Electroconvulsive therapy in adolescents: experience, knowledge, and attitudes of recipients

Electroconvulsive therapy knowledge and attitudes among patients and caregivers in South China: A preliminary study

Background

Electroconvulsive therapy (ECT) is a safe and effective therapy for individuals suffering from major psychiatric disorders, but attitudes towards ECT among patients and caregivers have not been well studied. This study was conducted to elucidate patient and caregiver knowledge and attitudes concerning ECT in South China.

Methods

The sample comprised 92 patients diagnosed with major psychiatric disorders and their caregivers (n = 92). Participants completed questionnaire measures of knowledge and attitudes related to ECT.

Results

Information before ECT was inadequately provided to both caregivers and patients (55.4% versus 37.0%, p < 0.05). Caregivers reported receiving more adequate information about the therapeutic effects (50.0% versus 44.6%), side effects (67.4% versus 41.3%), and risks (55.4% versus 20.7%) of ECT when compared to patients (all p < 0.05). However, less than half of patients and caregivers believed that ECT was effective (43.5% versus 46.7%, p > 0.05), while more than half of them believed that ECT was beneficial (53.3% versus 71.7%, p < 0.05), and approximately half of them believed that ECT was safe (50.0% versus 51.1%, p > 0.05). A total of 32.6% of patients and 55.4% of caregivers (p < 0.05) reported that ECT was used only for critically ill patients. A total of 62.0% of patients experienced side effects, with memory impairment being the most commonly reported.

Conclusion

Clinicians should develop a systematic health education program before ECT treatment and ensure that patients and caregivers have an accurate understanding of ECT, particularly the treatment process, its therapeutic effects and potential side effects prior to administering this treatment.

Electroconvulsive Therapy in Children and Adolescents in Germany-A Case Series From 3 University Hospitals

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.

[Use of electroconvulsive therapy in adolescents - A retrospective survey on 12- to 17-year-old patients at three university hospitals in Germany]

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.

Catatonia in Patients with Autism Spectrum Disorder

Catatonia was first described by Karl Ludwig Kahlbaum in 1874, occurring in association with other psychiatric and medical disorders. However, in the nineteenth century the disorder was incorrectly classified as a subtype of schizophrenia. This misclassification persisted until the publication of DSM-5 in 2013 when important changes were incorporated. Although the etiology is unknown, disrupted gamma-aminobutyric acid has been proposed as the underlying pathophysiological mechanism. Key symptoms can be identified under 3 clinical domains: motor, speech, and behavioral. Benzodiazepines and electroconvulsive therapy are the only known effective treatments. Timely recognition and treatment have important outcome, and sometimes lifesaving, implications.

Maintenance Electroconvulsive Therapy Is an Essential Medical Treatment for Patients With Catatonia: A COVID-19 Related Experience

Aim: Describe naturalistic clinical course over 14 weeks in a mixed adolescent and a young-adult patient group diagnosed with developmental delays and catatonia, when the frequency of maintenance electroconvulsive therapy (M-ECT) was reduced secondary to 2020 COVID-19 pandemic restrictions. Methods: Participants were diagnosed with catatonia, and were receiving care in a specialized clinic. They (n = 9), F = 5, and M = 4, ranged in age from 16 to 21 years; ECT frequency was reduced at end of March 2020 due to institutional restrictions. Two parents/caregivers elected to discontinue ECT due to concern for COVID-19 transmission. Majority (n = 8) were developmentally delayed with some degree of intellectual disability (ID). Observable symptoms were rated on a three point scale during virtual visits. Results: All cases experienced clinically significant decline. Worsening of motor symptoms (agitation, aggression, slowness, repetitive self-injury, stereotypies, speech deficits) emerged within the first 3 weeks, persisted over the 14 week observation period and were more frequent than neurovegetative symptoms (appetite, incontinence, sleep). Four participants deteriorated requiring rehospitalization, and 2 among these 4 needed a gastrostomy feeding tube. Conclusion: Moderate and severe symptoms became apparent in all 9 cases during the observation period; medication adjustments were ineffective; resuming M-ECT at each participant's baseline schedule, usually by week 7, resulted in progressive improvement in some cases but the improvement was insufficient to prevent re-hospitalization in 4 cases. In summary, rapid deterioration was noted when M-ECT was acutely reduced in the setting of COVID-19 related restrictions.

The Incidence of Post-Electroconvulsive Therapy Headache: A Systematic Review

Headache is a common side effect of electroconvulsive therapy (ECT), but reports on its incidence vary widely. A broad array of treatment regimens have been proposed in the literature. The pathophysiology of post-ECT headache is unclear but a vascular origin has been suggested. A systematic literature search was executed in PubMed and Embase to identify relevant articles. Articles were screened on title, abstract, and full text according to predefined inclusion and exclusion criteria. Study characteristics and results concerning the incidence of post-ECT headache were extracted, and a weighted mean incidence was calculated. Forty-seven relevant articles were found, of which 36 reported on the incidence of post-ECT headache in patients and 9 on the incidence in sessions. The incidence of post-ECT headache varied greatly in the literature. The weighted mean incidence in patients was 32.8%, as 786 of a total population of 2399 patients experienced headache. The weighted mean incidence in sessions was between 9.4% (246 of 2604 sessions) and 12.1% (236/1958 sessions). The variation in incidences of post-ECT headache found might be due to different methods of measuring headache, different study designs, and different drugs used for anesthesia. The mean-weighted incidence of post-ECT headache in patients was 32.8% and in sessions between 9.4% and 12.1%.

Monitoring Electroconvulsive Therapy-Related Anxiety: The ECT-Related Anxiety Questionnaire

OBJECTIVES

A reliable questionnaire designed to measure electroconvulsive therapy (ECT)-related anxiety is currently not available. We report the development and evaluation of the ECT-Related Anxiety Questionnaire (ERAQ), a questionnaire that measures anxiety with respect to ECT in clinical practice.

METHODS

Patients 18 years or older who were about to start with or were having an ECT course were asked to complete a self-designed 17-item ECT-related anxiety questionnaire. We investigated the psychometric properties of the ERAQ through the use of an exploratory and confirmatory factor analysis and Item Response Theory analysis.

RESULTS

One hundred eighty-three patients were included. From the exploratory factor analysis, we conclude that the scale is unidimensional. The confirmatory factor analysis model did not fit well to the data. The Item Response Theory analysis showed that the slope estimates ranged from 1.23 to 2.95 and that location parameters reflected a sizable underlying anxiety for ECT.

CONCLUSIONS

The ERAQ is a questionnaire that assesses ECT-related anxiety. It offers a measure of global severity and differentiates between various topics of anxiety. The ERAQ thus informs the clinician about the specific aspects of an ECT course that could trigger a patient's anxiety and can guide clinicians in how to discuss ECT-related anxieties with patients.

Catatonia in Patients with Autism Spectrum Disorder

Catatonia was first described by Karl Ludwig Kahlbaum in 1874, occurring in association with other psychiatric and medical disorders. However, in the nineteenth century the disorder was incorrectly classified as a subtype of schizophrenia. This misclassification persisted until the publication of DSM-5 in 2013 when important changes were incorporated. Although the etiology is unknown, disrupted gamma-aminobutyric acid has been proposed as the underlying pathophysiological mechanism. Key symptoms can be identified under 3 clinical domains: motor, speech, and behavioral. Benzodiazepines and electroconvulsive therapy are the only known effective treatments. Timely recognition and treatment have important outcome, and sometimes lifesaving, implications.

Electroconvulsive Therapy in Children and Adolescents: Clinical Indications and Special Considerations

Electroconvulsive therapy (ECT) is a well-tolerated, well-established, and efficacious treatment in adults, particularly in the setting of severe mood and psychotic disorders. In children and adolescents, however, ECT is infrequently administered and likely underutilized. Results from older studies evaluating the utility of ECT in children and adolescents were mixed, but recent studies have supported ECT treatment success in these patients, with particularly high response rates for treating depression. In this Perspectives, we discuss the current clinical indications for ECT in managing mood and psychotic disorders in children and adolescents. We then review the pretreatment evaluation and management of patients receiving ECT and examine the efficacy of ECT for those indications. We also address issues unique to children and adolescents, versus adults, that need to be considered when determining whether treatment with ECT is appropriate for a patient in this age group. Included in this context are the distinct side-effect profile in children and adolescents, ethical issues regarding informed consent, incorporating the child into the decision-making process when developmentally appropriate, and the need to take into account differing state jurisdictional processes.

Efficacy and Safety of Electroconvulsive Therapy in Adolescents: A Retrospective Chart Review Study From Turkey

OBJECTIVE

The aim of this study was to report the efficacy and safety of electroconvulsive therapy (ECT) in manic, depressed, psychotic, and catatonic adolescent patients.

METHODS

Medical records of 78 adolescents who had received ECT in Department of Psychiatry, Gaziantep University Medical Faculty, during 2011 to 2017 were reviewed. Sixty-two subjects in this sample were identified to have complete records and met the study inclusion criteria.

RESULTS

The mean ± SD age of subjects was 17.11 ± 1.04 years and female sex was 53.2% (n = 33). Primary the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses were bipolar mood disorders (n = 33, 53.2%), major depressive disorder (n = 16, 25.8%), schizophrenia (n = 8, 12.9%), and schizoaffective disorders (n = 5, 8.1%). Electroconvulsive therapy was significantly effective in treating manic, depressive, psychotic, and catatonia symptoms as evidenced by significant differences in pretreatment and posttreatment scores in outcome measures including Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression-Severity Scale (P < 0.001). Presence of comorbidity adversely affected treatment response (P = 0.001). However, ECT was also effective in those with comorbid diagnoses (P < 0.001). Depressive symptoms in patients with bipolar depression responded better than those with unipolar depression (P = 0.012). Electroconvulsive therapy was generally safe with subjective memory complaints (85%), headache (69%), and prolonged seizure (8%) as the reported adverse effects possibly related to ECT. Four subjects (6%) developed a manic switch during ECT.

CONCLUSIONS

Electroconvulsive therapy is an effective and a safe treatment option in adolescent patients with severe and resistant psychopathology. Although comorbidity may decrease treatment response, ECT seems to be effective even in the presence of multiple psychiatric diagnoses.

Patients', Carers', and the Public's Perspectives on Electroconvulsive Therapy

Aims and Method: The aim of this study was to present patients', carers', and the public's perspectives on electroconvulsive therapy (ECT) through a narrative review of the literature. Results: People's perspectives on ECT are often negative due to media and Internet portrayal. Perspectives are influenced by risks, short-term side effects, and the most commonly reported longer-term side effect: memory loss. However, many patients do not report memory loss. Most people who experience ECT and their carers report a positive perspective. In the future, people's perspectives may become more positive with higher service delivery standards and a more balanced, well-informed view of modern ECT presented by the media. However, ECT has risks and side effects, and negative and critical perspectives on the use and effects of ECT will persist. Clinical Implications: Perspectives on ECT are important because of the impact on stigma, patient treatment choice, patient consent, and provision of and referral for ECT.

Pediatric Catatonia: A Case Series-Based Review of Presentation, Evaluation, and Management

BACKGROUND

Pediatric catatonia is believed to be a rare condition, but challenges in recognition and variability in presentation may lead to underdiagnosis. Early identification and effective treatment of pediatric catatonia is critical given the significant morbidity and mortality associated with the condition. Given the widespread shortage of child and adolescent psychiatrists, at times consultation-liaison (C-L) psychiatrists without child training may be the frontline specialty providers asked to guide treatment of these pediatric patients.

OBJECTIVE

To review the literature on pediatric catatonia using clinical cases to illustrate unique aspects of its presentation, evaluation, and management.

METHODS

We describe the presentation and management of 6 adolescents with catatonia on an inpatient pediatric service at a general hospital and use these cases as a focal point for a review of the literature.

CONCLUSION

Pediatric catatonia is a potentially lethal disease entity that can be effectively treated if accurately identified early in its course. Psychiatrists working in a C-L setting may encounter this syndrome and should be aware of its presentation, evaluation, and management.

A Follow-up Study of Electroconvulsive Therapy in Children and Adolescents

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.

Adult and Adolescent Patient Evaluations of Electroconvulsive Therapy in Comparison to Other Therapeutic Modalities

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.

Proposed treatment for adolescent psychosis. 2: Bipolar illness

Bipolar illnesses are typically considered as disorders primarily occurring in adult life, but a substantial number have their onset during the teenage years. Any acute illness in the teenage years affects social, emotional and educational development disproportionately, as it may prevent the normal transitions and learning experiences inherent in adolescence. Additionally, there is some evidence for a lack of early recognition or for misdiagnosis in early-onset cases of psychiatric disorders in general and the psychotic disorders in particular, with consequent increased suffering and impairment of functioning. Finally, bipolar affective disorders rarely present with one single episode followed by full and permanent recovery, but are usually illnesses characterised by a relapsing and remitting course through adult life. Prompt and effective recognition and treatment may therefore not merely reduce immediate impact but may also set up patterns of understanding and treatment compliance with longer-term implications. In this paper, I consider the particular features of bipolar affective disorder in adolescence and to describe a practical framework for its management. In view of the relative lack of age-specific research findings, particularly in respect of treatment effectiveness, I draw heavily upon clinical practice and extrapolation from studies carried out among adult sufferers.

ECT-Related Anxiety: A Systematic Review

BACKGROUND

A significant proportion of electroconvulsive therapy (ECT)-treated patients experience anxiety anticipating the treatment, often to such an extent that they refuse or discontinue a much-needed treatment. Despite its great impact on treatment adherence, anxiety in patients receiving ECT is underexposed in the scientific literature.

OBJECTIVES

We aimed to review the prevalence and specific subjects of ECT-related anxiety and therapeutic interventions to reduce it.

METHODS

We performed a computerized search (EMBASE, MEDLINE, and PsycINFO) for articles meeting the following inclusion criteria: (1) qualitative (interview) studies, quantitative (questionnaire) studies, or experimental (interventional) studies that (2) report on anxiety that is related to a planned, ongoing, or past ECT treatment.

RESULTS

Of 1160 search results, 31 articles were included. Electroconvulsive therapy-related anxiety is estimated to be present in 14% to 75% of patients and is most often linked to worries about memory impairment or brain damage. Only a few interventions (chlorpromazine, meprobamate, propofol, a talking-through technique, an information leaflet, and animal-assisted therapy) have been proposed to reduce patients' ECT-related anxiety.

CONCLUSIONS

Electroconvulsive therapy-related anxiety is a highly prevalent phenomenon, and the literature provides little guidance for its clinical management. Most studies are of a low methodological quality and suffer from significant limitations, thereby hampering generalized conclusions. Given the clinical importance of ECT-related anxiety, further study on its nature and evolution through the course of treatment and on anxiety-reducing interventions is warranted.

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.

Thinking About Electroconvulsive Therapy: The Opinions of Parents of Adolescents with Schizophrenia Spectrum Disorders

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.

Transcranial Direct Current Stimulation: Considerations for Research in Adolescent Depression

Adolescent depression is a prevalent disorder with substantial morbidity and mortality. Current treatment interventions do not target relevant pathophysiology and are frequently ineffective, thereby leading to a substantial burden for individuals, families, and society. During adolescence, the prefrontal cortex undergoes extensive structural and functional changes. Recent work suggests that frontolimbic development in depressed adolescents is delayed or aberrant. The judicious application of non-invasive brain stimulation techniques to the prefrontal cortex may present a promising opportunity for durable interventions in adolescent depression. Transcranial direct current stimulation (tDCS) applies a low-intensity, continuous current that alters cortical excitability. While this modality does not elicit action potentials, it is thought to manipulate neuronal activity and neuroplasticity. Specifically, tDCS may modulate N-methyl-d-aspartate receptors and L-type voltage-gated calcium channels and effect changes through long-term potentiation or long-term depression-like mechanisms. This mini-review considers the neurobiological rationale for developing tDCS protocols in adolescent depression, reviews existing work in adult mood disorders, surveys the existing tDCS literature in adolescent populations, reviews safety studies, and discusses distinct ethical considerations in work with adolescents.

A 20 Year Practice Review of Electroconvulsive Therapy for Adolescents

OBJECTIVE

Clinical reviews of practice outcomes of adolescent patients who have received electroconvulsive therapy (ECT) remain relatively rare. This study reports the clinic practice and outcome of adolescents receiving ECT at a tertiary medical center.

METHODS

From April 1991 through November 2013, 51 adolescents (30 female; mean [SD] age, 16.8 [1.6] years) received ECT. The electronic medical record at the time of the first ECT session was reviewed for the clinical diagnosis, ECT lead placement and general administration, seizure duration, adverse effects, concurrent medications, and clinical outcome.

RESULTS

ECT was recommended for primary mood and psychotic disorders or catatonia. Patients received a mean (SD) of 9.3 (3.5) treatments, with initial bitemporal lead placement in 36 patients (71%). Thirty-nine patients (77%) were much or very much improved based on Clinical Global Impressions-Improvement scale at the end of the acute treatment. Prolonged seizure duration (>120 seconds) was relatively common (63%) but appeared to decrease in older patients.

CONCLUSIONS

This report describes the largest group of adolescents receiving ECT since 1947, and supports ECT as a safe and effective modality for most treatment-recalcitrant psychiatric illness in youth.

Knowledge and Attitude of Patients with Psychiatric Disorders and their Relatives Toward Electroconvulsive Therapy

OBJECTIVE

Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives.

MATERIALS AND METHODS

Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives.

RESULTS

Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73).

CONCLUSIONS

Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment.

Perceptions and awareness of electroconvulsive therapy among patients and their families: a review of the research from developing countries

OBJECTIVES

Although electroconvulsive therapy (ECT) is used frequently in many developing countries, investigations of patients' awareness and perceptions of the treatment are rare. This review attempted to pool the research evidence in this area from developing countries.

METHODS

Electronic searches of databases using relevant keywords were supplemented by extensive manual checking of cross-references and other sources.

RESULTS

Sixteen such reports were found suitable for inclusion. The limited data showed that patients were usually poorly informed about ECT, which was partly attributable to unsatisfactory pretreatment explanations received by approximately two thirds of the recipients. About a third also reported deficiencies in the process of consent, including a sense of coercion. Fear of ECT was reported by a significant percentage (36%-75%). Distressing adverse effects were frequent; memory impairment (25%-95%) being the most common one. Despite these problems, most studies found that most patients perceived ECT to be helpful and had positive views about it. Simultaneously, a sizeable percentage (10%-32%) was quite critical of ECT. In contrast, relatives of patients were invariably better aware, more satisfied with the experience, and had more favorable attitudes toward ECT.

CONCLUSIONS

Overall, the weight of the evidence supported the notion that patients undergoing ECT and their relatives are well disposed towards it. However, the lacunae in treatment highlighted by this review and extreme variations in practice of ECT suggest that much more needs to be done to improve the practice of ECT in developing countries, to enhance patients' and relatives' satisfaction with the treatment.

Electroconvulsive therapy in adolescents with the catatonia syndrome: efficacy and ethics

OBJECTIVES

In child and adolescent psychiatry, catatonia is infrequent, but it is one of the most severe syndromes, characterized by the coexistence of psychic and motor symptoms. In this report, we explore the therapeutic experience with electroconvulsive therapy (ECT) in adolescents with catatonia.

METHODS

We review the literature (1985-2009) to clarify issues related to the use of ECT in child and adolescent patients with catatonia.

RESULTS

Electroconvulsive therapy is used as second-line management after high-dose benzodiazepine trials. Electroconvulsive therapy is an effective, safe, and useful procedure in the treatment of catatonic youngsters as reported in 59 patients. Ethical issues regarding the use of ECT are analyzed and their implications briefly discussed in the light of general medical ethics.

CONCLUSIONS

Electroconvulsive therapy is a safe and effective treatment for catatonia in children and adolescents.

The emerging role for repetitive transcranial magnetic stimulation in optimizing the treatment of adolescent depression

Major depressive disorder (MDD) in adolescents is a common illness and significant public health problem. Treatment is challenging because of recurrences and limited modalities. Selective serotonin reuptake inhibitors and cognitive behavioral therapy are considered the standard of care in severe or treatment-resistant MDD in this age group. However, responses to these interventions are often suboptimal. A growing body of research supports the efficacy of repetitive transcranial magnetic stimulation (rTMS) for the treatment of MDD in adults. Induced seizures are a primary safety concern, although this is rare with appropriate precautions. There is, however, limited experience with rTMS as a therapeutic intervention for adolescent psychiatric disturbances. This review will summarize the rTMS efficacy and safety data in adults and describe all published experience with adolescent MDD. Applications in other adolescent psychiatric illnesses such as schizophrenia and attention-deficit/hyperactivity disorder are reviewed. Safety and ethical issues are paramount with investigational treatments in adolescent psychiatric illnesses. However, further research with rTMS in adolescent MDD is imperative to establish standards for optimal stimulation site, treatment parameters, and its role in treatment algorithms. These may diverge from adult data. Early intervention with neuromodulation could also hold the promise of addressing the developmental course of dysfunctional neurocircuitry.

Electroconvulsive therapy: a review of knowledge, experience and attitudes of patients concerning the treatment

OBJECTIVES

Despite its proven efficacy and safety, electroconvulsive therapy (ECT) has a negative image and attracts widespread public criticism. In contrast, perceptions of patients who have received ECT appear to be more favourable. This review intended to encapsulate the evidence on knowledge and views concerning ECT among its recipients.

METHODS

Extensive electronic and manual searches were conducted to identify all relevant studies on the subject.

RESULTS

Seventy-five reports were found suitable. The evidence from these studies suggested that patients undergoing ECT were usually poorly informed about it. This was attributable to factors such as unsatisfactory pre-treatment explanations or post-ECT memory impairment. About one-third undergoing ECT reported feeling coerced to have the treatment. Fear of ECT and distressing side effects were also present in a majority. Despite these problems, a vast majority of patients perceived ECT to be helpful and had positive views regarding the treatment. Simultaneously, a sizeable proportion was quite critical, although little was known about the extent and nature of such disapproval.

CONCLUSIONS

Overall, the weight of the evidence supports the notion that patients undergoing ECT are well-disposed towards it. However, much needs to be done to improve the practice of ECT and to enhance patients' satisfaction with the experience of treatment.

ECT for self-injury in an autistic boy

OBJECTIVE

Self-injurious behavior presents a significant challenge in autism, and first-line psychopharmacological and behavioral interventions have limited efficacy in some patients. These intractable cases may be responsive to electroconvulsive therapy.

CLINICAL PICTURE

This article presents an eight-year-old boy with autism, mental retardation, prominent mood lability and a five-year history of extreme self-injurious behavior towards his head, averaging 109 self-injurious attempts hourly. The patient was at high risk for serious head trauma, and required usage of bilateral arm restraints and protective equipment (i.e., padding on shoulders, arms, and legs). All areas of daily functioning were profoundly impacted by dangerous self-injury.

TREATMENT

Fifteen bilateral ECT treatments resulted in excellent mood stabilization and reduction of self-injury to 19 attempts hourly, and maintenance ECT was pursued. The patient was able to return to developmentally-appropriate educational and social activities.

CONCLUSION

ECT should be considered in the treatment algorithm of refractory cases of severe self-injury in autism.

Eletroconvulsoterapia na depressão maior: aspectos atuais

OBJETIVO: A eficácia da eletroconvulsoterapia em tratar sintomas depressivos está estabelecida por meio de inúmeros estudos desenvolvidos durante as últimas décadas. A eletroconvulsoterapia é o tratamento biológico mais efetivo para depressão atualmente disponível. O objetivo deste estudo foi demonstrar o papel da eletroconvulsoterapia no tratamento da depressão e destacar aspectos atuais relativos à sua prática. MÉTODO: Foram revisados na literatura estudos de eficácia, remissão de sintomas, fatores preditores de resposta, assim como aspectos atuais acerca da qualidade de vida, percepção dos pacientes, mecanismo de ação, técnica e prejuízo cognitivos. RESULTADOS: Os principais achados desta revisão foram: 1) a eletroconvulsoterapia é mais efetiva do que qualquer medicação antidepressiva; 2) a remissão da depressão com a eletroconvulsoterapia varia, em geral, de 50 a 80%; 3) Ainda é controverso o efeito da eletroconvulsoterapia nos níveis de fator neurotrófico derivado do cérebro (acho que aqui pode colocar entre parenteses o "BNDF"); 4) a eletroconvulsoterapia tem efeito positivo na melhora da qualidade de vida; 5) os pacientes submetidos à eletroconvulsoterapia, em geral, têm uma percepção positiva do tratamento. CONCLUSÃO: A eletroconvulsoterapia permanece sendo um tratamento altamente eficaz em pacientes com depressão resistente. Com o avanço da sua técnica, a eletroconvulsoterapia tornou-se um procedimento ainda mais seguro e útil tanto para a fase aguda, quanto para a prevenção de novos episódios depressivos.

Patients' and their relatives' attitudes toward electroconvulsive therapy in bipolar disorder

Although electroconvulsive therapy (ECT) is a safe and efficacious treatment, there is a widespread negative view of ECT in public and professional circles. Previous studies that reported psychiatric patients' and their relatives' feelings and attitudes toward ECT revealed generally positive results. However, there are no data focusing on bipolar patients' and their relatives' attitudes toward ECT. In this study, the perspectives of 70 bipolar patients and their 70 relatives were examined before ECT. The study showed that the majority of patients and relatives believed they had not received adequate information about ECT, but they were satisfied with the treatment, found it beneficial, and maintained a positive attitude toward its use. The most commonly reported side effect was memory impairment. This is the first study focusing on bipolar patients' and their relatives' attitudes toward ECT in the literature.

Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan

BACKGROUND

Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients.

METHODS

This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan.

RESULTS

We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001).

CONCLUSION

We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.

A Western Australian survey on public attitudes toward and knowledge of electroconvulsive therapy

AIMS

Healthcare professionals have debated the use and effects of electroconvulsive therapy (ECT) for more than 65 years. Yet, knowledge about, and attitudes towards, ECT have not been thoroughly researched within the Australian community. This study focused on a Western Australian perspective on these issues.

METHOD

The objectives were achieved with specifically developed questionnaires. Six hundred surveys were distributed across the metropolitan area of Perth, Australia.

RESULTS

A total of 379 completed questionnaires indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on individuals with psychosocial issues, on children and on involuntary patients. Public perceptions of ECT were also found to be mainly negative.

CONCLUSION

The findings suggest that clinicians should ensure that individuals recommended for ECT are knowledgeable about basic ECT processes and implications in order to ensure their full informed consent.

Electroconvulsive therapy (ECT) in a six-year-old girl suffering from major depressive disorder with catatonic features

OBJECTIVE

ECT is generally both effective and safe in the treatment of adolescents, but treatment using ECT in children of pre-pubertal age has been less reported and is a controversial treatment.

CLINICAL PICTURE

This article reports a 6-year-old girl who has been diagnosed as having major depressive disorder with catatonic features and 50% loss of weight due to food refusal.

TREATMENT

The seven-session ECT treatment with bilateral and brief pulse stimulation was successfully done. Propofol 1% was used for anesthesia.

OUTCOME

After the third session, the patient's clinical improvement began by eating. As the ECT sessions went on the signs of depression and catatonic features completely resolved. There were no noticeable clinical side effects.

CONCLUSION

ECT should be considered in severe cases of child psychiatric disorders where it is life threatening, as an effective and safe method.

ECT and The Youth: Catatonia in Context

Electroconvulsive therapy (ECT) has been in psychiatric practice for well over half a century, but it continues to incite controversy. However, it is regarded amongst psychiatrists as a safe and effective treatment and at times even a lifesaver. It offers a fairly swift but a time-limited response, opening up opportunities for initiation of more longer lasting treatments. The use of ECT in the youth is limited, and as such good studies are few and far between. The recent Practice Parameters by the American Academy of Child and Adolescent Psychiatry, specifically addressing ECT in adolescents, is indeed a welcome addition. Electrocovulsive therapy is as effective in the youth as it is in the adults, and the indications and contraindication are the same. The administration of ECT follows the same general principles in all age groups. One particular indication is of the use in catatonia, a motor syndrome that could occur with affective disorders, schizophrenia or medical conditions, in which it is considered to be extremely effective. The association between catatonia and autism and spectrum disorders has been noted, and in this situation, ECT is considered by some to be effective. Ethical considerations and that of capacity and informed consent are of paramount importance as are the human rights. Working in partnership with the parents/carers all the way is a must. The lack of information leaflets on ECT especially designed for young patients and their parents has to be rectified soon. Registers based on geographical health regions for those below the age of 18 will assist tremendously in epidemiological studies as well as pave the way toward more evidence-based studies that are essential.

ECT: Knowledge and attitude among patients and their relatives

BACKGROUND

It is believed that people lack sound knowledge and appropriate attitude towards electroconvulsive therapy (ECT). However, very little systematic research has gone into this area.

AIM

To examine the knowledge and attitude of patients and their relatives towards ECT.

METHODS

A 16-item questionnaire with satisfactory face validity and content validity was constructed and translated into Hindi. It was then administered to 89 patients and 83 relatives attending the psychiatry services in a major hospital in north India.

RESULTS

More than 65% of the respondents in both the groups-patients as well as relatives-gave correct responses such as ECT is life saving, many times it causes temporary but not permanent memory impairment and that ECT is not a non-scientific treatment. There was non-significant disagreement between the two groups.

CONCLUSION

The study is a preliminary exploratory one and is likely to give direction for further research with refined methodology.

Somatic treatment for depressive illnesses in children and adolescents

Numerous somatic interventions have been studied as potential treatments of depressive disorders in children and adolescents. These include antidepressant medications, light therapy, electro-convulsive therapy, and alternative therapies. The available evidence suggests that several somatic interventions hold promise as potentially safe and effective treatments for depressed youths; however, there is still much to be learned about these interventions. This article reviews what is known and what needs to be learned about the somatic treatment of pediatric depression.

How fixed are child psychiatrists' views about ECT in the young?

The experience, knowledge, and attitudes of Australian and New Zealand child psychiatrists in relation to ECT in the young were surveyed in 2000 to ascertain whether their views had changed since a similar survey was conducted in 1996. Fifty-four percent (n = 129) of the original sample answered a mailed questionnaire. Psychiatrists in 2000 had greater self-rated level of knowledge on the subject and were less likely to base that knowledge on adult ECT data. Psychiatrists in 2000 were also more likely than in 1996 to approve the use of ECT in adolescents. The finding that the views of child psychiatrists can change is reassuring, given emerging data showing ECT in young persons to be an effective and safe treatment, and the requirement in various countries that child psychiatrists participate in the decision to administer the treatment. It is possible that a number of publications and presentations on the topic after the first survey contributed to the change in views. Nevertheless, there remain gaps in child psychiatrists' knowledge about ECT in the young that need to be addressed. The study findings should not be over interpreted because of the reduced response rate in the follow-up survey.

Has the practice and outcome of ECT in adolescents changed? findings from a whole-population study

OBJECTIVE

To investigate whether there were changes in the practice and outcome of electroconvulsive therapy (ECT) in adolescents in a whole population over a decade.

METHOD

All persons younger than 19 years who received ECT in the state of New South Wales, Australia, in the period from 1990 to 1999 were identified. Detailed information about diagnosis, treatment and outcome were then obtained.

RESULTS

Seventy-two patients aged 14-18 years underwent a total of 84 courses of ECT (1.53/100,000 adolescents were treated with ECT per year). In 1996 to 1999 compared with 1990 to 1995, there was an increase in ECT among females hospitalized involuntarily, EEG monitoring, stimulus dosing, bilateral ECT, and use of thiopentone. Overall, mood disorders derived most benefit from ECT while comorbid personality disorder predicted poorer short term outcome. Side effects were minor and transient.

CONCLUSIONS

The changes in ECT practice are consistent with changes in ECT practice generally over the survey period. The overall data on effectiveness and safety further support the treatment's use in young people.

The subjective experience of patients who received electroconvulsive therapy

OBJECTIVE

Despite the vast amount of scientific literature available on electroconvulsive therapy (ECT), there is little qualitative focus upon the patients' subjective experience of this procedure. Using an exploratory descriptive methodology, this study aims to provide a more unique insight into what certain patients actually think of ECT.

METHOD

Semistructured interviews were conducted to explore eight patients' opinions and experiences of ECT. Interviews were subjected to analysis by a five-step framework approach that identified prominent themes in relation to five broad questions and in conjunction with issues raised by the subjects themselves.

RESULTS

Eleven major themes were identified. Four of these were chosen for discussion, not only as the most prevalent themes (in terms of how frequently they were mentioned by the subjects), but also as the most striking (in regards to the intensity of emotions evoked, or their influence on their perception of ECT as a future treatment option). The four themes are fear of ECT, attribution of cognitive decline and memory loss to ECT, positive ECT experiences, and patients' suggestions.

CONCLUSIONS

Using such a qualitative approach, the depth of the information obtained has revealed new perspectives on how patients perceive the experience of ECT. Fears reported by patients present an opportunity to address specific areas of the procedure that generate the most angst. These were closely associated with recommendations that many patients proposed throughout the interviews. Patients' perceptions of the cognitive effects of ECT do not necessarily correspond with those commonly reported in the literature on ECT. Positive experiences with ECT were more complex than simply its efficacy. There is a need for future research in order to explore and address patients' experiences of ECT.

Patients' and their relatives' knowledge of, experience with, attitude toward, and satisfaction with electroconvulsive therapy in Hong Kong, China

Although electroconvulsive therapy (ECT) is a safe and efficacious treatment, there is a widespread negative view of ECT in public and professional circles. There are no data on Chinese patients' knowledge of, experience with, attitude toward, and level of satisfaction with ECT in Hong Kong. The aims of this study were to examine patients' experience of ECT, and patients' and their relatives' knowledge of, attitude toward, and level of satisfaction with ECT. To this effect, a prospective cross-sectional survey was conducted, involving 96 patients and their 87 relatives. The study showed that the majority of patients believed they had not received adequate information about ECT. The most commonly reported side effect was memory impairment. Patients and relatives had only limited knowledge of ECT, yet the majority of them were satisfied with the treatment and, having found it beneficial, maintained a positive attitude toward its use. The researchers concluded that Hong Kong Chinese patients and their relatives accepted ECT as a treatment. The way information is provided to patients and relatives when obtaining consent for ECT needs improvement.

Clinical relevance of electroconvulsive therapy (ECT) in adolescents with severe mood disorder: evidence from a follow-up study

Given the limited knowledge on the long-term outcome of adolescents who receive electroconvulsive therapy (ECT), the study aimed to follow-up adolescents treated with ECT for severe mood disorder. Eleven subjects treated during adolescence with bilateral ECT for psychotic depression (n = 6) or mania (n = 5), and ten psychiatric controls matched for sex, age, school level, and clinical diagnosis, completed at least 1 year after treatment a clinical and social evaluation. Mean duration between time of index episode and time of follow-up evaluation was 5.2 years (range 2-9 years). At follow-up: (1) all patients except two in the control group received a diagnosis of bipolar disorder. (2) Fifteen patients had had more than one episode of mood disorder. (3) The two groups did not differ in social functioning nor school achievement. (4) Impact on school achievement was related to the severity of the mood disorder rather than ECT treatment. The results suggest that adolescents given ECT for bipolar disorder, depressed or manic, do not differ in subsequent school and social functioning from carefully matched controls.

ECT treatment of malignant catatonia/NMS in an adolescent: a useful lesson in delayed diagnosis and treatment

A 17-year-old adolescent female presented to a psychiatric emergency room with excitement, confusion, and psychotic symptoms. After brief exposure to haloperidol and olanzapine, she developed fever, rigidity, waxy flexibility, autonomic instability, and elevated creatinine phosphokinase enzyme. Approximately 6 weeks after the onset of the illness, multiple laboratory tests, and evaluation at three different hospitals, the condition was effectively treated with electroconvulsive therapy (ECT). This case is a lesson in delayed recognition and the delayed use of ECT for the malignant catatonia/neuroleptic malignant syndrome.

[Electroconvulsive therapy in the adolescent: clinical considerations apropos of a series of cases]

OBJECTIVE

To report on observations of 6 adolescents treated with electroconvulsive therapy (ECT) and to compare the data with literature data.

METHOD

We conducted a retrospective study of our division charts of adolescents treated with ECT and hospitalized in the last 20 years. We also undertook a computer search in several databases (including Medline) to identify the reported observations on this treatment.

RESULTS

We studied the charts of 6 adolescents aged 14 to 16 years. There were 3 cases of major depressive disorder (including 1 case of delusion of negation), 2 cases of neuroleptic malignant syndrome, and 1 case of schizoaffective disorder with catatonic characteristics. Four adolescents received ECT as a first-line treatment. They were given an average of 9 ECT, which was judged to be efficacious. Tolerance was adequate, and in this series, ECT does not seem to have caused alterations to long-term cognitive functions. No relapse was noted after a minimum of one-year follow-up.

CONCLUSIONS

For some severe psychiatric disorders in adolescents, ECT could be a treatment with a good efficacy and tolerance profile.

The portrayal of ECT in American movies

OBJECTIVE

To describe the portrayal of electroconvulsive therapy (ECT) in American films. This has not been systematically studied previously, despite some notorious ECT scenes in the history of American cinema and the impact of films on audiences.

METHOD

All movies depicting or making reference to ECT were identified from a number of sources. Available movies were viewed on at least two occasions.

RESULTS

22 films, beginning with The Snake Pit and ending with Requiem for a Dream, portraying or making reference to ECT were made between 1948 and 2000. 20 (91%) of these movies were obtained and viewed.

CONCLUSION

Having commenced its movie career as a severe but helpful remedy for personal distress, ECT on film has become a progressively more negative and cruel treatment, leaving the impression of a brutal, harmful, and abusive maneuver with no therapeutic benefit.

Electroconvulsive therapy in adolescents: similarities to and differences from adults

OBJECTIVE

Information on the indications, technique, and effectiveness of electroconvulsive therapy (ECT) in adolescent patients is scarce. The recommendations for the use of ECT in this age group are similar to those in adults. This study compares the experience with ECT in the two age groups in the same community psychiatric institution, which adheres to the accepted protocols for diagnosis and treatment.

METHOD

The files of 24 consecutive adolescent patients treated in an ECT unit located in the center of Israel in the years 1991-1995 were retrospectively examined, and the findings were compared with those in 33 adult patients who started their ECT course on the same day. The technique for applying ECT was essentially the same in the two age groups.

RESULTS

ECT was equally effective for adolescents and adults (58% in each group achieved remission). The main difference was the diagnosis for which patients were referred: most of the adolescents were in the "psychotic spectrum, whereas most of the adults were in the "affective spectrum."

CONCLUSIONS

The findings support the current medical recommendations for the use of ECT in adolescents. Possible explanations for the differences in diagnosis between the two age groups are discussed.

Electroconvulsive therapy in adolescents with mood disorder: patients' and parents' attitudes

The aim of the study was to assess retrospectively patients' and parents' experiences and attitudes towards the use of electroconvulsive therapy (ECT) in adolescence. The experiences of subjects (n=10) who were administered ECT in adolescence for a severe mood disorder and their parents (n=18) were assessed using a semi-structured interview after a mean of 4.5 years (range, 19 months to 9 years). Their attitudes were mostly positive and ECT was considered a helpful treatment. Concerns were frequently expressed, probably because ECT was not fully understood by the patients and their families. Most complaints were of transitory memory impairment. The parents were satisfied with the consent procedure, while all but one patient did not remember the consent procedure. We concluded that, despite negative views about ECT in public opinion, adolescent recipients and their parents shared overall positive attitudes towards the use of ECT in this age range.

The use of electroconvulsive therapy in special patient populations

BACKGROUND

Despite its well-established efficacy and its increasing use, electroconvulsive therapy (ECT) remains a controversial treatment. Lack of clarity in the issues related to its use in special patient populations (for example, in children, in adolescents, in pregnant women, in the elderly, and in the medically ill) often contributes to the debate about the use of ECT.

METHOD

The literature on ECT use in special patient populations is reviewed, together with the commonly associated high-risk medical conditions in clinical practice. Specific reference is made in each case to the safety, tolerability, and efficacy of the procedure.

RESULTS

Much of the literature surveyed consists of case studies, although a few controlled trials are available. In general, ECT use in special populations is relatively safe and extremely effective. In small case series, ECT use in children and adolescents is effective but requires further systematic study. In pregnant women, ECT is very effective, and with proper medical care, it is relatively safe in all trimesters of pregnancy, as well as in the postpartum period. The frail elderly are particularly good candidates for ECT because they are often unresponsive to or intolerant of psychotropic medication. Medical conditions that should receive particular attention during a course of ECT are disorders of the central nervous system (CNS), cardiovascular, and respiratory system. With modern anesthesia techniques and careful medical management of each high-risk patient, most can successfully complete a course of ECT. The process of obtaining informed consent also requires special consideration in this group of patients because their capacity to consent to treatment may be compromised.

CONCLUSIONS

With careful attention to each patient's medical and anesthesia needs, ECT is an effective and relatively safe procedure in high-risk special patient populations.

Electroconvulsive therapy for minors: experiences and attitudes of child psychiatrists and psychologists

OBJECTIVE

To estimate knowledge, experience, and attitudes towards the use of electroconvulsive treatment in minors (patients < 18 years of age), among child and adolescent psychiatrists and psychologists.

METHOD

1,600 questionnaires were mailed to a group of child and adolescent psychiatrists and psychologists.

RESULT

There were 625 (39%) respondents. 329 (53.8%) of the respondents stated that they possessed minimal knowledge about the use of ECT in children and adolescents. Lack of confidence in providing a second opinion was common and reported by 75%. Compared with those with minimal knowledge, respondents with advanced knowledge reported a higher perception of safety and efficacy. The majority (70%) of the respondents regarded ECT as a treatment of last resort.

CONCLUSION

Many child and adolescent psychiatrists and psychologists have very little knowledge, training, or experience in this treatment. They seem to be ill equipped to appropriately consider or advise patients and families about ECT. Clinical and research implications of these findings are discussed.