Hip Fracture With Unmodified ECT: Bad Practice on Display
Out on PubMed, from clinicians in Taiwan, is this case report:
Management for A Depressive Patient with Femoral Neck Fracture by Electroconvulsive Therapy during COVID-19 Pandemic: A Case Report and Literature Review.
Int J Environ Res Public Health. 2023 Feb 23;20(5):4004. doi: 10.3390/ijerph20054004.PMID: 36901014
The abstract is copied below:Electroconvulsive therapy (ECT) is an effective treatment for refractory major depressive disorder with suicidal ideation. The most common adverse medical events are transient retrograde amnesia, falls and pneumonia. Hip fractures, associated with high-energy trauma by convulsions, were occasionally reported in western countries, in the period before the COVID-19 pandemic. Strict COVID-19 regulations influenced the course and further investigation of the treatment of post-ECT complications. A 33-year-old man, previously diagnosed with major depressive disorder, had a history of nine successful sessions of ECT treatment for depression five years ago. He was hospitalized again for 12 sessions of ECT for recurrent depression. Unfortunately, an ECT-induced right hip-neck fracture was noted after the ninth session of ECT, in March 2021. After receiving close reduction and internal fixation of the right femoral neck fracture, with three screws, his original daily function was restored. His treatment was regularly followed up at the outpatient clinic for 20 months; he achieved partial remission with three combined antidepressants. This case of ECT-induced right hip-neck fracture informed psychiatric staff to be aware of this rare adverse complication and ensure its appropriate management, especially during the COVID-19 pandemic.
Keywords: COVID-19 pandemic; depression; electroconvulsive therapy; femoral neck fracture; shared decision-making.
The report is here.
I blog about this case report of unmodified ECT so that you will know to avoid reading it; yes,it is that bad. Usually I have some sympathy for under-resourced ECT services in other countries, but not here. This is poor practice at every turn, an irresponsible literature review focusing on archaic practice/side effects, and a confusingly presented report. This journal claims an impact factor ~4, which stretches credibility. Enough said!
Electroconvulsive therapy (ECT) is an effective treatment for refractory major depressive disorder with suicidal ideation. The most common adverse medical events are transient retrograde amnesia, falls and pneumonia. Hip fractures, associated with high-energy trauma by convulsions, were occasionally reported in western countries, in the period before the COVID-19 pandemic. Strict COVID-19 regulations influenced the course and further investigation of the treatment of post-ECT complications. A 33-year-old man, previously diagnosed with major depressive disorder, had a history of nine successful sessions of ECT treatment for depression five years ago. He was hospitalized again for 12 sessions of ECT for recurrent depression. Unfortunately, an ECT-induced right hip-neck fracture was noted after the ninth session of ECT, in March 2021. After receiving close reduction and internal fixation of the right femoral neck fracture, with three screws, his original daily function was restored. His treatment was regularly followed up at the outpatient clinic for 20 months; he achieved partial remission with three combined antidepressants. This case of ECT-induced right hip-neck fracture informed psychiatric staff to be aware of this rare adverse complication and ensure its appropriate management, especially during the COVID-19 pandemic.
Keywords: COVID-19 pandemic; depression; electroconvulsive therapy; femoral neck fracture; shared decision-making.
The report is here.
I blog about this case report of unmodified ECT so that you will know to avoid reading it; yes,it is that bad. Usually I have some sympathy for under-resourced ECT services in other countries, but not here. This is poor practice at every turn, an irresponsible literature review focusing on archaic practice/side effects, and a confusingly presented report. This journal claims an impact factor ~4, which stretches credibility. Enough said!
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