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

Abstract

ObjectiveElectroconvulsive 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.MethodsWe 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.ResultsWe 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.ConclusionsThis 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.

A new technology for pacifier weaning: a thematic analysis

“…Abrams (48) stated, "ECT as a procedure is ethical", and he also stated, "that the response to ECT in children … is no different from that obtained in adults: excellent". There are studies reported the use of ECT on children for many reasons like mental issues, bad behaviours, disorders, and mood disorders (49)(50)(51)(52)(53) which confirms that an electric shock is ethically acceptable. Considering that ECT uses voltage ranging from 70 to 120 volts (32), while the current patent uses only 2-4 voltage.…”

Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia

“…It was initially used for seizure treatment in children as young as three years of age 29 . Since that time, numerous studies support the safety and efficacy of pediatric ECT for depression, psychosis, and catatonia 30-34 . Despite these encouraging findings, however, it is estimated that 0.03% of youth hospitalizations involved the administration of ECT, suggesting that it is rarely utilized for pediatric patients 35 .…”

“…29 Since that time, numerous studies support the safety and efficacy of pediatric ECT for depression, psychosis, and catatonia. [30][31][32][33][34] Despite these encouraging findings, however, it is estimated that 0.03% of youth hospitalizations involved the administration of ECT, suggesting that it is rarely utilized for pediatric patients. 35 Administration in pediatric populations is likely limited by stigma, minimal education in psychiatric training programs, provider comfort, and access.…”

Editor's Roundup for Issue #4 of 2022

“…In parallel, this issue of the journal describes recommended guidelines for the pre-ECT evaluation 2 . We also present 2 articles on the use of ECT in vey psychiatrically ill adolescents, finding that young patients respond well to ECT, 3 but those adolescents with catatonia are often not offered this effective treatment 4 . At the other end of the age spectrum, we learn that nonresponse to ECT in depressed older people may still be followed by remission to other treatments in 24.5% of cases of nonresponse over the subsequent 2 years 5 .…”