Tratamiento electroconvulsivo en niños y adolescentes

A qualitative study of experience of parents of adolescents who received ECT

AIM OF THIS STUDY

To evaluate the experience of parents of adolescents who received ECT for severe mental illness.

METHODOLOGY

Using qualitative methods, 6 parents of 5 adolescents were interviewed by using a self-designed semi-structured interview after the completion of ECT course. The clinicians involved in the ECT procedure, i.e., seeking informed consent and administration of ECT were not aware about the study. All the interviews were recorded and the content was analysed and themes were generated.

RESULTS

Parents of all the 5 adolescents expressed that their children were considered for ECT only after the patient had not responded to medication and were unmanageable. Prior to ECT the treating doctors did explain to them about the ECT procedure, they were given information booklet and they were not coerced to consent for ECT. Some of the parents reported that they had dilemma prior to giving consent and were scared prior to the first ECT. However, as the clinical condition of their children improved, they felt that ECT was a good treatment. Majority of the parents felt that ECT was delayed for their children. When asked about restriction in use of ECT in children and adolescents, the parents expressed that it is important for law makers to understand the distress of the parents,when their children are acutely ill. They expressed that decision of administration of ECT must be left to the family and the treating clinicians.

CONCLUSION

Parents of adolescents considered for ECT are generally satisfied with the treatment procedure.

Clinical experience using electroconvulsive therapy in adolescents with schizophrenia spectrum disorders

OBJECTIVES

The aim of this study was to evaluate the effectiveness and safety of electroconvulsive therapy (ECT) in adolescent patients diagnosed with schizophrenia spectrum disorders (SSD).

METHODS

All patients diagnosed with SSD who received ECT in the Child and Adolescent Psychiatry and Psychology Department in a general hospital in Barcelona, Spain, from January, 2003, to December, 2007, were identified retrospectively. As part of the usual evaluation protocol, Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scales were administered before ECT, after the acute ECT phase (CGI), and at 6 months from baseline. Data related to characteristics of these patients such as demographics, pharmacological treatment, ECT parameters, and side effects were registered.

RESULTS

Thirteen cases, ages 13-17 (mean age, 16.6 +/- 1.2 years), were included. Compared to pre-ECT scores, mean PANSS decreased significantly at 6-month assessment (t = 3.58, p = 0.004). Clinical response (20% or greater reduction in PANSS total scores at the 6-month end point) was achieved in 54% of patients. A significant improvement of mean CGI score was observed after the acute ECT phase (t = 11.88, p < 0.001) and at 6-month assessment (t = 12.48, p < 0.001). There were no severe incidents related to any session during the acute ECT phase, although 1 patient experienced a tardive seizure during the continuation ECT.

CONCLUSIONS

Our clinical experience supports the assertion that ECT is a safe and effective treatment for SSD in adolescent patients.