Electroconvulsive Therapy in Children and Adolescents

311 Pages·2013·1.47 MB·English

by  Neera Ghaziuddin

Electroconvulsive Therapy in Children
and Adolescents
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Electroconvulsive
Therapy in Children
and Adolescents

Editors
Neera Ghaziuddin, MD, MRCPsych
Associate Professor of Psychiatry, University of Michigan
Garry Walter, MD, PhD
Professor of Child and Adolescent Psychiatry, University of Sydney
1
1

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Library of Congress Cataloging-in-Publication Data
Electroconvulsive therapy in children and adolescents / edited by Neera Ghaziuddin, Garry Walter.
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–19–993789–9 (alk. paper)
I. Ghaziuddin, Neera. II. Walter, Garry.
[DNLM: 1. Electroconvulsive Th erapy. 2. Adolescent. 3. Child. 4. Mental Disorders—
therapy. 5. Nervous System Diseases—therapy. WM 412]
RC485
616.89´122 —dc23
2013017118
Th is material is not intended to be, and should not be considered, a substitute for medical or
other professional advice. Treatment for the conditions described in this material is highly
dependent on the individual circumstances. And, while this material is designed to off er
accurate information with respect to the subject matter covered and to be current as of the time
it was written, research and knowledge about medical and health issues is constantly evolving
and dose schedules for medications are being revised continually, with new side eff ects
recognized and accounted for regularly. Readers must therefore always check the product
information and clinical procedures with the most up-to-date published product information
and data sheets provided by the manufacturers and the most recent codes of conduct and safety
regulation. Th e publisher and the authors make no representations or warranties to readers,
express or implied, as to the accuracy or completeness of this material. Without limiting the
foregoing, the publisher and the authors make no representations or warranties as to the
accuracy or effi cacy of the drug dosages mentioned in the material. Th e authors and the
publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk
that may be claimed or incurred as a consequence of the use and/or application of any of the
contents of this material.
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
Dedicated to young people, who should never be denied
an opportunity to overcome problems and thrive.
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CONTENTS
Foreword ix
Preface xi
About the Editors x iii
Contributors xv
1. Th e History of Pediatric ECT 1
Edward Shorter
2. Th e Mechanism of Action of ECT 18
Max Fink
3. ECT and Stigma 29
Andrew McDonald and Garry Walter
4. Ethical and Consent Aspects 56
Michael Robertson, Joseph M. Rey, and Garry Walter
5. A Practical Guide to Using ECT in Minors 7 6
Neera Ghaziuddin, Polly Gipson, and Elise Hodges
6. ECT in Youth with Comorbid Medical and Neurological
Disorders 1 04
Daniel F. Maixner
7. Anesthesia 1 24
Daniel E. Gih, Emma Taylor, and Bernard Biermann
8. Side Eff ects of ECT 140
Angèle Consoli, William de Carvalho, and David Cohen
9. ECT for Mood Disorders 161
Neera Ghaziuddin
10. ECT for Schizophrenia Spectrum Disorders 191
Yuval Bloch, Daniel Stein, and Garry Walter
11. ECT for Catatonia in Autism 217
Dirk M. Dhossche and Lee E. Wachtel
12. ECT for Self-injurious Behavior 247
Lee E. Wachtel and Dirk M. Dhossche
Index 281
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FOREWORD
Th e universe of psychiatric practice is broad and varied, including dis-
ciplines as diff erent as forensic psychiatry, sleep-medicine psychiatry,
consultation-liaison psychiatry, addictions psychiatry, geriatric psychiatry,
child and adolescent psychiatry, and electroconvulsive therapy (ECT). Th is
marvelous diff erentiation of subspecialties is both a blessing and a problem—
a blessing because of the number of career choices available to the psychiatric
trainee, a problem because of the limited cross-talk and cross-collaboration
that occur among the sub-disciplines of psychiatry.
Such is the case with the application of ECT in children and adolescents. Th e
vast majority of ECT providers come from a background of training in general
psychiatry and/or geriatric psychiatry, with almost none trained in child and
adolescent psychiatry. Similarly, very few child and adolescent psychiatrists
provide ECT, and child and adolescent psychiatry training typically does not
include a rotation on an ECT service. As a result, when a psychiatrically ill
child or adolescent comes to the attention of either an ECT provider or a child
and adolescent psychiatrist, neither practitioner is likely to have had specifi c
training in responding to the needs of the young patient being considered
for ECT. In this context, Electroconvulsive Th erapy in Children and Adolescents ,
edited by Neera Ghaziuddin and Garry Walter, off ers a most welcome, com-
prehensive compilation of all that we know about the use of ECT in minors,
which will meet the needs of key practitioners from diff erent backgrounds.
It is estimated that only 1% of all persons receiving ECT in the United
States are younger than 18 years of age. Only a fraction of that proportion is
less than 12 years of age. Th is means that a busy ECT service evaluating one or
two new patients per week might evaluate one adolescent per year (probably
less). Th is rate of accrual is too slow to allow the typical practitioner of adult
ECT to gain any signifi cant experience in child and adolescent ECT before
mid-career, or later.
As a consequence, even the experienced ECT physician can feel lost when
faced with the referral of a child or adolescent. Do the same diagnostic indica-
tions apply? For a given diagnosis, are the success rates the same as would be