ECT in Adolescents: New Data From India
Out on PubMed, from investigators in India, is this report:
Use of Electroconvulsive Therapy in Adolescents: A Retrospective Study.
Background: This study aimed to evaluate the clinical profile of adolescents aged up to 19 years who had received electroconvulsive therapy (ECT).
Methods: A retrospective chart review was carried out to identify adolescents aged up to 19 years who had received ECT during the period 2012-2018. Details regarding their sociodemographic and clinical variables and ECT data were extracted from the records.
Results: During the study period, a total of 51 adolescents received ECT, and complete records of 50 patients were available for analysis. 4.04% (51 out of 1260) of the patients who received ECT were aged up to 19 years. There was a decreasing trend of use of ECT over the years. The most common diagnosis was schizophrenia (42%), and this was followed by bipolar disorder (22%) and unipolar depression (20%). The mean number of ECTs administered per patient was 8.84 (SD: 5.34; range: 1-21). On the various rating scales, the percentage improvement in patients with psychotic disorders was 77.4%. For patients with depression, the percentage improvement was 77.2%, and that for mania was 80.3%. The percentage improvement in organic catatonia was 64.6%. The number of patients achieving ≥50% response ranged from 87.5% to 100%, and when the response was defined as ≥75% improvement, the proportion of patients varied from 50% to 76.9%. The majority of patients with depression (72.7%) and mania (77.8%) achieved remission. Immediate complications associated with the use of ECT included acute blood pressure changes (18%).
Keywords: Effectiveness; Electroconvulsive therapy; adolescents.
An from the Discussion:
This study supports the notion that ECT is useful in adolescents with severe mental disorders and is effective in a large proportion of cases. Further, this study suggests that adolescents form a small percentage of patients receiving ECT. It can be said that there is a need to change the recommendation of MHCA-2017, and the clinicians should be allowed to decide about starting ECT timely without having to go through the review board, which can lead to delay in the beginning of the treatment.
This study should be interpreted in light of its limitations, which include the retrospective study design and small sample size. Further, the study did not include a comparison group. The side effects were not recorded systematically, and some of the side effects could have been missed or underestimated. While receiving ECT, some patients also undergo a change of medications, and hence, all the improvement seen may not be attributed to ECT alone. Future studies must attempt to overcome these limitations.
To conclude, this study suggests that ECT is safe and effective in adolescents with severe mental disorders. Accordingly, clinicians should not abandon the use of ECT in adolescents where it is required. If an indication for ECT exists, clinicians should follow the MHCA-2017 and give ECT to adolescents to improve the overall outcome.
This is a well-presented, retrospective study that adds important data to the evidence base for the effectiveness of ECT in adolescents.
It is from a tertiary care hospital in India and refers to some specifics of mental health care law in India. The higher representation of the diagnosis of schizophrenia, typical of Asian ECT cohorts, is present. The population is skewed towards the older end of adolescence (most patients were 17-19 years old, with 36% being 19).
The main take home points are the high success rates, low adverse effect rates, and the authors' call for the earlier use of ECT in severe cases.
Overall, these data are in line with the uncommon use of ECT in adolescents and the rare use in children. The obvious explanation for this is that the vast majority of psychiatric illnesses for which ECT is indicated typically do not occur until adolescence or adulthood. But when the presentation is typical, severe, and unresponsive to initial treatments, then ECT needs to be considered as part of the standard treatment armamentarium, at any age.
Kudos to these authors, for their important contribution to the ECT literature.
Comments
Post a Comment