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Li H, Hou L, Wang D, Wu Q, Li H, He W, Li S, Pang J, Zhang Y, Ma Q, Li C, Cheng J. Response rate and safety of antidepressants combined with electroconvulsive therapy in adolescent depression: Real-world clinical application. J Affect Disord 2023; 339:98-103. [PMID: 37390926 DOI: 10.1016/j.jad.2023.06.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND METHODS: This study included 210 depression patients receiving antidepressants and ECT. The symptoms of depression were examined with the Hamilton Depression Scale (HAMD) and Clinical Global Impressions Scale (CGI) at baseline and the end of treatment. Response and safety were compared among adolescent and adult patients. RESULTS For adolescents, the response rate (much improved or very much improved) was 80.9 %, and CGI-Severity (CGI-S), HAMD, and suicide factor scores were significantly changed as compared to baseline (P < 0.001), results of which were similar to the adult group. There were no significant differences in HAMD, CGI scores between adolescent and adult depression before or after treatment (P > 0.05). Notably, adolescents expressed stronger suicidal intent than adults, and ECT observably relieved it. Side effects (memory problems, headache, nausea/vomiting, muscle soreness) in adolescents were not statistically different from those in adults (P > 0.05). LIMITATIONS As data were derived from a single center, the generalizability of results may be limited, and the potential factors affecting the efficacy of ECT were not further explored. CONCLUSION Antidepressants combined with ECT are associated with high response rate and safety for treating depression, regardless of age. A stronger expression of suicide ideation was observed in depressed adolescents, and side effects of ECT were similar to the adults.
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Affiliation(s)
- Hong Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Lingzhi Hou
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dong Wang
- Department of Geriatric Psychiatry, Suzhou Mental Health Center, Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215000, China
| | - Qijin Wu
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Haijin Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wen He
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Sheng Li
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jianyue Pang
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yanyan Zhang
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Quangang Ma
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Cai Li
- Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou 450052, China.
| | - Jun Cheng
- Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Karl S, Methfessel I, Weirich S, Rothermel B, Crozier J, Besse M, Reinhardt M, Buchmann J, Dück A, Schulz J, Zilles-Wegner D, Häßler F, Kölch M, Uebel von Sandersleben H, Poustka L, Sartorius A. Electroconvulsive Therapy in Children and Adolescents in Germany-A Case Series From 3 University Hospitals. J ECT 2022; 38:249-254. [PMID: 35700967 DOI: 10.1097/yct.0000000000000861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is a well-established, safe, and efficacious treatment for severe psychiatric disorders. In children and adolescents, it is used much less frequently than in adults, likely because of a lack of knowledge. METHODS We retrospectively analyzed all patients aged 12 to 17 years who completed a course of ECT at 3 psychiatric university hospitals in Germany between 2010 and 2020. Clinical Global Impression Severity (CGI-S) scores were assessed based on electronic medical records. Changes in CGI-S scores were assessed using a paired samples t test. Predictors for response and remission were assessed using binomial logistic regression. RESULTS We included 32 patients. The CGI-S scores improved significantly from before to after ECT treatment (6.9 vs 3.9, t = 10.0, P < 0.01). A total of 40.6% of patients responded (CGI ≤ 3) and 21.9% remitted (CGI ≤ 2). The number of ineffective medication trials in the 6 months before ECT treatment was significantly associated with response (odds ratio, 0.54; P = 0.028) and remission (odds ratio, 0.31; P = 0.048). Five patients reported subjective cognitive adverse effects, 2 patients exhibited a prolonged seizure, 1 patient reported headaches, and 1 patient experienced a mild allergic reaction after anesthesia with etomidate. A total of 65.6% of patients experienced no adverse effects at all. CONCLUSIONS This retrospective analysis found ECT to be effective and safe in children and adolescents irrespective of their main diagnosis. The reported data point to the importance of an early use of ECT for severe psychiatric diseases in child and adolescent psychiatry.
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Affiliation(s)
- Sebastian Karl
- From the Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim
| | - Isabel Methfessel
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | - Steffen Weirich
- Department for Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, Rostock University Medical Center, Rostock
| | - Boris Rothermel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim
| | - Jesse Crozier
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | - Matthias Besse
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | - Martin Reinhardt
- Department for Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, Rostock University Medical Center, Rostock
| | - Johannes Buchmann
- Department for Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, Rostock University Medical Center, Rostock
| | - Alexander Dück
- Department for Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, Rostock University Medical Center, Rostock
| | - Jan Schulz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | - David Zilles-Wegner
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | - Frank Häßler
- Department of Child and Adolescent Psychiatry, GGP Group, Rostock, Germany
| | - Michael Kölch
- Department for Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, Rostock University Medical Center, Rostock
| | | | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen
| | - Alexander Sartorius
- From the Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim
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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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Methfessel I, Weirich S, Rothermel B, Crozier J, Besse M, Reinhardt M, Buchmann J, Dück A, Zilles-Wegner D, Häßler F, Kölch M, von Sandersleben HU, Poustka L, Sartorius A. [Use of electroconvulsive therapy in adolescents - A retrospective survey on 12- to 17-year-old patients at three university hospitals in Germany]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 49:190-200. [PMID: 33719525 DOI: 10.1024/1422-4917/a000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Use of electroconvulsive therapy in adolescents - A retrospective survey on 12- to 17-year-old patients at three university hospitals in Germany Abstract. Abstract. Background: Electroconvulsive therapy (ECT) is a highly effective and well-researched therapy in adult psychiatry and has been successfully used especially as a treatment for severe depressive, catatonic, and psychotic disorders. Although severe disease progressions also occur in child and adolescent psychiatry, ECT is used much less frequently there. This may be because hardly any data have been collected on the use, effectiveness, and tolerability of ECT in child and adolescent psychiatric patients. This article outlines the application, effectiveness, and tolerability of ECT when applied to young adolescents in Germany. Methods: A retrospective survey on ECT in 29 patients under 18 years of age was conducted at three German university centers. All documented cases were recorded and evaluated for effectiveness and tolerability. In addition, a comprehensive PubMed-based database search was carried out. Results and conclusions: Internationally, there are no meta-analyses or randomized controlled studies and hardly any published cases on electroconvulsive therapy in German child and adolescent psychiatry. Our data on ECT show high efficacy in previously treatment-resistant and severely ill patients. Side effects occurred rarely. There was no evidence of differences between adults and adolescents in indication (depression, catatonia, schizophrenia), effectiveness, tolerability, and negative predictors of response to ECT. The results also suggest that the use of ECT in adolescents should be considered earlier in the treatment course.
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Affiliation(s)
- Isabel Methfessel
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Steffen Weirich
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock
| | - Boris Rothermel
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg, Mannheim
| | - Jesse Crozier
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Matthias Besse
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Martin Reinhardt
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock
| | - Johannes Buchmann
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock
| | - Alexander Dück
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock
| | - David Zilles-Wegner
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Frank Häßler
- Tagesklinik für Kinder- und Jugendpsychiatrie, GGP, Gruppe Rostock, Rostock
| | - Michael Kölch
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock
| | | | - Luise Poustka
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Alexander Sartorius
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/ Universität Heidelberg, Mannheim
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Mayur Anthony Harris P. Acute followed by continuation right unilateral ultrabrief ECT for 12 months in first episode schizophrenia-a single case report. Asian J Psychiatr 2019; 43:182-183. [PMID: 31220746 DOI: 10.1016/j.ajp.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Prashanth Mayur Anthony Harris
- University of Sydney Medical School, Discipline of Psychiatry, 1-11 Hainsworth Street, Cumberland Hospital, Sydney, 2145, Australia.
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Rootes-Murdy K, Carlucci M, Tibbs M, Wachtel LE, Sherman MF, Zandi PP, Reti IM. Non-suicidal self-injury and electroconvulsive therapy: Outcomes in adolescent and young adult populations. J Affect Disord 2019; 250:94-98. [PMID: 30844603 DOI: 10.1016/j.jad.2019.02.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/17/2018] [Accepted: 02/24/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Electroconvulsive (ECT) therapy is a highly effective treatment for severe depression. Although the clear majority of patients respond to ECT, not all do, and we still lack good predictors for ECT outcome, especially in adolescents and young adults. One clinical variable that has been associated with reduced likelihood of ECT antidepressant response in adults is comorbid borderline personality disorder. As self-injurious behavior is often a feature of borderline personality disorder, we hypothesized that adolescent and young adult patients with a history of non-suicidal self-injury (NSSI), who were being treated for major depression with ECT, would have a poorer response than patients without such a history. METHODS We conducted a retrospective chart review of 48 patients treated with ECT for depression at The Johns Hopkins Hospital between the ages of 14 and 25. RESULTS Initial analyses showed that the presence of NSSI was not associated with ECT outcomes. However, sub-group analyses suggested that it was associated with response to ECT and overall remission among female patients. Specifically, the results suggested that in adolescent and young adult female ECT patients, the presence of NSSI was associated with lower odds of response (OR: 0.04; 95% CI: 0.0004, 0.81, p = 0.03) and remission (OR: 0.09; 95% CI: 0.0000, 0.81, p = 0.03), and a greater mean number of treatments (5.83; 95% CI: 0.27, 11.39, p = 0.04) compared with patients without NSSI. CONCLUSIONS Clearly, the finding that NSSI may be associated with poorer ECT outcomes among female patients needs to be replicated. Nonetheless, our data suggest caution when considering an adolescent or young adult woman for a course of ECT.
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Affiliation(s)
- Kelly Rootes-Murdy
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Loyola University Maryland, Baltimore, MD, United States
| | | | - Michael Tibbs
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lee E Wachtel
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Peter P Zandi
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Irving M Reti
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Abstract
OBJECTIVE There is a dearth of up-to-date literature regarding electroconvulsive therapy (ECT) in adolescents, and the question of when to pronounce course failure has not been properly addressed. The current study aims to evaluate trajectories of clinical status throughout ECT courses in adolescent patients. METHODS We retrieved detailed data of 36 patients who received ECT in our treatment center. Clinical records were retrospectively assessed and evaluated every 6 ECT sessions to quantify Clinical Global Impressions-Improvement (CGI-I) scores. RESULTS The mean number of sessions per course was 24.4 ± 14.2. The mean CGI-I score at the conclusion of the ECT courses was 2.47 ± 1.19. At the end of the acute treatment stage, 26 patients (72.2%) were much or very much improved, based on CGI-I scores. Only 5 patients exhibited a significant response after 6 sessions or fewer, whereas 21 patients (56.6%) improved after 12 sessions. Pearson correlations between CGI-I scores throughout the course of ECT showed no significant correlation between CGI-I scores after 6 sessions and the final CGI-I scores. However, a significant correlation was found between CGI-I scores after 12 sessions and the final CGI-I score. CONCLUSIONS An improvement in the clinical status of adolescents treated by ECT might occur only after a substantial number of sessions. An early lack of response does not necessarily predict a failed ECT course.
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Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an effective and a safe treatment for several severe psychiatric disorders across the age span. However, its use remains controversial and highly stigmatized especially among patients under 18 years. In this study, we examined current symptoms, attitudes, perception, and functioning of patients treated with ECT when they were less than 18 years old. METHODS Participants had received ECT before age 18, between 1989 and 2015, at a tertiary medical center. Institutional review board-approval was obtained, and study documents (cover letter, consent, self-ratings scales for depression, anxiety, global functioning, and suicidality) were mailed. RESULTS Based on self-rated depression, 59.1% (13/22) participants indicated mild or no depression; 65% (13/20) reported mild or no anxiety; the majority, 84.3% (16/19) perceived ECT as having improved their overall illness; and 27.3% (6/22) among the respondents reported no clinical impairment on a global functioning scale, whereas 72.7% (16/22) reported significant or severe impairment. Despite reports of ongoing impaired global functioning among some participants, adequate academic performance (83.3%, 5/6) and mild or no suicidality (78.3%, 18/23) were endorsed by the majority reported. CONCLUSIONS The majority of participants who had received ECT before age 18 years reported mild or absence of depression and anxiety on self-rated follow-up measures after treatment with ECT. Most notably, the majority reported absence of suicidality and adequate academic performance. A number of respondents, however, continued to endorse global impairment, which may be a reflection of their baseline severe illness, which had warranted treatment with ECT.
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Adult and Adolescent Patient Evaluations of Electroconvulsive Therapy in Comparison to Other Therapeutic Modalities. J ECT 2018; 34:45-49. [PMID: 29461985 DOI: 10.1097/yct.0000000000000464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES There is an increasing awareness of the importance of patients' subjective evaluations of therapy. Regarding electroconvulsive therapy (ECT), the results are conflicting. We hypothesized that making a comparison between patients' satisfaction with ECT and other forms of psychiatric therapies would capture personal experience as opposed to opinion about the treatment modalities. We compared adult responses to adolescent responses. METHODS Four unmatched patient groups were recruited (N = 98) and were divided as follows: (a) patients treated with ECT as adolescents (n = 13), (b) patients treated with ECT as adults (n = 25), (c) patients hospitalized as adolescents but not treated with ECT (n = 30), and (d) patients hospitalized as adults but not treated with ECT (n = 30). All patients were interviewed using similar questions related to their satisfaction regarding the treatment modalities they experienced, including psychotherapy, pharmacotherapy, hospitalization and ECT, and years after being treated. RESULTS Adults and adolescents viewed ECT as a legitimate and effective form of treatment (70%). Patients who were treated with ECT had a more positive attitude toward this treatment compared with patients who had not been treated with ECT. In comparison to other treatment modalities, ECT was considered by both adolescents and adults as the least effective form of therapy. Psychotherapy was considered the most effective, specifically among adolescents. CONCLUSIONS Comparing patients' satisfaction in regard to different therapeutic modalities can potentially help clarify discrepancies in patient reports on satisfaction with ECT. Patients' satisfaction with ECT, just like their clinical response to ECT, is more dichotomous than with other forms of therapy.
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Grover S, Varadharajan N, Avasthi A. A qualitative study of experience of parents of adolescents who received ECT. Asian J Psychiatr 2017; 30:109-113. [PMID: 28869922 DOI: 10.1016/j.ajp.2017.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Natarajan Varadharajan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Flamarique I, Baeza I, de la Serna E, Pons A, Bernardo M, Castro-Fornieles J. Thinking About Electroconvulsive Therapy: The Opinions of Parents of Adolescents with Schizophrenia Spectrum Disorders. J Child Adolesc Psychopharmacol 2017; 27:75-82. [PMID: 26983067 DOI: 10.1089/cap.2015.0196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the experience with, knowledge of, and attitudes toward electroconvulsive therapy (ECT) among parents of adolescents with schizophrenia spectrum disorders (SSD) who have received ECT. METHODS A self-administered questionnaire was used to assess the experience with, knowledge of, and attitudes toward ECT in a sample of parents of adolescents diagnosed with SSD. Parents of adolescents treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of parents of adolescents treated only with antipsychotics (No ECT group; n = 20). RESULTS Most parents in the ECT group claimed that they had received adequate information about the ECT procedure (94.7%), most of them thought it had been helpful for their children (73.7%) and none thought that it had made things worse. The large majority of parents in the ECT group (80%) thought that the illness had been worse than ECT or medication, and none thought that ECT was the worst. Parents in the ECT group generally had better knowledge of what ECT is and its indications. All the parents in the ECT group (100%) and almost all of those in the No ECT group (94.7%) would agree to the treatment for their children if recommended in the future by a doctor, there being no differences between the groups in this respect (p = 0.447). Most parents in the ECT group (88.9%) thought it was a legitimate treatment when used appropriately, an opinion that was held by a much smaller proportion of parents in the No ECT group (52.6%), although the remaining parents in that group were unsure about it (47.4%). CONCLUSIONS Most parents of adolescents with SSD treated with ECT had positive views about the treatment. Parents of adolescents treated only with antipsychotics tended either to have positive views about ECT or claimed to have no knowledge about it, with negative views being uncommon.
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Affiliation(s)
- Itziar Flamarique
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Barcelona, Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , CIBERSAM, Barcelona, Spain
| | - Inmaculada Baeza
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Barcelona, Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , CIBERSAM, Barcelona, Spain .,3 Institut d'Investigació Biomèdica August Pi i Sunyer , IDIBAPS, Barcelona, Spain
| | - Elena de la Serna
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Barcelona, Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , CIBERSAM, Barcelona, Spain
| | - Alexandre Pons
- 2 Centro de Investigación Biomédica en Red de Salud Mental , CIBERSAM, Barcelona, Spain .,4 Barcelona Clinic Schizophrenia Unit, Department of Psychiatry and Psychology, Institut Clínic de Neurociències, Hospital Clínic of Barcelona , Barcelona, Spain
| | - Miguel Bernardo
- 2 Centro de Investigación Biomédica en Red de Salud Mental , CIBERSAM, Barcelona, Spain .,3 Institut d'Investigació Biomèdica August Pi i Sunyer , IDIBAPS, Barcelona, Spain .,4 Barcelona Clinic Schizophrenia Unit, Department of Psychiatry and Psychology, Institut Clínic de Neurociències, Hospital Clínic of Barcelona , Barcelona, Spain .,5 Department of Psychiatry and Clinical Psychology, University of Barcelona , Barcelona, Spain
| | - Josefina Castro-Fornieles
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Barcelona, Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , CIBERSAM, Barcelona, Spain .,3 Institut d'Investigació Biomèdica August Pi i Sunyer , IDIBAPS, Barcelona, Spain .,5 Department of Psychiatry and Clinical Psychology, University of Barcelona , Barcelona, Spain
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Flamarique I, Castro-Fornieles J, de la Serna E, Pons A, Bernardo M, Baeza I. Patients' Opinions About Electroconvulsive Therapy: What Do Adolescents with Schizophrenia Spectrum Disorders Think? J Child Adolesc Psychopharmacol 2015; 25:641-8. [PMID: 26447644 DOI: 10.1089/cap.2015.0113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess, in patients with schizophrenia spectrum disorders (SSD) who received electroconvulsive therapy (ECT) prior to the age of 18, their experience, knowledge, and attitudes toward ECT, and to compare the findings with those obtained in adolescents treated only with antipsychotics. METHODS Patients diagnosed with SSD (n = 19) and treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of patients with SSD treated only with antipsychotics (non-ECT group, n = 21). A self-administered questionnaire was used to assess their experience, knowledge, and attitudes. RESULTS Most adolescents in the ECT group thought that the intervention had been helpful (78.9%) and believed that their illness had been worse than ECT or medication (68.4%). Similarly, almost three quarters of these patients did not believe the treatment to be cruel (73.7%) or outdated (73.7%), or that it should be illegal (68.4%). Patients in the non-ECT group often chose "don't know" as their response to the survey questions, and significant differences between the groups were observed. Most patients in both the ECT group (84.2%) and the non-ECT group (80%) said that they would accept the treatment in the future if necessary, there being no differences between the groups in this respect (p = 0.2). CONCLUSIONS Most adolescents in the ECT group had positive views about ECT. By contrast, most adolescents in the non-ECT group either did not know or did not have a clear opinion regarding ECT treatment, although they did not have negative views about it.
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Affiliation(s)
- Itziar Flamarique
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , Barcelona, Spain
| | - Josefina Castro-Fornieles
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , Barcelona, Spain .,3 Institut d'Investigació Biomèdica August Pi i Sunyer , Barcelona, Spain .,4 Department of Psychiatry and Clinical Psychology, University of Barcelona , Spain
| | - Elena de la Serna
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , Barcelona, Spain
| | - Alexandre Pons
- 2 Centro de Investigación Biomédica en Red de Salud Mental , Barcelona, Spain .,5 Barcelona Clinic Schizophrenia Unit, Department of Psychiatry and Psychology, Institut Clínic de Neurociències, Hospital Clínic of Barcelona , Spain
| | - Miguel Bernardo
- 2 Centro de Investigación Biomédica en Red de Salud Mental , Barcelona, Spain .,3 Institut d'Investigació Biomèdica August Pi i Sunyer , Barcelona, Spain .,4 Department of Psychiatry and Clinical Psychology, University of Barcelona , Spain .,5 Barcelona Clinic Schizophrenia Unit, Department of Psychiatry and Psychology, Institut Clínic de Neurociències, Hospital Clínic of Barcelona , Spain
| | - Inmaculada Baeza
- 1 Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic of Barcelona , Spain .,2 Centro de Investigación Biomédica en Red de Salud Mental , Barcelona, Spain .,3 Institut d'Investigació Biomèdica August Pi i Sunyer , Barcelona, Spain
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Flamarique I, Baeza I, de la Serna E, Pons A, Bernardo M, Castro-Fornieles J. Long-term effectiveness of electroconvulsive therapy in adolescents with schizophrenia spectrum disorders. Eur Child Adolesc Psychiatry 2015; 24:517-24. [PMID: 25183368 DOI: 10.1007/s00787-014-0602-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
To compare a sample of adolescents with schizophrenia spectrum disorders (SSD) treated with either ECT or antipsychotics (AP) alone at long-term follow-up. Patients diagnosed with SSD (n = 21) treated with ECT due to resistance to AP or catatonia under the age of 18 years (ECT group), were compared to a randomly selected group of patients with SSD treated only with AP (non-ECT group) (n = 21) and matched for age, gender, diagnosis and duration of illness. Baseline data were gathered retrospectively from medical records. Subjects were assessed at follow-up (mean of follow-up period = 5.5 years; range 2-9 years) using several clinical scales such as the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI) and the Global Assessment of Functioning (GAF). Improvement in PANSS positive, negative, general, total and CGI and GAF scores between baseline and follow-up assessment did not differ significantly between groups. At follow-up, no differences were observed for the PANSS negative, CGI and GAF scores between groups, but patients in the ECT group still had higher PANSS total, positive and general scores. ECT treatment followed by AP medication in treatment-resistant SSD or catatonia is at least as effective in the long term as AP alone in non-resistant patients.
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Affiliation(s)
- Itziar Flamarique
- Department of Child and Adolescent Psychiatry and Psychology, SGR1119, Institut Clinic de Neurociències, Hospital Clínic Universitari de Barcelona, C/Villarroel, 170, 08036, Barcelona, Spain,
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Shoirah H, Hamoda HM. Electroconvulsive therapy in children and adolescents. Expert Rev Neurother 2014; 11:127-37. [DOI: 10.1586/ern.10.178] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination? J Clin Psychopharmacol 2012; 32:756-66. [PMID: 23131877 DOI: 10.1097/jcp.0b013e318270e2c7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of the combination of electroconvulsive therapy (ECT) and clozapine compared to ECT with other antipsychotics or benzodiazepines in a sample of adolescents diagnosed with schizophrenia spectrum disorders. METHODS Data regarding 28 adolescent subjects aged 13 to 18 with diagnoses of schizophrenia spectrum disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and treated with ECT were retrospectively collected. Twelve subjects were also treated with clozapine and 16 with other antipsychotics or benzodiazepines during ECT course and follow-up. Electroconvulsive therapy parameters and adverse effects were assessed using a systematic protocol. Positive and Negative Syndrome Scale and Clinical Global Impression scores before ECT and after acute ECT, and rate of rehospitalization during 1-year follow-up were used to assess effectiveness. Response was defined as a 20% decrease in Positive and Negative Syndrome Scale scores. RESULTS No differences were observed in the mean charge needed to induce seizure and electroencephalographic duration, but there was a slight difference in the current used. The nonclozapine group showed greater restlessness and agitation, although no differences were found in other adverse effects. The percentage of responders was similar: 66.7% in the clozapine group and 68.8% in the nonclozapine group. However, the rate of rehospitalization was lower in the patients treated with clozapine during 1-year follow-up (7.1%) compared to that of the nonclozapine group (58.3%) (P = 0.009). CONCLUSIONS The main findings of this study were that combining ECT with clozapine, compared to ECT with other antipsychotics or benzodiazepines, was safe and that both treatments were equally effective. Charges needed to induce seizure were similar in both groups. Patients treated with clozapine during 1-year follow-up had a lower rate of rehospitalization.
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de la Serna E, Flamarique I, Castro-Fornieles J, Pons A, Puig O, Andrés-Perpiña S, Lázaro L, Garrido JM, Bernardo M, Baeza I. Two-year follow-up of cognitive functions in schizophrenia spectrum disorders of adolescent patients treated with electroconvulsive therapy. J Child Adolesc Psychopharmacol 2011; 21:611-9. [PMID: 22136098 DOI: 10.1089/cap.2011.0012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate the long-term cognitive effects of electroconvulsive therapy (ECT) in a sample of adolescent patients in whom schizophrenia spectrum disorders were diagnosed. METHODS The sample was composed of nine adolescent subjects in whom schizophrenia or schizoaffective disorder was diagnosed according to DSM-IV-TR criteria on whom ECT was conducted (ECT group) and nine adolescent subjects matched by age, socioeconomic status, and diagnostic and Positive and Negative Syndrome Scale (PANSS) total score at baseline on whom ECT was not conducted (NECT group). Clinical and neuropsychological assessments were carried out at baseline before ECT treatment and at 2-year follow-up. RESULTS Significant differences were found between groups in the number of unsuccessful medication trials. No statistically significant differences were found between the ECT group and the NECT group in either severity as assessed by the PANSS, or in any cognitive variables at baseline. At follow-up, both groups showed significant improvement in clinical variables (subscales of positive, general, and total scores of PANSS and Clinical Global Impressions-Improvement). In the cognitive assessment at follow-up, significant improvement was found in both groups in the semantic category of verbal fluency task and digits forward. However, no significant differences were found between groups in any clinical or cognitive variable at follow-up. Repeated measures analysis found no significant interaction of time×group in any clinical or neuropsychological measures. CONCLUSIONS The current study showed no significant differences in change over time in clinical or neuropsychological variables between the ECT group and the NECT group at 2-year follow-up. Thus, ECT did not show any negative influence on long-term neuropsychological variables in our sample.
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Affiliation(s)
- Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain.
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Use of continuation or maintenance electroconvulsive therapy in adolescents with severe treatment-resistant depression. J ECT 2011; 27:168-74. [PMID: 21233763 DOI: 10.1097/yct.0b013e3181f665e4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Retrospective data are presented for 6 adolescents ranging in age from 14 to 17 years, who were diagnosed with severe treatment-resistant major depression (TRD). Subjects were treated with one or more index courses of electroconvulsive therapy (ECT) followed by continuation ECT (C-ECT, up to 6 months of ECT) or maintenance ECT (M-ECT; ECT beyond 6 months) when necessary. Electroconvulsive therapy was continued until remission or until minimal residual symptoms were evident. Pharmacotherapy and psychotherapy were reintroduced during C-ECT or M-ECT. Premorbid functioning was achieved by 5 of 6 cases. Cognitive deficits were not evident. In fact, comparison of pre-ECT and post-ECT neuropsychological functioning revealed a trend toward improved auditory and verbal memory on most of the results. We concluded that C-ECT and M-ECT are useful and safe treatment strategies for selected adolescents with severe treatment-resistant depression, and symptom remission may be achieved without experiencing cognitive impairment.
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Baeza I, Flamarique I, Garrido JM, Horga G, Pons A, Bernardo M, Morer A, Lázaro ML, Castro-Fornieles J. Clinical experience using electroconvulsive therapy in adolescents with schizophrenia spectrum disorders. J Child Adolesc Psychopharmacol 2010; 20:205-9. [PMID: 20578933 DOI: 10.1089/cap.2009.0066] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Inmaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic i Universitari, Barcelona, Spain.
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Gross A, Altman M, Salvatore P, Baldessarini RJ, Chanoff M, Powers JP. An atypical, chronic psychotic disorder in a 55-year-old man. Harv Rev Psychiatry 2010; 17:329-43. [PMID: 19832047 DOI: 10.3109/10673220903299203] [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: 11/13/2022]
Affiliation(s)
- Anne Gross
- Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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