Use Of ECT Research Articles

Promising effects of 1,8 Cineole to control Giardia lamblia infection: Targeting the inflammation, oxidative stress, and infectivity

Reportedly, synthetic drugs such as metronidazole, furazolidone, tinidazole, and quinacrine are used for the treatment of giardiasis but are associated with adverse effects. In this study, we aimed to investigate the in vitro and in vivo effects of eucalyptol (ECT, 1,8 cineole) alone and in combination with metronidazole (MNZ) on Giardia lamblia. The effects of ECT on cell viability, plasma membrane permeability, and gene expression levels of adenylate cyclase (AK) and extracellular signal kinases 1 and 2 (ERK1 and ERK2) in trophozoites of G. lamblia were assessed. In vivo, the effects of ECT alone and in combination with MNZ were assessed on mice infected with G. lamblia. In addition, the gene expression of inflammatory genes (e.g., TNF-α, IL-1β, and IL-10) and antioxidant genes (catalase (CAT), superoxide dismutase 1 (SOD1), glutathione peroxidase 2 (GPX2)) was determined by real-time PCR. The IC50 values of ECT, MNZ, and ECT+MNZ on trophozoites were 30.2 µg/mL, 21.6 µg/mL, and 8.5 µg/mL, respectively. The estimated Fractional inhibitory concentration index (FICI) values for ECT and MNZ were 0.28 and 0.39, respectively. The application of ECT on G. lamblia trophozoites resulted in a dose-dependent increase in plasma membrane permeability, particularly at concentrations of ½ IC50 and IC50 (P < 0.05). The treatment of infected mice with various doses of ECT, mainly in combination with MNZ for 7 days, resulted in a significant decrease (P < 0.001) in the average number and viability of cysts. ECT, especially when combined with MNZ, caused a significant (P < 0.001) reduction in the expression of TNF-α and IL-6 genes, and an increase (P < 0.05) in the expression of IL-10 genes. ECT alone and mainly in combination with MNZ leads to a significant (P < 0.001) increase in the gene expression of CAT, SOD, and GPX genes. These findings demonstrate that the use of ECT in these doses, even for 14 days, does not have any toxic effects on the function of vital liver and kidney tissues. The study findings confirmed the promising effects of ECT against G. lamblia infection both in vitro and in vivo. Considering the possible mechanisms, ECT increases plasma membrane permeability and reduces the expression levels of infectivity-related genes. In addition, ECT suppresses inflammation and oxidative stress, controlling giardiasis in mice. More studies are needed to clarify these findings.

Major depressive episode in the elderly. Use of maintenance ECT: a case report.

IntroductionWe present the case of an elderly patient with a severe depressive episode who, in order to maintain psychopathological stabilisation, receives ECT on an outpatient basis.ObjectivesThe objective is to briefly review the use of ECT as a maintenance treatment for severe depression in the elderly.MethodsPatient aged 76 years, multipathological, with a history of hypertension, DM and LBP. Femoral head fracture, myelodysplastic syndrome, severe osteoporosis with vertebral crushing, requiring rescue treatment with tramadol, and renal failure.She came for consultation, reporting depressive symptoms of months’ duration, together with delusions of ruin and nihilism. Despite antidepressant and stabilising treatment with duloxetine at daily doses of 120mg, extended-release quetiapine 600mg, lorazepam 2.5mg and mirtazapine 45mg, the patient began to show negative behaviour towards accepting food, clinophilic behaviour and abandonment, which led to her being admitted to the short-term hospitalisation unit.ResultsDue to the severity of the depressive symptomatology, it was decided to start ECT, administering a total of 12 sessions, which were effective, and outpatient follow-up was resumed. However, after a week, the patient again began to show marked apathy and abulia, as well as complete anorexia lasting more than 24 hours, which led to a new admission. It was then that it was decided to maintain the ECT treatment, on an outpatient basis, as maintenance treatment, together with pharmacological treatment.ConclusionsECT is indicated in severe depression, with or without psychotic symptoms, with malnutrition and organic pathology. According to studies, it has a beneficial response of more than 60%. However, the rate of receiving depressive symptomatology in a severe episode is high, despite ECT, so studies and clinical practice recommend maintenance ECT. It is usual to start with weekly sessions, and progressively space them out to maintain the minimum that guarantees stability.Disclosure of InterestNone Declared

Experiences and attitudes of UK early career psychiatrists towards electroconvulsive therapy

IntroductionElectroconvulsive therapy (ECT) is effective in treating severe major depressive disorder, manic episodes, and catatonia. Despite this, it is a controversial treatment amongst patients, carers, and even some psychiatrists in the UK.ObjectivesTo determine the experiences and perceptions of UK psychiatric trainees and early-career psychiatrists regarding the use of ECT in clinical practice.Methods An anonymous survey was distributed online to UK psychiatric trainees and early-career psychiatrists across the country. The questionnaire consisted of 36 multiple-choice and Likert scale questions.ResultsSo far, 44 trainees and early-career psychiatrists have responded. The vast majority had witnessed ECT administration during training and had administered ECT under supervision. Most respondents agreed or strongly agreed that ECT was a safe and effective treatment, and most respondents disagreed or strongly disagreed that ECT is cruel or outdated. There were more varied views regarding perceptions of side effects and contraindications: a minority of respondents were unsure about whether ECT had long-term side effects, and whilst most respondents disagreed or strongly disagreed that ECT has many risks and contraindications, just under half were unsure or agreed.Conclusions Most UK psychiatric trainees and early-career psychiatrists have experience of ECT during training and believe ECT is a safe and effective treatment. Respondents had a mixed view regarding the side-effect profile and risks/contraindications of ECT, which may be an important area for further education and training.Disclosure of InterestNone Declared

Application of Transcranial Magnetic Stimulation for the Treatment of Residual Catatonia

Catatonia is a common syndrome among psychiatric patients, diagnosed in 20-43% of cases. Treatment methods for patients with catatonia are limited to the use of benzodiazepines and ECT in the acute period, and the problem of anti-relapse and maintenance therapy remains one of the most difficult. Currently, transcranial magnetic stimulation is a promising approach in the treatment of catatonia. The purpose of the study was to evaluate the possibility of using the method of transcranial magnetic stimulation of the brain in patients with schizophrenia in remission with residual catatonic symptoms. Material and methods. 50 patients diagnosed with schizophrenia and residual catatonic symptoms were examined by clinical and psychometric methods and divided into 2 groups (therapeutic and comparison groups) to prospectively evaluate the effectiveness of transcranial magnetic stimulation for 4 weeks. Results. Transcranial magnetic stimulation of the DLPFC on the left in patients with residual catatonia TMS turned out to be effective and safe a tendency was revealed to reduce psychomotor impairments that made up the clinical picture before the start of stimulation, along with an improvement in basic cognitive functions. Conclusions. Augmentation of standard psychopharmacotherapy protocols with TMS is effective for the correction of psychomotor symptoms.

The Use of ECT in Children and Adolescents

The Use of ECT in Children and Adolescents

64.3 Barriers to ECT Use: Provider-Related Issues

64.3 Barriers to ECT Use: Provider-Related Issues

DS12 Experience of electrochemotherapy in cutaneous tumours and skin metastases within a UK specialist tertiary centre

Abstract Electrochemotherapy (ECT) has gained recognition as an effective treatment that uses electrical pulses to permeabilize cell membranes in tumours, enhancing the cytotoxicity of anticancer agents. The National Institute for Health and Care Excellence suggests use of ECT for the management of primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in selected patients after discussion within a specialist skin cancer multidisciplinary team. It also supports ECT as a palliative treatment for metastases in the skin from tumours of nonskin origin and malignant melanoma (MM). The objective of the study was to evaluate the outcomes and complications of ECT with bleomycin when used for palliative and curative intent. A retrospective cohort study of all patients who underwent ECT in a UK tertiary centre was performed between June 2016 and December 2022. Seventy-one patients (28 men and 43 women) with a total of 89 tumours were included in the study (mean age 69 years; range 29–99). Prior treatments included surgery (n = 9; 13%), immunotherapy (n = 14; 20%), radiotherapy (n = 26; 37%) and chemotherapy (n = 18; 25%). The linear array electrode was used in most cases with median sequence of 47 (range 1–500). Electrochemotherapy was used for palliative intent in 73% (n = 52) and for curative intent in 27% (n = 19). For palliation, ECT was used to treat patients with MM (n = 18/52; 35%), SCC (n = 17/52; 33%) and breast cancer metastases (n = 11/52; 21%), often in patients who had progressed despite conventional management. The most common site treated was the lower limb (n = 16/52; 31%). Twenty-two patients in this group had a good or partial response, with reduction in tumour size, and 52% had improvement in their symptoms (n = 27/52). The crude 1-year survival in this group was 83% (n = 43/52). Complications of ECT when used for palliation included pain, ulceration, tonic–clonic seizure and pneumothorax. In those where ECT was used for curative intent, the majority had ECT for BCCs (n = 12/19; 63%). The most common site treated was the head and neck. Resolution was reported in 58% (n = 11/19) and partial response in 11% (n = 2/19), while two patients underwent excision following recurrence. Complications when used for curative intent included ectropion, indented scarring, nerve palsy, ulceration, pain and webbing. In our opinion, ECT may represent a robust and efficacious treatment option particularly for smaller, lower-risk tumours which may produce improved outcomes. Electrochemotherapy may serve as an alternative to surgical intervention, particularly in patients with multiple comorbidities, and can be used for primary tumour management.

Electroconvulsive Therapy in Thrombocytopenic Patients: A Case Report and Literature Review

AbstractIntroductionElectroconvulsive therapy (ECT) continues to be one of the most effective treatments for severe and treatment-resistant major depression. Although there are no absolute contraindications to performing ECT, the risks and benefits need to be assessed in all patients. We present a patient with a history of paroxysmal nocturnal hemoglobinuria (PNH) with significant thrombocytopenia, who completed an index course of six ECT sessions without complication. Currently, there are only two published case reports which describe the use of ECT in patients with thrombocytopenia.MethodsAD is a 37-year-old female with a history significant for MDD, GAD, panic disorder, PNH, and Budd Chiari, who presented to ED for suicidal ideation. Initial labs showed pancytopenia (Hb 4.56 mg/dl, Absolute Neutrophil 0.7 x 103/mL). Given her history of multiple failed SSRIs, ECT was proposed to treat her depression. Anesthesia delayed her initial pre-operative assessment due to concerns regarding her platelet count and risk of bleeding. They recommended transfusion with a preprocedural platelet count goal of 50 x 103/mL. Psychiatry recommended a platelet goal of 20 x 103/mL given previous ECT literature. Patient underwent six ECT sessions without complications. Her platelets ranged from 24–40 x 103/mL and she did not require preprocedural platelet transfusion.ResultsDue to a lack of published literature, there are no formal guidelines for performing ECT in thrombocytopenic patients. The first case report details a 64-year-old female who underwent 12 ECT sessions without complication, while her platelet count ranged from 7–38 x 103/mL. The most recent case report describes a 74-year-old male who underwent nine ECT treatments without complications. The authors decided to transfuse prophylactically if pre-procedure platelet count was less than 20 x 103/mL. The patient underwent nine treatments, requiring eight transfusions. CT head did not show any signs of hemorrhage or structural changes. The authors remarked it is unclear whether the transfusions were necessary.ConclusionsEven though ECT has been in use for over 80 years, there is still much that is unknown about this treatment modality. This case highlights the lack of absolute contraindications to performing ECT. However, the lack of literature and studies regarding platelet goals in thrombocytopenic patients for ECT delayed patient care in this specific case. We add a third case report in a thrombocytopenic patient who underwent ECT without complications with a pre-procedure transfusion criterion if platelet count was less than 20 x 103/mL. More research needs to be conducted to determine risk and cut-off limits for platelet transfusion prior to performing ECT in thrombocytopenic patients.FundingNo funding

Non-Invasive Neuromodulation Methods to Alleviate Symptoms of Huntington's Disease: A Systematic Review of the Literature.

Huntington's disease (HD) is a progressive and debilitating neurodegenerative disease. There is growing evidence for non-invasive neuromodulation tools as therapeutic strategies in neurodegenerative diseases. This systematic review aims to investigate the effectiveness of noninvasive neuromodulation in HD-associated motor, cognitive, and behavioral symptoms. A comprehensive literature search was conducted in Ovid MEDLINE, Cochrane Central Register of Clinical Trials, Embase, and PsycINFO from inception to 13 July 2021. Case reports, case series, and clinical trials were included while screening/diagnostic tests involving non-invasive neuromodulation, review papers, experimental studies on animal models, other systematic reviews, and meta-analyses were excluded. We have identified 19 studies in the literature investigating the use of ECT, TMS, and tDCS in the treatment of HD. Quality assessments were performed using Joanna Briggs Institute's (JBI's) critical appraisal tools. Eighteen studies showed improvement of HD symptoms, but the results were very heterogeneous considering different intervention techniques and protocols, and domains of symptoms. The most noticeable improvement involved depression and psychosis after ECT protocols. The impact on cognitive and motor symptoms is more controversial. Further investigations are required to determine the therapeutic role of distinct neuromodulation techniques for HD-related symptoms.

Electroconvulsive Therapy for Neuroleptic Malignant Syndrome: A case report

IntroductionNeuroleptic malignant syndrome (NMS) is a rare syndrome observed in around 0.2% of psychiatric patients. This syndrome consists of the presentation of muscular rigidity, tachycardia, hyperpyrexia, leukocytosis and elevated levels of CPK. Any antipsychotic drug, including atypical ones, can cause this syndrome. This being an idiosyncratic response to dopamine receptor antagonist medications.The use of ECT in patients suffering from NMS is very effective, seeing the progressive resolution of the picture in the first sessions.ObjectivesThe patient was a 43-year-old man, whose somatic history only highlights hypothyroidism, and according to his psychiatric history, he was diagnosed of mental retardation and paranoid schizophrenia. He was a resident of a group home. And he was recently admitted to a mid-stay psychiatric unit. During this admission, the responsible doctor added haloperidol to his medication regimen. His other medications at the time were; valproic acid, risperidone and trazodone. A few days later, the patient began to present a dysthermic sensation (presenting a temperature of 39ºC) and drowsiness. A laboratory tests and a chest X-ray was performed, highlighting: leukocytosis and an increase in elevated creatine phosphokinase (CPK).Due to his recent exposure to 2 different antipsychotics, with fever, rigidity, and elevated CPK, we considered NMS. Antipsychotics were withdrawn and supportive measures were started. Within the next 2 days, his CPK level began to decline and the fever and leukocytosis resolved. But without resolving muscle rigidity. At the same time, he began to exhibit staring, negativism and prejudice delusions. Therefore, electroconvulsive therapy sessions were started.Methods.ResultsAfter the third session, his catatonic symptoms increased to better; he became more verbal, with less negativism and the psychotic symptomatology ceased. After the fifth session of ECT, he returned to his initial level and was able to walk to the bathroom without assistance and perform other activities of daily living.ConclusionsIt is extremely important that professionals specialized in psychiatry become familiar with ECT and consider this technique as treatment in cases of neuroleptic malignant syndrome.Disclosure of InterestNone Declared

Electroconvulsive Therapy Use in Pregnant Patients Case Report

Background: ECT has been used as an intervention for patients with treatment resistant depression, sever psychosis, catatonia, acute mania, certain types of schizophrenic syndromes, and suicidality. ECT is safe in all trimesters, whereas certain medications are only safe at certain times during pregnancy and can be associated with more severe side effects. ECT does not interfere with breastfeeding. Moreover, ECT use in pregnancy has not been shown to increase risk of labor and delivery complications or congenital anomalies, while untreated depression or pharmacotherapy for depression can do so.&#x0D; Case Presentation: We discuss three cases in which pregnant patients with psychiatric diagnoses of bipolar disorder or schizoaffective disorder receive ECT in combination with pharmacotherapy. ECT improved the symptoms of the patients in these cases, but only one of the three patients was discharged home with her baby.&#x0D; Conclusion: The women in these cases demonstrate that ECT can be a helpful treatment for psychosis and depression, especially in combination with pharmacotherapy. ECT is safe and effective for both the mother and the fetus. ECT should be considered alongside other mainstays of treatment with special consideration to possible pregnancy-related safety measures.

NICE asthma guidelines: time to re-evaluate the diagnostic value of exercise challenge testing?

NICE asthma diagnosis recommendations for the use of ECT are based on a limited number of studies that violate current ECT recommendations. Further research is therefore required to re-evaluate the diagnostic value of ECT. https://bit.ly/3iS4smw.

Underuse of recommended treatments among people living with treatment-resistant psychosis.

BackgroundInternational guidelines recommend that individuals with treatment-resistant psychosis must be treated with clozapine. ECT has also been reported to improve symptom profiles. Identification of clozapine and/or ECT use in real-world practice enables understanding of the extent to which this evidence-base is implemented.SettingStatewide public health tertiary referral service, the Tertiary Referral Service for Psychosis (TRSP), NSW, Australia.ObjectivesTo (i) describe clinical characteristics of individuals with treatment-resistant psychosis and to detail the proportion who had received a trial of clozapine or ECT at any point during their illness course; (ii) describe the characteristics of the treatment trials in both those currently on clozapine and those previously on clozapine; (iii) document reasons in relevant individuals why clozapine had never been used.MethodsAll TRSP clients who met the criteria for treatment resistance (TR) were included. A detailed casenote review was conducted to examine whether clozapine and/or ECT had ever been prescribed. Characteristics of clozapine and ECT trials were documented. Tertiary service treatment recommendations are described.FindingsThirty-six of 48 individuals had TR. They had marked clinical and functional impairment. A minority were currently receiving clozapine (n = 14/36). Most had received a clozapine trial at some point (n = 32/36). Most experienced persistent clinical symptoms while on clozapine (n = 29/32). Clozapine plasma levels were very rarely reported (4/32). Augmentation and antipsychotic polypharmacy were common among those currently on clozapine. The median clozapine trial duration was 4.0 (IQR: 3.0–20.3) months in individuals previously prescribed clozapine. Reasons for clozapine discontinuation included intolerable side effects (n = 10/18) and poor adherence (n = 7/18). One-quarter of TR individuals had trialed ECT (n = 9/36). Tertiary service recommendations included routine plasma monitoring to optimize dose among people currently on clozapine; clozapine retrial in those previously treated; and clozapine initiation for those who had never received clozapine. ECT was recommended to augment clozapine and as an alternative where clozapine trial/retrial was not feasible.ConclusionAmong people with TR referred to a tertiary service, clozapine and ECT were underutilized. Clozapine trials are typically terminated without an adequate trial. Strategies to optimize the use of clozapine therapy and ECT in clinical settings are needed to increase the therapeutic effectiveness of evidence-based therapies for treatment-resistant psychosis.

Electrochemotherapy: An Alternative Strategy for Improving Therapy in Drug-Resistant SOLID Tumors.

Simple SummaryChemotherapy is becoming an increasingly difficult antitumor therapy to practice due to the multiple mechanisms of drug resistance. To overcome the problem, it is possible to use alternative techniques, such as electrochemotherapy, which involves the simultaneous administration of the electrical pulse (electroporation) and the treatment with the drug in order to improve the effectiveness of the drug against the tumor. Electroporation has improved the efficacy of some chemotherapeutic agents, such bleomycin, cisplatin, mitomycin C, and 5-fluorouracil. The results of in vitro, veterinary, and clinical oncology studies are promising on various cancers, such as metastatic melanoma. The purpose of this review is to give an update on the state of the art of electrochemotherapy against the main solid tumors in the preclinical, clinical, and veterinary field.Electrochemotherapy (ECT) is one of the innovative strategies to overcome the multi drug resistance (MDR) that often occurs in cancer. Resistance to anticancer drugs results from a variety of factors, such as genetic or epigenetic changes, an up-regulated outflow of drugs, and various cellular and molecular mechanisms. This technology combines the administration of chemotherapy with the application of electrical pulses, with waveforms capable of increasing drug uptake in a non-toxic and well tolerated mechanical system. ECT is used as a first-line adjuvant therapy in veterinary oncology, where it improves the efficacy of many chemotherapeutic agents by increasing their uptake into cancer cells. The chemotherapeutic agents that have been enhanced by this technique are bleomycin, cisplatin, mitomycin C, and 5-fluorouracil. After their use, a better localized control of the neoplasm has been observed. In humans, the use of ECT was initially limited to local palliative therapy for cutaneous metastases of melanoma, but phase I/II studies are currently ongoing for several histotypes of cancer, with promising results. In this review, we described the preclinical and clinical use of ECT on drug-resistant solid tumors, such as head and neck squamous cell carcinoma, breast cancer, gynecological cancer and, finally, colorectal cancer.

Can electrical interventions be helpful in treating mood disorders in patients diagnosed with personality disorders? Case report and literature review.

Abstract Introduction: The main indication for electrical interventions remains mood disorders. Depressive disorders have high comorbidity, which is one factor in poorer remission and higher suicide risk. Borderline personality disorder is characterized by a variety of psychopathology, in particular the presence of mood swings, impulsive behaviour, and difficulties in maintaining stable interpersonal relationships. An extremely serious clinical problem is the occurrence of episodes of self-harm and suicidal behaviour in these patients. Comorbidity in affective disorders increases the risk of suicide and also reduces the likelihood of achieving symptomatic remission. Material and methods: A case report of a patient with a major depressive episode and suicidal tendencies with coexisting borderline personality disorder who received electrical treatments with good results is presented and literature from the last 10 years is reviewed using the keywords: borderline personality disorder, depression, electroconvulsive therapy, suicide. Results: The results of several studies indicate that electrical treatments are partially effective in patients suffering from depressive disorders and borderline personality disorder. Conclusions: The case of the patient described, as well as data from the literature, suggest that further research is needed into the use of electrical interventions in patients with mood disorders and comorbidity, and their use may be considered in them as a potentially good therapeutic method. The use of ECT in a patient with comorbid personality disorder reflects an individualized treatment approach; however, there is a need for further research in this area, especially in the context of long-term treatment effects.

ECT on a world map - a narrative review of the use of electroconvulsive therapy and its frequency in the world

Abstract Introduction: Since implementation, electroconvulsive therapy has remained very effective treatment in psychiatry. The aim of this study is to present the differences in its use in medical practice around the world. The range of diseases in which ECT is most commonly used and the frequency of its use in different countries were compared with special attention to the differences between highly and poorly developed countries. Material and method: Review of literature by searching PubMed and Google Scholar databases using the keywords: indications of ECT, frequency of ECT use for papers published from 1991 to 2021. Results: Among the diseases for which electroconvulsive therapy is used worldwide, major depression dominates, while in Asia and Africa this therapy is used in schizophrenia. In Latin America it is used primarily for schizophrenia and bipolar disorder. In Poland, it is used for depression, bipolar disorder, and fewer for schizophrenia. The highest rate of people treated with therapy per 100,000 population is found in countries such as the USA (51), Canada (23.2-25.6), Australia (37.85), Sweden (41), Finland (23), Slovakia (29.2), Estonia (27.8) and Belgium (47). Conclusions: There is a relationship between the range of diseases most frequently treated with ECT, the frequency of use and the level of country development. In the high developed countries, ECT is used mainly in major depression, in less developed countries more frequent treatment of schizophrenia may be determined by the high cost of medications and limited availability of hospital beds. The highest rates of use of this therapy are found in more developed countries.

Something inside my head

IntroductionElectroconvulsive therapy (ECT) is a medical treatment for those patients with high suicide risk or refractory psychiatric disorders. It is currently a safe technique, and its effectiveness has been widely demonstrated.ObjectivesPresentation of a clinical case about a patient with drug-resistant delusional disorder and high suicide risk, who eventually received ECT treatment.MethodsBibliographic review including the latest articles in Pubmed about ECT procedure, effects and use.ResultsWe present a 45-year-old man, who visited different doctors several times by reporting he had the feeling of “having a brain tumor or a vascular disorder”, so he requested imaging tests (computed tomography and magnetic resonance). These tests were absolutely normal, but he kept thinking something was wrong, and eventually attempted suicide by hanging (his family founded him before it was too late). The patient was admitted to hospital, and started psychopharmacological treatment, with minimal response. He desperately insisted that he had “something inside his head”. At this point, it was proposed to start ECT, and the patient accepted. After 6 bilateral ECT sessions, he was visibly more relaxed and less worried, and he no longer presented autolytic ideation. He was still a little bit suspicious about the feeling of having a neurological disease. Currently, the patient runs a follow-up consultation.ConclusionsElectroconvulsive therapy is a safe and effective technique for those patients with high suicide risk. It may be useful to perform imaging tests in certain cases, for detecting intracranial pressure, acute hemorrhage, tumors… A follow-up of these patients must be performedDisclosureNo significant relationships.

Symposium

ECT is an important type of biological treatment in psychiatry that remains highly efficacious in the treatment of various disorders like severe depression, treatment-resistant depression, mania, acute schizophrenia, and catatonia and is even considered safe for the treatment of severe depression and bipolar disorder in women with pregnancy if all precautions are taken. It can even be life-saving in certain conditions. Due to various reasons, ECT became a subject of scrutiny from judicial quarters and human rights activists. Violent convulsions induced in unmodified ECT were also responsible for the distorted depiction of ECT in mass media. WHO, in its publication, “Resource Book on Mental Health, Human Rights, and Legislation” (2005) mentions the controversy regarding its very usefulness. The book also states that there is no indication of ECT in minors and categorically recommends stoppage of the use of the unmodified ECT and ECT to minors through legislation. The Mental Healthcare Act, 2017 (MHCA, 2017) was enacted recently in which provisions regarding the ECT are largely based on the WHO recommendations, though the ECT to minors is not outrightly prohibited with restrictions that have been imposed on its use in minors. Regardless of the fact of negative depiction in the media as well as in society, the place of ECT in psychiatric practice cannot be denied. In this symposium, we shall discuss various aspects of ECT including its present status in our country. Subtopics and speakers are as follows. Practice of ECT in Psychiatry: Clinical Facts and Changing Trends – Dr. Rajesh Kumar, Professor and HOD of Psychiatry, IGIMS, PatnaECT and Human Rights: Global Law/ Statutes and its Implications – Dr. Pankaj Kumar, Additional Professor of HOD, AIIMS, Patna.Current Status of ECT in India – Post MHCA, 2017. – Dr. C.L. Narayan, Ex-Professor of Psychiatry, AN Magadh Medical College, GAYA, BIHAR

How Do People Perceive and Adapt to Any Consequences of Electro Convulsive Therapy on Their Daily Lives?

Great controversy surrounds the use of electroconvulsive therapy or ECT. However, it continues to be used internationally. While research on short term effects of ECT abound, there is limited knowledge about long term impacts of ECT on individuals, especially from the lived experience perspective. The aim of this qualitative study was to gain an in-depth understanding of longer-term lived experiences of ECT and how people navigate any impacts on their daily lives. Twenty-three people participated in semi-structured interviews. Data collection and analysis involved an iterative process. Data were coded into four categories: (1) My ECT experience included physical mechanics, decision making, clinic experiences, post ECT support and attitudes and support of others); (2) Direct impacts of ECT on me encompassed both cognitive and emotional impacts; (3) Impacts on my life comprised daily activities, relationships, ongoing health care; and My strategies incorporated fixing or working around the problem, reframing, using support networks, protecting myself and taking control. Insights gleaned through lived experiences have important implications for other service users, direct service providers and those striving for system reforms that embrace more recovery orientated and trauma informed practices.

8.4 OUTCOMES OF YOUTH TREATED WITH ECT

The use of ECT in children and adolescents is based on a limited evidence base in the medical literature. Our objective is to review the available evidence for the safety and efficacy of ECT in pediatric patients with refractory mental health disorders. In this session, we review the available high-quality literature of ECT use in pediatric patients. We emphasize a recent study of youth treated with ECT at a single US academic medical center. Using a retrospective chart review, clinical outcomes from all patients aged 18 years and younger who received ECT at the University of Utah from 1985 through 2016 were assessed. For each patient record, 3 short-term clinical outcomes were evaluated: 1) response on the Clinical Global Impression-Improvement (CGI-I) scale; 2) number of treatments administered; and 3) reported side effects. Baseline characteristics were tested as predictors of clinical outcomes. A total of 107 youth (ages 10-18 years; 46% female) received ECT for a mood disorder, psychotic disorder, catatonia, or neuroleptic malignant syndrome. Mood disorders represented the most common diagnoses (DSM-IV-TR or DSM-5), including MDD (76 patients, 71% of the sample) and bipolar disorder (23 patients, 21% of the sample). The rate of response (much improved or very much improved) for the entire cohort was 77%. The mean number of treatments administered was 10.5. The most commonly reported side effects were headache (75%) and memory problems (65%). Although one patient experienced tardive seizures, there were no deaths or serious injuries. Clinical response was not predicted by age, sex, or clinical features. These data suggest that ECT is a safe and effective treatment for children and adolescents with certain severe mental illnesses. ECT outcomes and side effects were similar to those reported in adults, particularly for patients aged 15 to 18 years, for whom there are the most data. Despite its utility, ECT continues to suffer from considerable stigma, and access to ECT for pediatric patients is often challenging. Important areas for future development include increased dissemination of ECT outcomes, examination of predictors of treatment response in larger cohorts, and public advocacy to improve timely and equitable access to care for pediatric patients in need.