Out on PubMed is this thoughtful case report about unsuccessful ECT in a patient with severe anorexia nervosa (AN):
The pdf is here.
There is a small literature about ECT for patients with eating disorders, with and without, other co-morbid psychiatric conditions. This literature was summarized last year in JECT:
Duriez P, Maatoug R, Verbe J.
J ECT. 2020 Mar 31. doi: 10.1097/YCT.0000000000000678. [Epub ahead of print] No abstract available.
There is a small literature about ECT for patients with eating disorders, with and without, other co-morbid psychiatric conditions. This literature was summarized last year in JECT:
Pacilio RM, Livingston RK, Gordon MR.
J ECT. 2019 Dec;35(4):272-278. doi: 10.1097/YCT.0000000000000599.
The pdf is here.
ECT can be life-saving for patients with AN and severe depression, and possibly for some with severe AN without clear-cut depressive illness, although diagnosis in such patients is often complex.
For the clinician faced with such patients, the usual risk-reward calculation needs to be done, and discussed with patient and family.
It should be remembered that ECT is so safe, in some selected cases it is worth taking a chance that it will help, even when optimal, traditional indications are not present.
ECT can be life-saving for patients with AN and severe depression, and possibly for some with severe AN without clear-cut depressive illness, although diagnosis in such patients is often complex.
For the clinician faced with such patients, the usual risk-reward calculation needs to be done, and discussed with patient and family.
It should be remembered that ECT is so safe, in some selected cases it is worth taking a chance that it will help, even when optimal, traditional indications are not present.
Max Fink sent in this comment:
ReplyDeleteanorexia nervosa Duriez April 8
In reading this detailed story, we are frustrated by the poor outcome. The literature supports ECT for effective relief of anorexia nervosa. So, why the failure here? Is it possible that seizures were inadequate to affect the hormonal brain systems that are the likely target of inducing seizures?
We are given the arbitrary numbers used to set the stimulus, but nothing about seizure adequacy -- motor and EEG seizure durations, typology of EEG -- that are available from the instruments and often explain "failure". It is seizure quality and resulting interseizure EEG slowing that are available criteria of treatment efficacy.
Case reports, especially those of poor outcomes, should offer evidence of seizure adequacy to help us understand a report of failure.
Max Fink