Electroconvulsive Therapy In Adolescents Research Articles

Electroconvulsive therapy in children and adolescents

Electroconvulsive therapy (ECT) is a recognized and effective treatment in adults for several psychiatric and neurological conditions in which the use of pharmacotherapy is ineffective, untimely or contraindicated. It has been used with success in mood and psychotic disorders, catatonia, neuroleptic malignant syndrome, Parkinson’s disease and intractable seizures. Its benefits have been recognized and its risks identified through an extensive body of research. The benefits of ECT are not limited to the adult population; research has been conducted on its use in child and adolescent populations for decades. In 2004, the American Academy of Child and Adolescent Psychiatry published practice parameters for the use of ECT in adolescent populations. However, ECT continues to be underused in cases where it is clearly indicated. In this article, we review the use of ECT in the adolescent population; its indications, administration, contraindications and risks, with emphasis on articles published after the American Academy of Child and Adolescent Psychiatry practice parameters were formulated. We also review reasons behind the underutilization of ECT in adolescents for whom this treatment modality is indicated.

Clinical Experience Using Electroconvulsive Therapy in Adolescents with Schizophrenia Spectrum Disorders

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

Electroconvulsive therapy in adolescent and adult psychiatric inpatients—a retrospective chart design

Background: The knowledge available on electroconvulsive therapy (ECT) in adolescents is largely anecdotal, or based on findings from adults. The aim of the present study is to compare the use of ECT in adolescent and adult inpatients. Methods: We retrospectively analyzed the files of all 36 adolescent (between the ages of 13 and 19) and 57 randomly selected adult inpatients (above the age of 20) treated with ECT in a university-affiliated mental heath center in Israel between 1991 and 1997. Results: Sixty one percent of the adolescents improved by the end of treatment, and 53% were not hospitalized in the subsequent year. The respective percentages among adults were 83% and 49%. Whereas most adults were treated with ECT because of schizophrenic disorders, almost half of the adolescents received ECT for affective disorders. Significantly more adolescents were treated with ECT because of acute life-endangering conditions (catatonia or severe suicidal risk). No significant adverse effects were found in both groups. Limitations: Our study is based on a retrospective chart review. The adolescent and adult groups are different in psychiatric morbidity, diagnosis and outcome, have not been assessed in a blind manner, and we have not used standardized psychometric batteries for the evaluation of ECT-related memory disturbances. Conclusions: ECT may be an effective, well-tolerated and safe procedure in both adult and adolescent inpatients.

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

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

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.

Electroconvulsive Therapy in Adolescents: Similarities to and Differences From Adults

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. 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. 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." 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 adolescence.

The aim of this work is to discuss the ethical issues regarding the use of electroconvulsive therapy (ECT) in adolescents. Ethical implications of ECT in adolescents are analyzed in the light of general medical ethics, which include five prominent principles with respect to autonomy, nonmaleficence, beneficence, justice, and cautiousness. As adults, adolescents with acute psychotic impairment raise an inherent conflict between the respect for the patient's autonomy, on the one side, and the principle of beneficence on the other. However, this age group presents particular dilemmas: (i) As any adolescent suffering from a psychiatric illness is a highly vulnerable subject, society asks for particular attention. The consequence of potential overprotection is that the adolescent may remain untreated because of unrealistic fears regarding ECT. (ii) Some of these fears are linked to the cognitive secondary effects of ECT. Although preliminary data are reassuring, more empirical research on this population should be encouraged. (iii) Cautiousness recommends the use of ECT in limited indications catatonia, mood disorders, and intractable acute psychotic disorders. We conclude that there is no ethical reason to ban the use of ECT in adolescents. Ethical options in clinical practice must be evaluated empirically with respect to the consequences for the patient. Dogmatic views should be set aside.

Cognitive side effects of electroconvulsive therapy in adolescents.

The primary aim of this study was to determine the presence of cognitive impairments among adolescents treated with electroconvulsive therapy (ECT) and whether these deficits would persist several months following the treatment. Retrospective data resulting from standard clinical care of a convenience sample with naturalistic follow-up were used. Subjects were 16 adolescents (13 females, 3 males; mean age = 15.9 +/- 1.6 years) hospitalized with a mood disorder (unipolar depression = 14, bipolar depression = 2). Cognitive tests administered prior to ECT were compared with results at 7.0 +/- 10.3 days following the last treatment and with a second testing at 8.5 +/- 4.9 months after the last treatment. Comparison of pre-ECT and the first post-ECT testing administered during the first 10 days of the treatment yielded significant impairments of concentration and attention, verbal- and visual-delayed recall, and verbal fluency. A complete recovery of these functions was noted at the second post-ECT testing. There was no deficit in the ability to problem solve during the initial or the subsequent testing. Cognitive parameters found to be impaired during the first few days of ECT recovered over several months following the treatment. Therefore, there was no evidence of long-term damage to concentration, attention, verbal and visual memory, or verbal fluency. There were no impairments of motor strength and executive processing, even during the early (within 7-10 days) post-ECT period. These results should be regarded as preliminary, awaiting confirmation with larger samples.

Electroconvulsive Therapy in Adolescents: Experience, Knowledge, and Attitudes of Recipients

To ascertain the experience, knowledge, and attitudes regarding electroconvulsive therapy (ECT) of persons who received the treatment in adolescence. A 53-item survey was administered by telephone to persons who received ECT before the age of 19 years in the Australian state of New South Wales between 1990 and 1998. Twenty-six patients were interviewed. Experiences and opinions about ECT were generally positive. Fifty percent stated ECT had been helpful. Approximately three quarters believed their illness was worse than either ECT or pharmacotherapy. Frequencies of recalled side effects with ECT and medication were similar. Some patients perceived deficiencies in the consent process. A slight majority had attempted to conceal the history of ECT treatment. The vast majority considered ECT a legitimate treatment and, if medically indicated, would have ECT again and would recommend it to others. The findings are consistent with and complement evidence showing ECT to be an effective and safe treatment for seriously ill adolescents. The mostly favorable experiences and attitudes reported by interviewees will be reassuring to adolescent patients, their families, and treating health professionals when ECT is being considered.

Practitioner Review: Electroconvulsive Therapy in Adolescents

There is increasing interest regarding electroconvulsive therapy (ECT) in young persons but limited information about its optimal use. This paper reviews the indications, effectiveness, and side effects of the treatment in the teenage population and their implications for everyday clinical practice. There is particular reference to factors influencing the clinician to recommend or advise against convulsive therapy, steps in the assessment of patients, and consent issues. Practical aspects of ECT administration are also examined, including treatment locale, anaesthesia, electrode position, stimulus characteristics, EEG monitoring, and use of psychotropics during and after the ECT course.

Practitioner Review: Electroconvulsive Therapy in Adolescents

Practitioner Review: Electroconvulsive Therapy in Adolescents

Effects of Electroconvulsive Therapy in Adolescents with Severe Endogenous Depression Resistant to Pharmacotherapy

Background: This open, prospective study examined the effects of electroconvulsive therapy (ECT) in 10 adolescents with primary, endogenous, psychotic depression who were resistant to antidepressant pharmacotherapy. Methods: Change in symptom severity from baseline was assessed weekly with Hamilton Depression Rating Scale (HDRS) ratings, and outcome was measured additionally at 1 month, and again at 1 year, post-ECT. Results: All but 1 patient demonstrated dramatic improvement, with statistically significant decreases in mean HDRS score detected after the first week of treatment. All responders maintained the benefits of their treatment. Conclusions: The results provide evidence of the clinical effectiveness of ECT in adolescents with phenomenological characteristics shown to be predictive of ECT response in adults.

Half a century of ECT use in young people.

Pharmacological treatments for certain psychiatric disorders in young people are often ineffective and may cause major side effects; thus, it is important to investigate other treatments. This article reviews the literature on the efficacy and safety of ECT in this age group and examines the evidence for the suggestion that it may be used inappropriately. All studies published in English and other languages on the use of ECT in persons 18 years of age or younger were obtained. The reports were systematically reviewed and rated according to the quality of the information in several domains, yielding an overall quality score for each study. Individual cases from each report were then examined and grouped according to diagnosis and response to ECT. Sixty reports describing ECT in 396 patients were identified; most (63%) were single case reports. The overall quality was poor but improved in the more recent studies. There were no controlled trials. Rates of improvement across studies were 63% for depression, 80% for mania, 42% for schizophrenia, and 80% for catatonia. Serious complications were very rare, whereas minor, transient side effects appeared common. ECT in the young seems similar in effectiveness and side effects to ECT in adults. However, this conclusion is qualified by the lack of systematic evidence. More research and education of professionals and the public are needed. It is suggested that ECT registers be set up, that surveys and controlled trials be conducted, and that seizure thresholds, the optimal anesthetic, effects of concurrent medications, and cognitive consequences of ECT in the young be investigated.

The Use of ECT in Adolescents: A Reply to Jones and Baldwin

In reply to Jones and Baldwin's paper, the current practice of electroconvulsive therapy (ECT) is described with a retrospective case study. Particular reference is made to: indications, consent, immediate and longer term outcome. It is argued that the treatment is beneficial, but systematic audit is necessary.