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

Electroconvulsive Therapy in Children and Adolescents: A Systematic Review of Current Literature and Guidelines

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.

Knowledge, attitudes, and experience of child and adolescent psychiatrists in Turkey concerning pediatric electroconvulsive therapy

OBJECTIVE

Electroconvulsive therapy (ECT) is a treatment modality in children that can be life-saving but is rarely preferred. In this study, we aimed to evaluate the knowledge, experience, and attitudes of child and adolescent psychiatrists (CAPs) in Turkey about pediatric ECT and to draw attention to possible gaps and needs regarding this treatment in the child and adolescent psychiatric policies of Turkey.

METHOD

An electronic survey was prepared and shared with child and adolescent psychiatric residents and specialists. The participants were asked about their residency training, clinical experience, and opinion about ECT. The obtained data were entered in SPSS Statistics 23.0. Descriptive analyses and chi-squared tests were applied.

RESULTS

One hundred and ninety-one CAPs filled in the questionnaire, 28.8% of whom assessed their knowledge level as "I have no knowledge." Only 34% of them stated that their patients, most of whom had mood disorders, schizophrenia, and catatonia, had received ECT before. Four of these patients were under 12 years old. Sixty-six percent of the participants suggested that ECT was safe in adolescents, whereas only 5.8% held this view for prepubertal children. The most common reason for physicians not to apply ECT was "lack of means to apply ECT," and 92.7% stated that opportunities should be provided for pediatric ECT treatment by the hospital administration.

CONCLUSION

This is the first data to present the knowledge and attitudes of CAPs in Turkey about ECT. The results suggest that physicians need to have more knowledge about ECT.

Experience, Knowledge, and Attitudes of Child and Adolescent Psychiatrists in Belgium Toward Pediatric Electroconvulsive Therapy

OBJECTIVE

The purpose of the present study was to ascertain the experience, knowledge, and attitudes of child and adolescent psychiatrists toward the use of ECT (electroconvulsive therapy) in children and adolescents in Belgium.

METHODS

A questionnaire was mailed to all the members of the Flemish and Walloon Association of Child and Adolescent Psychiatrists.

RESULTS

Thirty-five percent (n = 151) of the psychiatrists responded to the questionnaire. Sixty-seven percent (n = 101) rated their knowledge about ECT in children and adolescents as nil or negligible. Only one percent (n = 2) estimated their knowledge to be advanced. Fifteen percent (n = 22) were aware of a minor treated with ECT. Ten (n = 16) and thirty-one percent (n = 47) believed that ECT is a safe treatment for children and adolescents, respectively. Only six percent (n = 10) would recommend ECT for a major psychiatric disorder in a child, whereas thirty-eight percent (n = 58) for an adolescent. Fifty-three percent (n = 71) regarded ECT as a treatment of last resort. A significant correlation was identified between knowledge and attitudes toward the use of ECT in minors. Respondents with some or advanced knowledge perceived ECT as a safer and a more effective treatment option than those with negligible knowledge. Most (91%, n = 138) of the child and adolescent psychiatrists are enthusiastic to learn more about the use of ECT in minors.

CONCLUSIONS

Flemish and Walloon child and adolescents psychiatrists have very little experience with using ECT in minors. They self-estimated their knowledge as negligible but are keen to learn more about this treatment option. The lack of knowledge likely explains the rare use of ECT in Belgium for children and adolescents with serious psychiatric disorders.

Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public

OBJECTIVE

To explore the state of knowledge and attitudes toward electroconvulsive therapy (ECT) among a sample of the adult British general public (n = 70) in comparison with a sample of medical students (n = 70) and MRCPsych students (n = 20). Despite documented efficacy, an uncritical anti-ECT stance is often adopted by the media. It has been suggested that medical students are relatively unfamiliar with ECT. If they do hold the same misconceptions as the general public, there are implications for the future use of ECT.

METHOD

Participants were opportunistically recruited for a Likert scale questionnaire developed for this study and designed to investigate the source of ideas about ECT, extent of knowledge, and lasting impressions of ECT as portrayed in films.

RESULTS

The lay sample was significantly less knowledgeable and had less positive attitudes and greater fear of ECT than the medical students. The aspects of ECT that medical students were least knowledgeable about were the potential risks and side effects involved. Popular films portraying ECT still seem to have a negative impact on their audiences.

CONCLUSIONS

The targets for education both in the public forum and in medical schools should be the procedure of administering ECT and explanation of the associated risks. Outdated and inaccurate depictions of ECT in films are still a frequently reported source of knowledge of ECT for both the general public and medical students.

New-generation antidepressants, suicide and depressed adolescents: how should clinicians respond to changing evidence?

The purpose of the present paper was to identify, from the voluminous literature on efficacy and safety in new-generation antidepressants (NGAs) with depressed children and adolescents, practical clinical strategies for acute phase treatment. To this end a pragmatic survey of studies and reviews was undertaken. Meta-analyses of randomized controlled trials of NGAs in depressed children and adolescents have noted a comparative lack of efficacy, and a weak but statistically significant increased risk of self-harm and suicidal thoughts. But NGA prescription rates and youth suicide rates are generally inversely related, and ensuing 'black box' warnings about NGAs, by deterring NGA prescribing, have possibly contributed to rising youth suicide rates. In moderate-severe depression, benefits for fluoxetine and possibly other NGAs demonstrably outweigh risks. NGAs are not present in adolescents who die by suicide. Concern about NGA risks must be balanced against risks of non-treatment. While mild depression entails regular review, psychoeducation, self-care strategies and psychological interventions, NGAs should be administered concurrently with psychological treatments if depression is moderate- to severe, or if mild depression persists. Patients should be warned about off-label status of NGAs in depression, serious side-effects such as 'activation', suicidality, emotional blunting and manic switches, the need for adherence and avoiding abrupt discontinuation. They should be monitored early and regularly. Better evidence is required regarding psychological treatments, clinical course, and clinical practice trends. In moderate-severe depression the risk of suicide if NGAs are not used may outweigh any risk of self-harm associated with them.

Electroconvulsive therapy: attitudes and misconceptions

This article deals with the current literature regarding general attitudes toward electroconvulsive therapy (ECT), and why there are so many misconceptions regarding this form of treatment. MEDLINE, PsychLIT and internet searches were carried out to gather the information discussed. Considerable stigma still surrounds ECT, and this probably remains the greatest barrier to public acceptance of this treatment.

Effect of two educational interventions on knowledge and attitudes towards electroconvulsive therapy

The aims of this study were to assess students' knowledge and attitudes toward ECT and to assess the effect of an educational video and pamphlet on knowledge and attitudes toward ECT. Additionally, this study aimed to assess which form of information delivery was most efficacious in improving knowledge and changing attitudes toward ECT. Seventy-seven students were allocated to an educational video, pamphlet, or control group. Participants completed questionnaires assessing knowledge and attitudes pre and post the aforementioned educational interventions, to assess the relative efficacy of both forms of information delivery. The majority of participants had reasonable knowledge of ECT indications, effects and side effects. However, participants still maintained a number of common misconceptions and possessed an overall neutral to negative attitude toward ECT. After education (video or pamphlet), participants' overall knowledge significantly increased and attitudes became significantly more favorable, relative to the control group. However, neither form of education was superior. Providing education about ECT, whether in the form of a video or information pamphlet, has the ability to increase knowledge and improve attitudes toward this treatment. The above results may have particular applicability when designing and tailoring educational efforts to the needs of an individual who may be considering ECT as a treatment option.