates the importance of maintaining vigilance for signs and symptoms of cyclosporine A-related neurotoxicity (including catatonia) in patients with steroid-resistant nephrotic syndrome. In addition, it highlights the challenges faced by clinicians in jurisdictions that prohibit the use of electroconvulsive therapy in pediatric patients.
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Moussa T, Afzal K, Cooper J, Rosenberger R, Gerstle K, Wagner-Weiner L. Pediatric anti-NMDA receptor encephalitis with catatonia: treatment with electroconvulsive therapy. Pediatr Rheumatol Online J 2019; 17:8. [PMID: 30777097 PMCID: PMC6378721 DOI: 10.1186/s12969-019-0310-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Anti-NMDA receptor encephalitis, an autoimmune disease associated with antibodies against N-methyl-D-aspartate (NMDA) receptors, is being diagnosed more frequently, especially in children and young adults. Acute neurological and psychiatric manifestations are the common presenting symptoms. Diagnosing anti-NMDA receptor encephalitis is often challenging given the wide range of clinical presentation, and may be further complicated by its overlap of symptoms, brain MRI changes, and CSF findings with other entities affecting the brain. Even though diagnosis can be made by identifying antibodies in immune-mediated encephalitis, the diagnosis may be delayed by weeks to months. Delay in initiation of treatment with immune suppressive therapies is shown to be associated with adverse outcomes. Malignant catatonia is a severe and life-threatening state associated with anti-NMDA receptor encephalitis. It is often inadequately assessed and may not respond to immunosuppressive treatment. CASE PRESENTATION We present a confirmed case of anti-NMDA receptor encephalitis in a 16 year old girl who had severe critical neurological and psychiatric manifestations, including malignant catatonia and autonomic instability. Our patient continued to manifest malignant catatonia despite the initiation of prompt, aggressive immune suppressive therapies, including corticosteroids, plasmapheresis, intravenous gammaglobulin and rituximab, as well as treatment with high-dose benzodiazepines. Once electroconvulsive therapy (ECT) began, she had a robust response with resolution of her catatonia. Six weeks after treatment with eight ECT cycles, she had returned to her normal baseline cognitive and motor function. CONCLUSIONS ECT was an effective and well-tolerated therapy in our patient, and should be considered for the treatment of children with anti-NMDA receptor encephalitis whose catatonia does not respond to immunosuppression and benzodiazepines.
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Affiliation(s)
- Taha Moussa
- 0000 0000 8736 9513grid.412578.dSection of Pediatric Rheumatology, Department of Pediatrics, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5044, Chicago, 60637 IL USA
| | - Khalid Afzal
- 0000 0000 8736 9513grid.412578.dSection of Pediatric Psychiatry, Department of Psychiatry, University of Chicago Medical Center, Chicago, USA
| | - Joseph Cooper
- 0000 0000 8736 9513grid.412578.dDepartment of Psychiatry, University of Chicago Medical Center, Chicago, USA
| | - Ryan Rosenberger
- 0000 0000 8736 9513grid.412578.dDepartment of Psychiatry, University of Chicago Medical Center, Chicago, USA
| | - Karyn Gerstle
- 0000 0000 8736 9513grid.412578.dDepartment of Pediatrics, University of Chicago Medical Center, Chicago, USA
| | - Linda Wagner-Weiner
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5044, Chicago, 60637, IL, USA.
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Experience, Knowledge, and Attitudes of Child and Adolescent Psychiatrists in Belgium Toward Pediatric Electroconvulsive Therapy. J ECT 2018; 34:247-252. [PMID: 29465501 DOI: 10.1097/yct.0000000000000489] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the present study was to ascertain the experience, knowledge, and attitudes of child and adolescent psychiatrists toward the use of ECT (electroconvulsive therapy) in children and adolescents in Belgium. METHODS A questionnaire was mailed to all the members of the Flemish and Walloon Association of Child and Adolescent Psychiatrists. RESULTS Thirty-five percent (n = 151) of the psychiatrists responded to the questionnaire. Sixty-seven percent (n = 101) rated their knowledge about ECT in children and adolescents as nil or negligible. Only one percent (n = 2) estimated their knowledge to be advanced. Fifteen percent (n = 22) were aware of a minor treated with ECT. Ten (n = 16) and thirty-one percent (n = 47) believed that ECT is a safe treatment for children and adolescents, respectively. Only six percent (n = 10) would recommend ECT for a major psychiatric disorder in a child, whereas thirty-eight percent (n = 58) for an adolescent. Fifty-three percent (n = 71) regarded ECT as a treatment of last resort. A significant correlation was identified between knowledge and attitudes toward the use of ECT in minors. Respondents with some or advanced knowledge perceived ECT as a safer and a more effective treatment option than those with negligible knowledge. Most (91%, n = 138) of the child and adolescent psychiatrists are enthusiastic to learn more about the use of ECT in minors. CONCLUSIONS Flemish and Walloon child and adolescents psychiatrists have very little experience with using ECT in minors. They self-estimated their knowledge as negligible but are keen to learn more about this treatment option. The lack of knowledge likely explains the rare use of ECT in Belgium for children and adolescents with serious psychiatric disorders.
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Fernández-Candil J, Castelltort Mascó L, Fàbregas Julià N, Urretavizcaya Sarachaga M, Bernardo Arroyo M, Valero Castell R. Anaesthesia in electroconvulsive therapy. Special conditions. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 13:36-46. [PMID: 30078550 DOI: 10.1016/j.rpsm.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 05/20/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drug-resistant depression. The pre-anaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. The present review aims to propose guidelines to achieve a higher level of safety and effectiveness during ECT in the most frequent situations, in accordance with the current literature. METHODS We conducted a search on the role of anaesthesia in ECT in the Ovid MEDLINE, PubMed, and SciELO (Scientific Electronic Library Online) databases, with special attention to the populations undergoing this type of therapy. The search was carried out between 1978 and December 2016. RESULTS We included the 96 articles that contained the most important recommendations for the preparation of this guide. CONCLUSIONS We propose these guidelines in order to achieve a higher level of safety and effectiveness during ECT in special conditions. We also summarize the most important attitude to be taken into account by the anaesthesiologist in these cases.
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Affiliation(s)
| | | | - Neus Fàbregas Julià
- Department of Anesthesiology, Hospital CLINIC de Barcelona, Barcelona, Spain
| | - Mikel Urretavizcaya Sarachaga
- Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Miquel Bernardo Arroyo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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Electroconvulsive therapy for self-injurious behaviour in autism spectrum disorders: recognizing catatonia is key. Curr Opin Psychiatry 2018; 31:116-122. [PMID: 29256924 DOI: 10.1097/yco.0000000000000393] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Self-injurious behaviour (SIB) is a devastating condition frequently encountered in autism spectrum disorders (ASDs) that can lead to dangerous tissue injury and profound psychosocial difficulty. An increasing number of reports over the past decade have demonstrated the swift and well tolerated resolution of intractable SIB with electroconvulsive therapy (ECT) when psychopharmacological and behavioural interventions are ineffective. The current article provides a review of the salient literature, including the conceptualization of repetitive self-injury along the catatonia spectrum, and further clarifies the critical distinction between ECT and contingent electric shock. RECENT FINDINGS We searched electronically for literature regarding ECT for self-injurious behaviour from 1982 to present, as the first known report was published in 1982. Eleven reports were identified that presented ECT in the resolution of self-injury in autistic or intellectually disabled patients, and another five reports discussed such in typically developing individuals. These reports and related literature present such self-injury along the spectrum of agitated catatonia, with subsequent implications for ECT. SUMMARY Intractable self-injury remains a significant challenge in ASDs, especially when patients do not respond adequately to behavioural and psychopharmacological interventions. ECT is well tolerated and efficacious treatment for catatonia, and can confer marked reduction in SIB along the agitated catatonia spectrum.
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Assess the etiologies associated with catatonia in children and adolescents• Evaluate the differential diagnosis of pediatric catatonia• Interpret the literature regarding the treatment of children and adolescents with catatonia OBJECTIVE: Pediatric catatonia is associated with many medical and psychiatric conditions. Mortality is high, and proper treatment can be lifesaving. Catatonia is increasingly recognized in pediatric populations, in which about 20% of cases are related to underlying medical conditions. To minimize morbidity, clinicians must rule out underlying disorders while simultaneously managing symptoms and causes. In our review we discuss (1) recommendations to aid rapid decision making, both diagnostic and therapeutic, (2) emergent conditions and management, (3) disorders associated with pediatric catatonia, including developmental, acquired, idiopathic, and iatrogenic etiologies, (4) available treatments, and (5) medicolegal considerations. METHODS Initial PubMed search without date constraints using MeSH terms related to pediatric catatonia, with subsequent searches on pertinent subtopics using PubMed and Google Scholar. RESULTS Pediatric catatonia is a dangerous but treatable neuropsychiatric condition. Psychiatrists need to be aware of differential diagnoses and to be able determine appropriate treatment within a short time frame. With prompt diagnosis and treatment, outcomes can be optimized. CONCLUSION Pediatric catatonia is underdiagnosed and requires rapid evaluation and management.
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Rask O, Suneson K, Holmström E, Bäckström B, Johansson BA. Electroconvulsive therapy for manic state with mixed and psychotic features in a teenager with bipolar disorder and comorbid episodic obsessive-compulsive disorder: a case report. J Med Case Rep 2017; 11:345. [PMID: 29228982 PMCID: PMC5725801 DOI: 10.1186/s13256-017-1508-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comorbidity of bipolar disorder and obsessive-compulsive disorder is common in adolescence. Obsessive-compulsive disorder symptoms may be episodic and secondary to alterations in mood, and display specific features. Management of pediatric bipolar disorder-obsessive-compulsive disorder is challenging, as pharmacotherapy of obsessive-compulsive disorder may induce or exacerbate manic episodes and there is limited evidence of treatment efficacy. Electroconvulsive therapy is sparsely used in children and adolescents, but is documented to be a safe and efficacious intervention in adults with bipolar disorder. In view of the severity of symptoms in juvenile mania, studies on treatment strategies are warranted. We report a case of an adolescent with bipolar disorder-obsessive-compulsive disorder who was successfully treated with electroconvulsive therapy during an episode of severe mania. CASE PRESENTATION A 16-year-old girl of Middle East origin first presented to us with depressed mood, irritability, and increased obsessive-compulsive disorder symptoms, which were initially interpreted in the context of acute stress secondary to migration. She had been diagnosed with bipolar disorder and obsessive-compulsive disorder in her previous home country, but had difficulties in accounting for earlier psychiatric history. During hospitalization her mood switched to a manic state with mixed and psychotic features, at times showing aggression toward others. Interruption in her lithium treatment for a short period and possibly the introduction of an atypical antipsychotic could in part have been triggering factors. After 8 weeks of in-patient care and psychotropic drug trials, electroconvulsive therapy was initiated and administered every second or third day for 4 weeks, with marked positive response. No apparent side effects were reported. CONCLUSIONS This case demonstrates the need for a detailed medical history, taking special note of periodicity and character of obsessive-compulsive disorder symptoms, in adolescents with mood disorders. When treating culturally diverse patients, extra consideration should be taken. Special concerns in the pharmacological treatment to avoid the patient's condition from worsening must be addressed, including giving priority to mood stabilization before obsessive-compulsive disorder symptoms. There are potential benefits in considering electroconvulsive therapy in young patients with severe mania where first-line treatment options have failed.
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Affiliation(s)
- Olof Rask
- Department of Clinical Sciences, Division of Pediatrics, Lund University, Lund, Sweden. .,Office for Healthcare 'Sund', Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden.
| | - Klara Suneson
- Department of Clinical Sciences, Division of Psychiatry, Lund University, Lund, Sweden.,Office for Healthcare 'Sund', Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden
| | - Eva Holmström
- Office for Healthcare 'Sund', Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden
| | - Beata Bäckström
- Office for Healthcare 'Sund', Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden.,Office for Healthcare 'Sund', Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden
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26
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Malas N, Brahmbhatt K, McDermott C, Smith A, Ortiz-Aguayo R, Turkel S. Pediatric Delirium: Evaluation, Management, and Special Considerations. Curr Psychiatry Rep 2017; 19:65. [PMID: 28801871 DOI: 10.1007/s11920-017-0817-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Delirium describes a syndrome of acute brain dysfunction with severe consequences on patient outcomes, medical cost, morbidity, and mortality. It represents a final common pathway of numerous pathophysiologic disturbances disrupting cerebral homeostasis. The diagnosis is predicated on recognition of the clinical features of the syndrome through ongoing clinical assessment. Early identification can be aided by routine screening, particularly in high-risk populations. Evaluation and management are continuous and simultaneous processes involving a multidisciplinary care team including child psychiatry consultation. Prevention, early identification and management are critical in alleviating symptoms, improving outcomes, and reducing distress for patients, families, and care teams. This review highlights our current understanding regarding pediatric delirium, its mechanisms, clinical manifestations, detection and management.
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Affiliation(s)
- Nasuh Malas
- Department of Psychiatry and Pediatrics, University of Michigan Medical School, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI, 48109, USA.
| | - Khyati Brahmbhatt
- Department of Psychiatry, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Cristin McDermott
- Department of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Allanceson Smith
- Department of Psychiatry, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Roberto Ortiz-Aguayo
- Department of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Susan Turkel
- Department of Psychiatry and Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, CA, Los Angeles, USA
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27
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Franklin AD, Sobey JH, Stickles ET. Anesthetic considerations for pediatric electroconvulsive therapy. Paediatr Anaesth 2017; 27:471-479. [PMID: 28211248 DOI: 10.1111/pan.13115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 01/23/2023]
Abstract
Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment. Dexmedetomidine is likely the most appropriate preoperative anxiolytic as oral benzodiazepines are relatively contraindicated. Methohexital, though becoming less available at many institutions, remains the gold standard for induction of anesthesia for pediatric electroconvulsive therapy though ketamine, propofol, and sevoflurane are becoming increasingly viable options. Proper planning and communication between the multidisciplinary teams involved in the care of children presenting for electroconvulsive therapy treatments is vital to mitigating risks and achieving the greatest therapeutic benefit.
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Affiliation(s)
- Andrew D Franklin
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric T Stickles
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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28
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Tørring N, Sanghani SN, Petrides G, Kellner CH, Østergaard SD. The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis. Acta Psychiatr Scand 2017; 135:388-397. [PMID: 28332236 DOI: 10.1111/acps.12721] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) remains underutilized because of fears of cognitive and medical risks, including the risk of death. In this study, we aimed to assess the mortality rate of ECT by means of a systematic review and pooled analysis. METHOD The study was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The ECT-related mortality rate was calculated as the total number of ECT-related deaths reported in the included studies divided by the total number of ECT treatments. RESULTS Fifteen studies with data from 32 countries reporting on a total of 766 180 ECT treatments met the inclusion criteria. Sixteen cases of ECT-related death were reported in the included studies yielding an ECT-related mortality rate of 2.1 per 100 000 treatments (95% CI: 1.2-3.4). In the nine studies that were published after 2001 (covering 414 747 treatments), there was only one reported ECT-related death. CONCLUSION The ECT-related mortality rate was estimated at 2.1 per 100 000 treatments. In comparison, a recent analysis of the mortality of general anesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100 000. Our findings document that death caused by ECT is an extremely rare event.
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Affiliation(s)
- N Tørring
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S N Sanghani
- The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - G Petrides
- The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - C H Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S D Østergaard
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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29
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Abstract
An increasing number of case reports and series document the safe and effective use of electroconvulsive therapy (ECT) in children, adolescents, and young adults with autism spectrum disorder who engage in severe, intractable, repetitive self-injurious behavior (SIB) without environmental or operant function. Although the treatment is very effective for such patients, they typically remain highly dependent on frequent maintenance ECT (M-ECT) to maintain suppression of the SIB achieved during the acute course. Some patients receive M-ECT as frequently as once every 5 days. Such a regimen is quite burdensome for the patient and the patient's family, and the long-term effects of such regimens, starting as early as childhood, are unknown. In this review, we explore the expanding literature supporting the use of ECT for suppressing severe SIB associated with autism spectrum disorder. We also focus on the possible development of alternate nonconvulsive focal forms of brain stimulation, which might replace frequent M-ECT or reduce how frequently a patient needs to receive it. Although there are scarce clinical data currently available supporting these latter treatments, future studies are clearly indicated.
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30
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Sallin K, Lagercrantz H, Evers K, Engström I, Hjern A, Petrovic P. Resignation Syndrome: Catatonia? Culture-Bound? Front Behav Neurosci 2016; 10:7. [PMID: 26858615 PMCID: PMC4731541 DOI: 10.3389/fnbeh.2016.00007] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/11/2016] [Indexed: 12/12/2022] Open
Abstract
Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family. Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis. Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution. Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioral systems in particularly vulnerable individuals.
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Affiliation(s)
- Karl Sallin
- Centre for Research Ethics and Bioethics (CRB), Uppsala UniversityUppsala, Sweden
- Department of Women’s and Children’s Health, Division of Neonatology, Karolinska InstituteSolna, Sweden
| | - Hugo Lagercrantz
- Department of Women’s and Children’s Health, Division of Neonatology, Karolinska InstituteSolna, Sweden
| | - Kathinka Evers
- Centre for Research Ethics and Bioethics (CRB), Uppsala UniversityUppsala, Sweden
| | - Ingemar Engström
- School of Health and Medical Sciences, Örebro UniversityÖrebro, Sweden
| | - Anders Hjern
- Centre for Health and Equity Studies (CHESS), Karolinska Institute and Stockholm UniversityStockholm, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska InstituteSolna, Sweden
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Dhossche D, Kellner CH. Pervasive refusal syndrome: A misnomer for catatonia. Asian J Psychiatr 2015; 18:113. [PMID: 26427582 DOI: 10.1016/j.ajp.2015.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Dirk Dhossche
- University of Mississippi Medical Center, Jackson, MS, United States.
| | - Charles H Kellner
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Hagen E, Shprung D, Minakova E, Washington J, Kumar U, Shin D, Sankar R, Mazarati A. Autism-Like Behavior in BTBR Mice Is Improved by Electroconvulsive Therapy. Neurotherapeutics 2015; 12:657-66. [PMID: 25916397 PMCID: PMC4489959 DOI: 10.1007/s13311-015-0357-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Autism is a developmental disorder characterized by impairments in social and communication abilities, as well as by restricted and repetitive behaviors. Incidence of autism is higher than earlier estimates, and treatments have limited efficacy and are costly. Limited clinical and experimental evidence suggest that patients with autism may benefit from electroconvulsive therapy (ECT). We examined the therapeutic potential of ECT in BTBR T+ tf/j mice, which represent a validated model of autism. A series of 13 electroconvulsive shocks (ECS) delivered twice a day over 7 days reversed core autism-like behavioral abnormalities-impaired sociability, social novelty, and repetitive behavior-when the animals were tested 24 h after the last ECS. The effect lasted up to 2 weeks after ECT. Neither single ECS nor a series of 6 ECS modified animals' behavior. Chronic infusion into the lateral brain ventricle of a preferential oxytocin receptor blocker (2S)-2-Amino-N-[(1S,2S,4R)-7,7-dimethyl-1-[[[4-(2-methylphenyl)-1-piperazinyl]sulfonyl]methyl]bicyclo[2.2.1]hept-2-yl]-4-(methylsulfonyl)butanamide hydrochloride abolished ECT-induced improvement of sociability and mitigated improvement of social novelty but did not affect ECT-induced reversal of repetitive behavior. These proof-of-principle experiments suggest that ECT may, indeed, be useful in the treatment of autism, and that its therapeutic effects may be mediated, in part, by central oxytocin signaling.
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Affiliation(s)
- Eunice Hagen
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Dana Shprung
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Elena Minakova
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - James Washington
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Udaya Kumar
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Don Shin
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Raman Sankar
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
- />Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
| | - Andrey Mazarati
- />Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752 USA
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33
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Weiner RD. Introduction to Convulsive Therapy. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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34
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Wachtel LE, Shorter E. Self-injurious behaviour in children: A treatable catatonic syndrome. Aust N Z J Psychiatry 2013; 47:1113-5. [PMID: 24071748 DOI: 10.1177/0004867413506500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Wachtel LE, Schuldt S, Ghaziuddin N, Shorter E. The potential role of electroconvulsive therapy in the 'Iron Triangle' of pediatric catatonia, autism, and psychosis. Acta Psychiatr Scand 2013; 128:408-9. [PMID: 23773168 DOI: 10.1111/acps.12158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L E Wachtel
- Neurobehavioral Unit, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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36
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Dhossche DM, Goetz M, Gazdag G, Sienaert P. New DSM-5 category ‘unspecified catatonia’ is a boost for pediatric catatonia: review and case reports. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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37
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Lima NN, Nascimento VB, Peixoto JA, Moreira MM, Neto ML, Almeida JC, Vasconcelos CA, Teixeira SA, Júnior JG, Junior FT, Guimarães DD, Brasil AQ, Cartaxo JS, Akerman M, Reis AO. Electroconvulsive therapy use in adolescents: a systematic review. Ann Gen Psychiatry 2013; 12:17. [PMID: 23718899 PMCID: PMC3680000 DOI: 10.1186/1744-859x-12-17] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/21/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents. METHODS Systematic review, performed in November 2012, conformed to the PRISMA statement. RESULTS From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure. CONCLUSIONS ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies.
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Affiliation(s)
- Nádia Nr Lima
- Research Group CNPq/UFC: Information Technology, Communication, Narrativity, Society and Plural Identities, Federal University of Ceará (UFC), Juazeiro do Norte, Ceará 63,048-060, Brazil.
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Nazarian RS, Liebman LS, Kellner CH. Electroconvulsive therapy (ECT) for catatonia: delay may be risky. Lupus 2013; 22:336. [DOI: 10.1177/0961203313476362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- RS Nazarian
- Mount Sinai School of Medicine, Psychiatry, NY, USA
| | - LS Liebman
- Mount Sinai School of Medicine, Psychiatry, NY, USA
| | - CH Kellner
- Mount Sinai School of Medicine, Psychiatry, NY, USA
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Häßler F, Reis O, Weirich S, Höppner J, Pohl B, Buchmann J. A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:69-74. [DOI: 10.1024/1422-4917/a000211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.
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Affiliation(s)
- Frank Häßler
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
| | - Olaf Reis
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
| | - Steffen Weirich
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
| | | | - Birgit Pohl
- Clinic for Anaesthesiology, University of Rostock, Germany
| | - Johannes Buchmann
- Clinic for Child and Adolescent Psychiatry, Neurology and Psychotherapy, University of Rostock, Germany
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Consoli A, Cohen J, Bodeau N, Guinchat V, Wachtel L, Cohen D. Electroconvulsive therapy in adolescents with intellectual disability and severe self-injurious behavior and aggression: a retrospective study. Eur Child Adolesc Psychiatry 2013; 22:55-62. [PMID: 22923049 DOI: 10.1007/s00787-012-0320-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
Efficacious intervention for severe, treatment-refractory self-injurious behavior and aggression (SIB/AGG) in children and adolescents with intellectual disability and concomitant psychiatric disorders remains a complex and urgent issue. The aim of this study is to assess the efficacy of electroconvulsive therapy (ECT) on severe and treatment-resistant SIB/AGG in young people with intellectual disability and current psychiatric disorder. We reviewed the charts of all patients (N = 4) who received ECT in the context of SIB/AGG with resistance to behavioral interventions, milieu therapy and pharmacotherapy from 2007 to 2011. We scored the daily rate of SIB/AGG per patient for each hospital day. Inter rater reliability was good (intraclass correlations = 0.91). We used a mixed generalized linear model to assess whether the following explanatory variables (time, ECT) influenced the course of SIB/AGG over time, the dependant variable. The sample included two girls and two boys. The mean age at admission was 13.8 years old [range 12-14]. The patients had on average 19 ECT sessions [range 16-26] and one patient received maintenance ECT. There was no effect of time before and after ECT start. ECT was associated with a significant decrease in SIB/AGG scores (p < 0.001): mean aggression score post-ECT was half the pre-ECT value. ECT appears beneficial in severe, treatment-resistant SHBA in adolescents with intellectual disability.
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Affiliation(s)
- Angele Consoli
- Department of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.
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