Maintenance ECT and Catatonia In Developmental Disability: Clinical Experience During the Pandemic, from Michigan
Out on PubMed, from authors in Michigan and Beirut, Lebanon,, is this study:
Maintenance Electroconvulsive Therapy Is an Essential Medical Treatment for Patients With Catatonia: A COVID-19 Related Experience.
Front Psychiatry. 2021 Jul 15;12:670476. doi: 10.3389/fpsyt.2021.670476. eCollection 2021.PMID: 34335326
The abstract is copied below:
Aim: Describe naturalistic clinical course over 14 weeks in a mixed adolescent and a young-adult patient group diagnosed with developmental delays and catatonia, when the frequency of maintenance electroconvulsive therapy (M-ECT) was reduced secondary to 2020 COVID-19 pandemic restrictions. Methods: Participants were diagnosed with catatonia, and were receiving care in a specialized clinic. They (n = 9), F = 5, and M = 4, ranged in age from 16 to 21 years; ECT frequency was reduced at end of March 2020 due to institutional restrictions. Two parents/caregivers elected to discontinue ECT due to concern for COVID-19 transmission. Majority (n = 8) were developmentally delayed with some degree of intellectual disability (ID). Observable symptoms were rated on a three point scale during virtual visits. Results: All cases experienced clinically significant decline. Worsening of motor symptoms (agitation, aggression, slowness, repetitive self-injury, stereotypies, speech deficits) emerged within the first 3 weeks, persisted over the 14 week observation period and were more frequent than neurovegetative symptoms (appetite, incontinence, sleep). Four participants deteriorated requiring rehospitalization, and 2 among these 4 needed a gastrostomy feeding tube. Conclusion: Moderate and severe symptoms became apparent in all 9 cases during the observation period; medication adjustments were ineffective; resuming M-ECT at each participant's baseline schedule, usually by week 7, resulted in progressive improvement in some cases but the improvement was insufficient to prevent re-hospitalization in 4 cases. In summary, rapid deterioration was noted when M-ECT was acutely reduced in the setting of COVID-19 related restrictions.
Keywords: catatonia; developmental delay; electroconvulsive therapy; maintenance ECT; maintenance electroconvulsive therapy.
The pdf is here.
And from the text:
Our findings underscore that M-ECT, as defined in the
present study, is an essential service, particularly in participants
diagnosed with catatonia, who may be particularly susceptible
to reduced frequency or to abrupt discontinuation of ECT.
The abrupt change in ECT for patients receiving M-ECT in
the setting of COVID-19, however, allowed us to observe
the resulting decline from either withdrawing or reducing MECT. Furthermore, we observed that deterioration was severe
enough to require major medical interventions such as a G-tube placement in 2 among the 9 participants for life-sustaining
reasons. While it is not possible to make generalizations based
on a relatively small group, the degree of witnessed decline was
sufficient to underscore that ECT is an essential medical service,
particularly for some diagnostic groups.
This is another excellent report of the consequences of abruptly decreasing the frequency of maintenance ECT, this time in a vulnerable, young population. The COVID pandemic led to this "experiment of nature," similarly reported from Belgium and Germany in adult populations.
Dr. Ghaziuddin (along with Lee Wachtel, Dirk Dhossche and others) has had a major role in championing the use of ECT in adolescents and young adults with developmental disorders, catatonia and self-injurious behavior.
Dan Maixner is a well-known ECT practitioner, researcher, and scholar.
Despite the small sample size, this is an important paper to have in the medical evidence base. Kudos to our colleagues in Michigan for this contribution to the maintenance ECT literature, a recommended read for all ECT practitioners (and child psychiatrists!), ~15 minutes.
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