ECT and mental retardation

Use of ECT in patients with an intellectual disability: review

Aims and method

The literature on the use of electroconvulsive therapy (ECT) in patients with an intellectual disability is scarce, despite a higher prevalence of psychiatric disorders than in the general adult population. We carried out a review of articles published before March 2010. All age ranges, severity of disability and diagnoses were included.

Results

We found 72 case reports, a retrospective chart review study and other reviews, but no controlled studies. Most patients (79%) showed a positive outcome following ECT. Complications were seen only in 13% and there were no reports of cognitive decline. Many patients relapsed following ECT (32%) and the majority were maintained with medication at follow-up (71%).

Clinical implications

Electroconvulsive therapy is a valuable treatment for this patient group and should be considered earlier as opposed to as a last resort. Obstacles to its use include diagnostic difficulties, ethical and legal issues, a lack of objective measurements and uncertainty about its safety in this population.

Electroconvulsive therapy in a man with autism experiencing severe depression, catatonia, and self-injury

We report the successful use of electroconvulsive therapy in a 19-year-old man with autism and mild mental retardation who developed severe depression with repeated suicide attempts, multiple symptoms of catatonia, and life-threatening repetitive self-injurious behaviors. After 3 years of failed psychotropic and behavioral interventions in inpatient settings, the patient demonstrated excellent remission of symptoms with bilateral electroconvulsive therapy.

Electroconvulsive therapy for affective disorders in persons with mental retardation

Despite the efficacy of electroconvulsive therapy for the treatment of affective disorders there are no systematic studies of its effectiveness or safety in the mentally retarded population. A literature search revealed 16 case reports that suggests that it is both as effective and safe with mentally retarded persons as in the general population. Four additional clinical vignettes, with extensive follow-up observation from four to eleven years, are presented in an effort to enrich the literature on this subject. They include patients with rapid cycling bipolar disorder, bipolar disorder, manic phase, major depression with psychotic features and schizoaffective disorder. Issues of diagnostic difficulty and pharmacologic prophylaxis are addressed.