Electroconvulsive Treatment Utilization for Inpatient Management of Catatonia in Adolescents With Schizophrenia Spectrum Disorders

Abstract

ObjectiveThe aim of this study was to determine rates of electroconvulsive therapy (ECT) use for catatonia in schizophrenia spectrum disorders, stratified by patient demographics and hospital characteristics, and its impact on inpatient length of stay and cost.MethodsWe found 155 adolescents (aged 12–18 years) with principal discharge diagnosis of schizophrenia spectrum disorders with catatonia from the National Inpatient Sample. They were subgrouped into ECT (n = 20) and non-ECT (n = 135) groups. We used descriptive statistics to evaluate the utilization of ECT for catatonia and independent-sample t test for continuous variables with statistical significance at P ≤ 0.05.ResultsThe overall utilization rate of ECT in adolescents for catatonia was 12.9%. A high rate of ECT use was evident for Whites (30.8%) compared with the other race/ethnicities and also was seen in private health insurance beneficiaries (20%). The rate of ECT use varied by the region, with highest for the Northeast (20%), followed by the South (18.2%), and the West (14.3%). Adolescent inpatients with catatonia in public and teaching type, and large bed-size hospitals were more likely to receive ECT than their counterparts. The mean number of ECT sessions required during the inpatient stay was 5.2 (range, 1–15), and the mean number of days from admission to initial ECT was 2.5 (range, 0–6).ConclusionsElectroconvulsive therapy is used for approximately only 13% of adolescents with catatonia when comorbid schizophrenia spectrum disorders are present, suggesting that many patients may not get evidence-based treatment. Future studies in this area are needed.

Electroconvulsive therapy efficacy in adolescents with mental illness: A retrospective comparison

“…ECT also has a positive effect on the clinical response of adults with treatment-resistant SCZ (4). A trial determined the rates of ECT used in adolescents with catatonia in schizophrenia spectrum disorders in America, the results suggested that ECT was used for only 13% of adolescents with catatonia when comorbid schizophrenia spectrum disorders, and a high rate of ECT use was evident for Whites compared with the other race and also was seen in private health insurance beneficiaries (5). These characteristics in the utilization of ECT in adolescents were also found by Trivedi et al (6).…”

Editor's Roundup for Issue #4 of 2022

“…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 This is in line with the earlier work showing that 16% of persons with depression who failed a course of ECT eventually remitted by other means of treatment over the next 6 months.…”

“…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 .…”