Out on PubMed today are these 2 review articles from the Child and Adolescent Psychiatric Clinics of
North America. Authors include noted child psychiatrists Lee Wachtel and Neera Ghaziuddin from Johns Hopkins University and the University of Michigan, respectively:
Use of Electroconvulsive Therapy in Autism.
Park SE, Grados M, Wachtel L, Kaji S.Child Adolesc Psychiatr Clin N Am. 2020 Jul;29(3):455-465. doi: 10.1016/j.chc.2020.03.003. Epub 2020 May 5.PMID: 32471595
From the abstract:
ECT is a treatment that can safely and rapidly resolve catatonia in autism and should be considered promptly. The literature available for ECT use in youth with autism is consistently growing. Under-recognition of the catatonic syndrome and delayed diagnosis and implementation of the anticatatonic treatment paradigms, including ECT, as well as stigma and lack of knowledge of ECT remain clinical stumbling blocks.
Ghaziuddin N, Andersen L, Ghaziuddin M.Child Adolesc Psychiatr Clin N Am. 2020 Jul;29(3):443-454. doi: 10.1016/j.chc.2020.03.001.PMID: 32471594 
From the abstract:
 Benzodiazepines and electroconvulsive therapy are the only known effective treatments. Timely recognition and treatment have important outcome, and sometimes lifesaving, implications.
The recognition that ECT is helpful for children and young adults with autism complicated
by catatonia is one of the most compelling recent advances in ECT. Severe self-injurious behavior (SIB), conceptualized as a form of excited catatonia, is a specific indication that responds well to ECT and maintenance ECT.
I also recommend the below book by Amy Lutz:

Each Day I Like It Better: Autism, ECT, and the Treatment of Our Most Impaired Children

As we saw from yesterday's epidemiological article from Lucarelli and colleagues, less than 1% of ECT in the USA is administered to patients 18 years old or younger. It is very likely that more children and adolescents with severe psychiatric illnesses, including catatonia in autism, could benefit from the appropriate prescription of ECT.

Comments

Post a Comment

Popular posts from this blog

ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Image
Out on PubMed, from investigators in the US, is this study: Ketamine versus  ECT   for Nonpsychotic Treatment-Resistant Major Depression. Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Online ahead of print. PMID:  37224232 The abstract is copied below: Background:  Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. Methods:  We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression . Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 rat
Read more

RUL ECT vs Low Amplitude Seizure Therapy (LAP-ST)

Image
Out on PubMed, from the team in Augusta, Georgia, is this study: Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST). Youssef NA, McCall WV, Ravilla D, McCloud L, Rosenquist PB. Brain Sci. 2020 Dec 13;10(12):E979. doi: 10.3390/brainsci10120979. PMID:  33322138 The pdf is here . And from the Introduction : In theory, LAP-ST can be helpful because of the direct effect of lower electric current, but the principal reason is that LAP-ST has a more focal electric field (EF) [ 34 , 35 ]. The current amplitude is the primary factor that drives the EF into brain regions located deeper in the brain and is responsible for cognition and memory such as the hippocampus and temporal lobe [ 33 , 35 ]. This extra focality of the EF can minimize or avoid high EF stimulation to the deeper hippocampal and temporal lobe regions [ 33 , 35 ]. Minimization of deeper stimulation by using LAP
Read more

ECT For Children at a University Hospital: New Study in JECT

Image
 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article: Use of   ECT   for Children With and Without Catatonia: A Single-Site Retrospective Analysis. Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print. PMID:  38265759 The abstract is copied below: Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation.
Read more