Electroconvulsive therapy in adolescents with mood disorder: patients' and parents' attitudes

The differential effects of psychiatrists' and patients' prior experiences on views about psychiatric electroceutical interventions

The aim of this study is to examine ways in which prior experiences and familiarity with psychiatric electroceutical interventions (PEI) shape psychiatrists' and patients' views about these interventions. We administered a national survey, with an embedded experiment, to psychiatrists (n = 505) and adults diagnosed with depression (n = 1050). We randomly assigned respondents to one of 8 conditions using a full factorial experimental design: 4 PEI modalities [ECT, rTMS, DBS, or adaptive brain implants (ABIs)] by 2 depression severity levels [moderate or severe]. We analyzed the survey data with ANOVA and OLS linear regression models. Patients having experience with any PEI reported more positive affect toward, but also greater perceived risk from, their assigned PEI than did patients with no such experience. Psychiatrists who referred or administered any PEI reported more positive affect toward and greater perceived influence on self and perceived benefit from their assigned PEI than did psychiatrists with no such familiarity. Limitations of our study include that our participants were randomly assigned to a PEI, not necessarily to the one they had experience with. Moreover, our study did not directly ask about the kind of experiences participants had with a given PEI. Overall, our survey data shows that greater experience with PEIs elicits more positive affect in both stakeholder groups. Beyond this, prior PEI experience shapes attitudes towards these interventions in complex ways. Further research linking different types of experience with a given PEI would help better understand factors shaping attitudes about specific PEIs.

The influence of prior awareness on views about psychiatric electroceutical interventions among non-clinician stakeholders

Psychiatric electroceutical interventions (PEIs) are emerging interventions in the treatment of depression and other mood disorders. The uptake of PEIs is strongly influenced by public, caregiver, and patient views. This study examines the influence of prior awareness and of trust in the medico-scientific establishment with respect to non-clinicians' views on PEI among a cohort of U.S. respondents. About 3098 U.S. caregivers, patients, and members of the general public completed an online survey with an embedded experiment to evaluate PEI views by stakeholder, modality, and disease severity. ANOVA statistical tests and logistic regression models were used to identify significant differences between groups and moderating factors. Overall, respondents had greater awareness of antidepressant medication (73-84%) and psychotherapy (68-76%) than of any PEI, and ECT garnered the most prior awareness (29-40%) within each group. Non-clinical respondents most often used websites or social media as information sources, and the least trusted sources included those with notable financial interests. Considering the low awareness level among non-clinicians, the implementation of programs to target and advance awareness levels about the use of PEIs in depression among this population may contribute to reducing negative views around these interventions. Fostering trust in the medico-scientific establishment may also increase public support for PEIs as well as uptake of these treatment modalities.

Views about neuromodulation interventions for depression by stakeholder group, treatment modality, and depression severity

BACKGROUND

The past few decades have seen the emergence both of new neuromodulation treatment protocols and novel applications of standard neuromodulation interventions in psychiatry. Yet little is known about different stakeholders' views about these interventions.

METHODS

We administered an online survey with an embedded video vignette experiment to four national samples: the general public (N = 1022), caregivers for people with depression (N = 1026), patients living with depression (N = 1050), and board-certified psychiatrists (N = 505). We randomly assigned subjects to one of eight conditions in our full factorial design: four neuromodulation interventions [electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, or adaptive brain implants] by two depression severity levels [moderate or severe]. In this paper we present results from ANOVA and linear regression models explaining how views about these four neuromodulation interventions-as measured in five attitudinal scales (general affect, perceived influence on self, perceived benefit, perceived risk, and perceived invasiveness)-vary by (1) intervention, (2) depression severity, and/or (3) stakeholder group.

RESULTS

Our results provide evidence that psychiatrists views differ significantly in important ways from other stakeholder groups. Type of intervention also shaped participants' attitudes, including perceptions of invasiveness, effectiveness, and safety.

CONCLUSIONS

Given the differing affective valence among stakeholders and the differences found by modality and stakeholder groups across the different scales, future targeted educational initiatives could be developed to help address key misunderstandings and misinformed perceptions.

Beyond the Cuckoo's Nest: Patient and Public Attitudes about Psychiatric Electroceutical Interventions

Recent research emphasizes the role of psychiatric electroceutical interventions (PEIs), bioelectronic treatments that employ electrical stimulation to affect and modify brain function, to effectively treat psychiatric disorders. We sought to examine attitudes about three PEIs-electroconvulsive therapy, transcranial magnetic stimulation, and deep brain stimulation-among patients with depression and members of the general public. As part of a larger study to assess different stakeholders' attitudes about PEIs, we conducted semi-structured key informant interviews with 16 individuals living with depression and 16 non-depressive members of the general public. We used a purposive sampling approach to recruit potential participants based on eligibility criteria. We performed qualitative content analysis of interview transcripts. Participants from both groups expressed an overall cautionary attitude towards PEIs, yet there were mixed attitudes in both groups. Patients commonly described electroconvulsive therapy as scary, traumatic, or intense, while members of the general public often referenced the treatment's negative portrayal in One Flew over the Cuckoo's Nest. Patients and the general public saw transcranial magnetic stimulation as a potentially viable option, but in most cases only if medication was not effective. Deep brain stimulation attitudes were predominantly negative among patients and cautionary among public. The overall cautionary attitudes towards PEIs, together with the technological features and social aspects underlying those attitudes, highlight the need for unbiased education to fill the gaps in knowledge and inform perceptions of those who may benefit from these treatments.

A systematic review of therapeutic ketamine use in children and adolescents with treatment-resistant mood disorders

Suicide is the second leading cause of death in the United States among individuals aged 10-24, and severe youth depression is often refractory to the current standards of care. Many studies have demonstrated the efficacy of ketamine in reducing depressive symptoms in adults with treatment-resistant mood disorders, though few studies utilizing ketamine in youth populations exist. This systematic review examines the current state of evidence for ketamine use in children with treatment-resistant mood disorders. We conducted a search utilizing two electronic databases for English-language studies investigating the therapeutic effects and side effect profile of ketamine in youth ≤ 19 years of age with a diagnosis of a treatment-resistant mood disorder. Analysis included subjects with treatment-resistant depression with and without psychotic features and with bipolar disorder. Primary outcome measures included the following scales: Montgomery-Asberg Depression Rating Scale, Children's Depression Rating Scale, Children's Depression Rating Scale Revised, Child Bipolar Questionnaire, Overt Aggression Scale, Yale-Brown Obsessive-Compulsive Scale, and Scale for Suicidal Ideation. Four published studies were identified that investigated therapeutic ketamine use in youth for the primary purpose of treating a treatment-resistant psychiatric disorder. Three additional studies that did not meet eligibility criteria were identified and discussed. Ketamine was shown in youth to generally improve depressive symptoms, decrease acute suicidality, and reduce mood lability, though a number of subjects remained resistant to its treatment. These findings substantiate the need for further longitudinal studies investigating ketamine's long-term safety, its efficacy, and abuse potential in the youth.

The Incidence of Post-Electroconvulsive Therapy Headache: A Systematic Review

Headache is a common side effect of electroconvulsive therapy (ECT), but reports on its incidence vary widely. A broad array of treatment regimens have been proposed in the literature. The pathophysiology of post-ECT headache is unclear but a vascular origin has been suggested. A systematic literature search was executed in PubMed and Embase to identify relevant articles. Articles were screened on title, abstract, and full text according to predefined inclusion and exclusion criteria. Study characteristics and results concerning the incidence of post-ECT headache were extracted, and a weighted mean incidence was calculated. Forty-seven relevant articles were found, of which 36 reported on the incidence of post-ECT headache in patients and 9 on the incidence in sessions. The incidence of post-ECT headache varied greatly in the literature. The weighted mean incidence in patients was 32.8%, as 786 of a total population of 2399 patients experienced headache. The weighted mean incidence in sessions was between 9.4% (246 of 2604 sessions) and 12.1% (236/1958 sessions). The variation in incidences of post-ECT headache found might be due to different methods of measuring headache, different study designs, and different drugs used for anesthesia. The mean-weighted incidence of post-ECT headache in patients was 32.8% and in sessions between 9.4% and 12.1%.

Use of electroconvulsive therapy in adolescents with schizophrenia in China

BACKGROUND

Electroconvulsive therapy (ECT) is an effective treatment for psychiatric disorders such as schizophrenia, major depression and bipolar disorder. However, few studies have addressed the use of ECT in adolescents with schizophrenia. The aims of our study were to investigate the frequency of ECT, and its relationship with clinical and demographic correlates among adolescents with schizophrenia in China.

METHODS

The study was a retrospective study and conducted in the Child and Adolescent Psychiatry Department of Beijing Anding Hospital, and adolescents with schizophrenia over a period of 10 years (2007-2016) were enrolled. The demographic and clinical data were collected from the electronic chart management system.

RESULTS

A total of 835 patients were included, 411/835 (49.2%) of the adolescent inpatients diagnosed with schizophrenia were in ECT group. There were significant differences in the sex, age, high risk for aggression and suicide, family history of psychiatric disorders and concomitant psychotropic medication (antidepressants and benzodiazepines) between the ECT and non-ECT groups. Multiple logistic regression analysis revealed that ECT use was independently and positively associated with sex, high risk for suicide.

CONCLUSIONS

In a major psychiatric center in China, the use of ECT was common, and reasons for the high use of ECT for adolescent patients in this hospital should warrant urgent investigations.

A Follow-up Study of Electroconvulsive Therapy in Children and Adolescents

OBJECTIVES

Electroconvulsive therapy (ECT) is an effective and a safe treatment for several severe psychiatric disorders across the age span. However, its use remains controversial and highly stigmatized especially among patients under 18 years. In this study, we examined current symptoms, attitudes, perception, and functioning of patients treated with ECT when they were less than 18 years old.

METHODS

Participants had received ECT before age 18, between 1989 and 2015, at a tertiary medical center. Institutional review board-approval was obtained, and study documents (cover letter, consent, self-ratings scales for depression, anxiety, global functioning, and suicidality) were mailed.

RESULTS

Based on self-rated depression, 59.1% (13/22) participants indicated mild or no depression; 65% (13/20) reported mild or no anxiety; the majority, 84.3% (16/19) perceived ECT as having improved their overall illness; and 27.3% (6/22) among the respondents reported no clinical impairment on a global functioning scale, whereas 72.7% (16/22) reported significant or severe impairment. Despite reports of ongoing impaired global functioning among some participants, adequate academic performance (83.3%, 5/6) and mild or no suicidality (78.3%, 18/23) were endorsed by the majority reported.

CONCLUSIONS

The majority of participants who had received ECT before age 18 years reported mild or absence of depression and anxiety on self-rated follow-up measures after treatment with ECT. Most notably, the majority reported absence of suicidality and adequate academic performance. A number of respondents, however, continued to endorse global impairment, which may be a reflection of their baseline severe illness, which had warranted treatment with ECT.

The Differential Diagnosis and Treatment of Catatonia in Children and Adolescents

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Assess the etiologies associated with catatonia in children and adolescents• Evaluate the differential diagnosis of pediatric catatonia• Interpret the literature regarding the treatment of children and adolescents with catatonia OBJECTIVE: Pediatric catatonia is associated with many medical and psychiatric conditions. Mortality is high, and proper treatment can be lifesaving. Catatonia is increasingly recognized in pediatric populations, in which about 20% of cases are related to underlying medical conditions. To minimize morbidity, clinicians must rule out underlying disorders while simultaneously managing symptoms and causes. In our review we discuss (1) recommendations to aid rapid decision making, both diagnostic and therapeutic, (2) emergent conditions and management, (3) disorders associated with pediatric catatonia, including developmental, acquired, idiopathic, and iatrogenic etiologies, (4) available treatments, and (5) medicolegal considerations.

METHODS

Initial PubMed search without date constraints using MeSH terms related to pediatric catatonia, with subsequent searches on pertinent subtopics using PubMed and Google Scholar.

RESULTS

Pediatric catatonia is a dangerous but treatable neuropsychiatric condition. Psychiatrists need to be aware of differential diagnoses and to be able determine appropriate treatment within a short time frame. With prompt diagnosis and treatment, outcomes can be optimized.

CONCLUSION

Pediatric catatonia is underdiagnosed and requires rapid evaluation and management.

ECT-Related Anxiety: A Systematic Review

BACKGROUND

A significant proportion of electroconvulsive therapy (ECT)-treated patients experience anxiety anticipating the treatment, often to such an extent that they refuse or discontinue a much-needed treatment. Despite its great impact on treatment adherence, anxiety in patients receiving ECT is underexposed in the scientific literature.

OBJECTIVES

We aimed to review the prevalence and specific subjects of ECT-related anxiety and therapeutic interventions to reduce it.

METHODS

We performed a computerized search (EMBASE, MEDLINE, and PsycINFO) for articles meeting the following inclusion criteria: (1) qualitative (interview) studies, quantitative (questionnaire) studies, or experimental (interventional) studies that (2) report on anxiety that is related to a planned, ongoing, or past ECT treatment.

RESULTS

Of 1160 search results, 31 articles were included. Electroconvulsive therapy-related anxiety is estimated to be present in 14% to 75% of patients and is most often linked to worries about memory impairment or brain damage. Only a few interventions (chlorpromazine, meprobamate, propofol, a talking-through technique, an information leaflet, and animal-assisted therapy) have been proposed to reduce patients' ECT-related anxiety.

CONCLUSIONS

Electroconvulsive therapy-related anxiety is a highly prevalent phenomenon, and the literature provides little guidance for its clinical management. Most studies are of a low methodological quality and suffer from significant limitations, thereby hampering generalized conclusions. Given the clinical importance of ECT-related anxiety, further study on its nature and evolution through the course of treatment and on anxiety-reducing interventions is warranted.

Thinking About Electroconvulsive Therapy: The Opinions of Parents of Adolescents with Schizophrenia Spectrum Disorders

OBJECTIVE

To assess the experience with, knowledge of, and attitudes toward electroconvulsive therapy (ECT) among parents of adolescents with schizophrenia spectrum disorders (SSD) who have received ECT.

METHODS

A self-administered questionnaire was used to assess the experience with, knowledge of, and attitudes toward ECT in a sample of parents of adolescents diagnosed with SSD. Parents of adolescents treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of parents of adolescents treated only with antipsychotics (No ECT group; n = 20).

RESULTS

Most parents in the ECT group claimed that they had received adequate information about the ECT procedure (94.7%), most of them thought it had been helpful for their children (73.7%) and none thought that it had made things worse. The large majority of parents in the ECT group (80%) thought that the illness had been worse than ECT or medication, and none thought that ECT was the worst. Parents in the ECT group generally had better knowledge of what ECT is and its indications. All the parents in the ECT group (100%) and almost all of those in the No ECT group (94.7%) would agree to the treatment for their children if recommended in the future by a doctor, there being no differences between the groups in this respect (p = 0.447). Most parents in the ECT group (88.9%) thought it was a legitimate treatment when used appropriately, an opinion that was held by a much smaller proportion of parents in the No ECT group (52.6%), although the remaining parents in that group were unsure about it (47.4%).

CONCLUSIONS

Most parents of adolescents with SSD treated with ECT had positive views about the treatment. Parents of adolescents treated only with antipsychotics tended either to have positive views about ECT or claimed to have no knowledge about it, with negative views being uncommon.

Knowledge and Attitudes of Patients and Their Relatives Toward Electroconvulsive Therapy in China

PURPOSE

To examine the knowledge and attitudes of patients and their relatives as well as patients' subjective experience with electroconvulsive therapy (ECT) in China.

DESIGN AND METHODS

Up to 420 responders including patients receiving ECT (n = 210) and their relatives (n = 210) were assessed with self-reported questionnaires.

FINDINGS

Patients and their relatives did not receive adequate information before ECT, particularly about the mode of its delivery, risks, and adverse effects. The most common adverse effect of ECT reported by patients was memory impairment. Both patients and their relatives had positive attitudes toward ECT and appeared satisfied with its therapeutic effects.

PRACTICE IMPLICATIONS

Mental health professionals need to address the inadequate information on ECT provided to patients and their relatives prior to the treatment.

Patients' Opinions About Electroconvulsive Therapy: What Do Adolescents with Schizophrenia Spectrum Disorders Think?

OBJECTIVE

The purpose of this study was to assess, in patients with schizophrenia spectrum disorders (SSD) who received electroconvulsive therapy (ECT) prior to the age of 18, their experience, knowledge, and attitudes toward ECT, and to compare the findings with those obtained in adolescents treated only with antipsychotics.

METHODS

Patients diagnosed with SSD (n = 19) and treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of patients with SSD treated only with antipsychotics (non-ECT group, n = 21). A self-administered questionnaire was used to assess their experience, knowledge, and attitudes.

RESULTS

Most adolescents in the ECT group thought that the intervention had been helpful (78.9%) and believed that their illness had been worse than ECT or medication (68.4%). Similarly, almost three quarters of these patients did not believe the treatment to be cruel (73.7%) or outdated (73.7%), or that it should be illegal (68.4%). Patients in the non-ECT group often chose "don't know" as their response to the survey questions, and significant differences between the groups were observed. Most patients in both the ECT group (84.2%) and the non-ECT group (80%) said that they would accept the treatment in the future if necessary, there being no differences between the groups in this respect (p = 0.2).

CONCLUSIONS

Most adolescents in the ECT group had positive views about ECT. By contrast, most adolescents in the non-ECT group either did not know or did not have a clear opinion regarding ECT treatment, although they did not have negative views about it.

Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia

We aimed to (1) describe the treatment used in a large sample of young inpatients with catatonia, (2) determine which factors were associated with improvement and (3) benzodiazepine (BZD) efficacy. From 1993 to 2011, 66 patients between the ages of 9 and 19 years were consecutively hospitalized for a catatonic syndrome. We prospectively collected sociodemographic, clinical and treatment data. In total, 51 (77%) patients underwent a BZD trial. BZDs were effective in 33 (65%) patients, who were associated with significantly fewer severe adverse events (p = 0.013) and resulted in fewer referrals for electroconvulsive therapy (ECT) (p = 0.037). Other treatments included ECT (N = 12, 18%); antipsychotic medications, mostly in combination; and treatment of an underlying medical condition, when possible. For 10 patients, four different trials were needed to achieve clinical improvement. When all treatments were combined, there was a better clinical response in acute-onset catatonia (p = 0.032). In contrast, the response was lower in boys (p = 0.044) and when posturing (p = 0.04) and mannerisms (p = 0.008) were present as catatonic symptoms. The treatment response was independent of the underlying psychiatric or systemic medical condition. As in adults, BZDs should be the first-line symptomatic treatment for catatonia in young patients, and ECT should be a second option. Additionally, the absence of an association between the response to treatment and the underlying psychiatric condition suggests that catatonia should be considered as a syndrome.

Knowledge and Attitude of Patients with Psychiatric Disorders and their Relatives Toward Electroconvulsive Therapy

OBJECTIVE

Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives.

MATERIALS AND METHODS

Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives.

RESULTS

Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73).

CONCLUSIONS

Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment.

Electroconvulsive therapy improves antipsychotic and somnographic responses in adolescents with first-episode psychosis--a case-control study

OBJECTIVE

Previous studies have demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis.

METHOD

This case-control study was conducted in inpatients aged 13-20 years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated.

RESULTS

Between March 2004 and November 2009, 112 eligible patients were allocated to control (n=38) and ECT (n=74) group. Additional ECT treatment significantly reduced hospital stay compared to controls (23.2±8.2 days versus 27.3±9.3 days, mean±SD, P=0.018). Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR)=1.961, P=0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls.

CONCLUSIONS

ECT is an effective and safe intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be considered as an early psychosis intervention.

Does the experience of electroconvulsive therapy improve awareness and perceptions of treatment among relatives of patients?

OBJECTIVE

Evidence suggests that the actual experience of electroconvulsive therapy (ECT) has a positive impact on perceptions regarding the treatment among patients and their relatives. This assumption was tested by comparing relatives of patients treated with ECT with those of patients treated by other means.

DESIGN

Knowledge about and attitudes toward ECT were assessed using specifically designed questionnaires among 206 relatives of patients who were undergoing psychiatric treatment but had never received ECT (non-ECT group). The results were compared with those obtained among 77 relatives of patients who had undergone the treatment (ECT-treated group).

RESULTS

The relatives of the ECT-treated group were more likely to have acquired their information about ECT from physicians, whereas relatives of the non-ECT group usually relied on the media for this purpose. The relatives who obtained their information from physicians were more aware and more positive about ECT than those who obtained their information from the media. Knowledge about ECT was greater among relatives of the ECT-treated group than those of the non-ECT group. The relatives of the ECT recipients had significantly more positive attitudes toward the treatment, whereas the relatives of the non-ECT group were more often either ambivalent about ECT or critical of the treatment.

CONCLUSIONS

Although the groups differed on certain clinical and demographic variables, these differences were unlikely to have influenced the results significantly. Thus, it was possible to conclude that sharing the experience of ECT with the patient had a significant and positive impact on the relative's knowledge and attitudes concerning the treatment.

Electroconvulsive therapy in adolescents with the catatonia syndrome: efficacy and ethics

OBJECTIVES

In child and adolescent psychiatry, catatonia is infrequent, but it is one of the most severe syndromes, characterized by the coexistence of psychic and motor symptoms. In this report, we explore the therapeutic experience with electroconvulsive therapy (ECT) in adolescents with catatonia.

METHODS

We review the literature (1985-2009) to clarify issues related to the use of ECT in child and adolescent patients with catatonia.

RESULTS

Electroconvulsive therapy is used as second-line management after high-dose benzodiazepine trials. Electroconvulsive therapy is an effective, safe, and useful procedure in the treatment of catatonic youngsters as reported in 59 patients. Ethical issues regarding the use of ECT are analyzed and their implications briefly discussed in the light of general medical ethics.

CONCLUSIONS

Electroconvulsive therapy is a safe and effective treatment for catatonia in children and adolescents.

Perceptions and awareness of electroconvulsive therapy among patients and their families: a review of the research from developing countries

OBJECTIVES

Although electroconvulsive therapy (ECT) is used frequently in many developing countries, investigations of patients' awareness and perceptions of the treatment are rare. This review attempted to pool the research evidence in this area from developing countries.

METHODS

Electronic searches of databases using relevant keywords were supplemented by extensive manual checking of cross-references and other sources.

RESULTS

Sixteen such reports were found suitable for inclusion. The limited data showed that patients were usually poorly informed about ECT, which was partly attributable to unsatisfactory pretreatment explanations received by approximately two thirds of the recipients. About a third also reported deficiencies in the process of consent, including a sense of coercion. Fear of ECT was reported by a significant percentage (36%-75%). Distressing adverse effects were frequent; memory impairment (25%-95%) being the most common one. Despite these problems, most studies found that most patients perceived ECT to be helpful and had positive views about it. Simultaneously, a sizeable percentage (10%-32%) was quite critical of ECT. In contrast, relatives of patients were invariably better aware, more satisfied with the experience, and had more favorable attitudes toward ECT.

CONCLUSIONS

Overall, the weight of the evidence supported the notion that patients undergoing ECT and their relatives are well disposed towards it. However, the lacunae in treatment highlighted by this review and extreme variations in practice of ECT suggest that much more needs to be done to improve the practice of ECT in developing countries, to enhance patients' and relatives' satisfaction with the treatment.

Electroconvulsive therapy: a review of knowledge, experience and attitudes of patients concerning the treatment

OBJECTIVES

Despite its proven efficacy and safety, electroconvulsive therapy (ECT) has a negative image and attracts widespread public criticism. In contrast, perceptions of patients who have received ECT appear to be more favourable. This review intended to encapsulate the evidence on knowledge and views concerning ECT among its recipients.

METHODS

Extensive electronic and manual searches were conducted to identify all relevant studies on the subject.

RESULTS

Seventy-five reports were found suitable. The evidence from these studies suggested that patients undergoing ECT were usually poorly informed about it. This was attributable to factors such as unsatisfactory pre-treatment explanations or post-ECT memory impairment. About one-third undergoing ECT reported feeling coerced to have the treatment. Fear of ECT and distressing side effects were also present in a majority. Despite these problems, a vast majority of patients perceived ECT to be helpful and had positive views regarding the treatment. Simultaneously, a sizeable proportion was quite critical, although little was known about the extent and nature of such disapproval.

CONCLUSIONS

Overall, the weight of the evidence supports the notion that patients undergoing ECT are well-disposed towards it. However, much needs to be done to improve the practice of ECT and to enhance patients' satisfaction with the experience of treatment.

Clinical outcomes and quality of life in patients submitted to electroconvulsive therapy

OBJECTIVES

The aims of this study were to evaluate the effect of electroconvulsive therapy (ECT) on clinical and quality of life improvement in patients hospitalized at the Hospital de Clínicas de Porto Alegre and to compare psychopathology measures between the patient's and the physician's perspectives.

METHODS

In a longitudinal and observational study, 58 patients who submitted to ECT were assessed for clinical symptoms and quality of life before and 24 hours after treatment. Symptoms were assessed using the Behavior and Symptom Identification Scale 32 (BASIS-32), Brief Psychiatry Rating Scale--Anchored (BPRS-A), and Clinical Global Impression (CGI). Quality of life was assessed using the World Health Organization Quality of Life--Bref (WHOQOL-BREF) assessment.

RESULTS

Of 58 patients assessed, 25 (43.1%) had major depression and 23 (39.7%) had bipolar disorder. Electroconvulsive therapy was indicated because of resistant depression in 47 patients (81.1%). There was a significant difference (P < 0.001) between the periods before and after ECT in BASIS-32, BPRS-A, and CGI scores and in all WHOQOL domains, with greater difference in physical and psychological domains than in social relationships and environment. Size effects of BASIS-32 and BPRS scales were similar.

CONCLUSION

Electroconvulsive therapy is associated with improvement in symptoms and in quality of life of patients with psychiatric disorders, which could be seen in measurements assessed by physicians (BPRS and CGI) and by patients (WHOQOL and BASIS-32). There was similarity between the patient's and the physician's perspectives.

Moderate clinical improvement with maintenance ECT in a 17-year-old boy with intractable catatonic schizophrenia

The use of electro-convulsive therapy (ECT) in adolescents is controversial, and few studies have been conducted to assess its efficacy and safety in this population. We report the case of a 19-year-old boy who received two series of ECT, one at 15 and another at 16, for intractable catatonic schizophrenia. Since the age of 17, he has required treatment combining clozapine and maintenance ECT. The course showed a sustained moderate improvement. The treatment permitted the patient to regain some autonomy with moderate adverse effects. ECT remains an uncommon treatment in adolescents, and the current case supports the view that it should not be banned in young people.

Neuropsychological effects and attitudes in patients following electroconvulsive therapy

The current study examined the effects of electroconvulsive therapy (ECT) on neuropsychological test performance. Forty-six patients completed brief neuropsychological and psychological testing before and after receiving ECT for the treatment of recalcitrant and severe depression. Neuropsychological testing consisted of the Levin Selective Reminding Test (Levin) and Wechsler Memory Scale-Revised Edition (WMS-R). Self-report measures included the Beck Depression Inventory (BDI), the Short-Term Memory Questionnaire (STMQ), and several other measures of emotional functioning and patient attitudes toward ECT. The mean number of days between pre-ECT and post-ECT testing was 24. T-test revealed a significant decrease in subjective ratings of depression as rated by the BDI, t(45) = 9.82, P < 0.0001 (Pre-BDI = 27.9 +/- 20.2; post-BDI = 13.5 +/- 9.7). Objective ratings of memory appeared impaired following treatment, and patients' self-report measures of memory confirmed this decline. More specifically, repeated measures MANOVA [Wilks Lambda F(11,30) = 4.3, p < 0.001] indicated significant decreases for measures of immediate recognition memory (p < 0.005), long-term storage (p < 0.05), delayed prose passage recall (p < 0.0001), percent retained of prose passages (p < 0.0001), and percent retained of visual designs (p < 0.0001). In addition, the number of double mentions on the Levin increased (p < 0.02). This study suggests that there may be a greater need to discuss the intermittent cognitive risks associated with ECT when obtaining informed consent prior to treatment. Further that self-reports of cognitive difficulties may persist even when depression has remitted. However, patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable.

Patients' and their relatives' attitudes toward electroconvulsive therapy in bipolar disorder

Although electroconvulsive therapy (ECT) is a safe and efficacious treatment, there is a widespread negative view of ECT in public and professional circles. Previous studies that reported psychiatric patients' and their relatives' feelings and attitudes toward ECT revealed generally positive results. However, there are no data focusing on bipolar patients' and their relatives' attitudes toward ECT. In this study, the perspectives of 70 bipolar patients and their 70 relatives were examined before ECT. The study showed that the majority of patients and relatives believed they had not received adequate information about ECT, but they were satisfied with the treatment, found it beneficial, and maintained a positive attitude toward its use. The most commonly reported side effect was memory impairment. This is the first study focusing on bipolar patients' and their relatives' attitudes toward ECT in the literature.

Treatments in child and adolescent bipolar disorders

The existence of bipolar disorder in adolescents is now clearly established. However, whether bipolarity exists in children is more controversial. We reviewed the literature on acute and prophylactic treatment of bipolar disorder in youths. The guidelines for the treatment of bipolar disorder in children and adolescents are generally similar to those applied in adult practice. But no evidence-based data support the use of mood stabilisers or antipsychotics since we only found two placebo-randomised controlled trials testing the efficacy of lithium in the paediatric literature. Therefore, we support the view that prescriptions should be limited to the most typical cases. In fact, the use of mood stabilisers or antipsychotics in the treatment of bipolar disorder in children and adolescents appears to be of limited use when a comorbid condition, such as attention deficit hyperactivity disorder, occurs unless aggressive behaviour is the target symptom.

ECT: Knowledge and attitude among patients and their relatives

BACKGROUND

It is believed that people lack sound knowledge and appropriate attitude towards electroconvulsive therapy (ECT). However, very little systematic research has gone into this area.

AIM

To examine the knowledge and attitude of patients and their relatives towards ECT.

METHODS

A 16-item questionnaire with satisfactory face validity and content validity was constructed and translated into Hindi. It was then administered to 89 patients and 83 relatives attending the psychiatry services in a major hospital in north India.

RESULTS

More than 65% of the respondents in both the groups-patients as well as relatives-gave correct responses such as ECT is life saving, many times it causes temporary but not permanent memory impairment and that ECT is not a non-scientific treatment. There was non-significant disagreement between the two groups.

CONCLUSION

The study is a preliminary exploratory one and is likely to give direction for further research with refined methodology.

Discourse analysis and the experience of ECT

The authors present a discourse analysis of an influential paper on the experience of electroconvulsive therapy (ECT). By focusing on how patients are construed in this article, they deconstruct the ways in which the case for ECT as 'helpful and not particularly frightening' is made. They argue that, as with all academic writing, a discourse of scientific objectivity can be used to privilege certain views and promote certain interests.

Can a seizure help? The public's attitude toward electroconvulsive therapy

Despite controversial discussions in the general population, little is known about the public's attitude toward electroconvulsive therapy (ECT). We examined in a representative opinion survey (N=1737) (1) whether the lay public views ECT as an appropriate treatment for schizophrenia and depression, and (2) how demographic, psychological, sociological, and cultural variables influence attitudes. Most respondents (57%) considered ECT as a harmful treatment, and only a small number (1.2%) were in favor of ECT. A large number of respondents did not consider ECT as a treatment. We identified three predictors of negative attitude toward ECT (younger age, cultural area, greater degree of contact with the mentally ill; R2=0.042). The finding was not affected by the type of illness. Thus, having a prejudice toward ECT is a 'uniform attitude' that does not significantly vary between individual, demographic, or cultural contexts.

Child and adolescent electroconvulsive therapy: a case report

Electroconvulsive therapy (ECT) is a controversial treatment modality that is only rarely performed on children and adolescents. There is a marked paucity of published data relating to the indications, use, clinical outcome and complications of ECT in this age group. The ethical and moral issues surrounding the use and in particular the research of ECT in this group of patients makes controlled data very difficult to come by. The following case report and review of the literature will address some of these issues.

Tratamiento electroconvulsivo en niños y adolescentes

It is well-known that electroconvulsive therapy (ECT) is a safe and effective treatment for some mental disorders in adults. However, its use in children and adolescents is still the cause of some fears which may not be justified. The aim of this article is to clarify and to present the state of this question by reviewing the literature about ECT in children and adolescents, with emphasis on efficacy, indications, adverse effects and limitations. Results from studies in this population group show similar safety and efficacy data as those observed in adults. There exists a misinformation about the ECT technique among child psychologists and psychiatrists. Large follow-up studies are needed.

How fixed are child psychiatrists' views about ECT in the young?

The experience, knowledge, and attitudes of Australian and New Zealand child psychiatrists in relation to ECT in the young were surveyed in 2000 to ascertain whether their views had changed since a similar survey was conducted in 1996. Fifty-four percent (n = 129) of the original sample answered a mailed questionnaire. Psychiatrists in 2000 had greater self-rated level of knowledge on the subject and were less likely to base that knowledge on adult ECT data. Psychiatrists in 2000 were also more likely than in 1996 to approve the use of ECT in adolescents. The finding that the views of child psychiatrists can change is reassuring, given emerging data showing ECT in young persons to be an effective and safe treatment, and the requirement in various countries that child psychiatrists participate in the decision to administer the treatment. It is possible that a number of publications and presentations on the topic after the first survey contributed to the change in views. Nevertheless, there remain gaps in child psychiatrists' knowledge about ECT in the young that need to be addressed. The study findings should not be over interpreted because of the reduced response rate in the follow-up survey.