Electro convulsive therapy in the treatment of severe psychiatric disorders in children and adolescents

Severe mental disorders endanger the lives and development of children and adolescents. For many of these patients’ other forms of therapy including psychotherapy and pharmacotherapy are not efficient, due to a significant time lag before these interventions may be effective. In many cases, the patient may have already failed several pharmacological trials and psychotherapeutic interventions. This chapter will discuss electroconvulsive therapy (ECT) in the treatment of severe psychiatric disorders in children and adolescents, in particular treatment resistant mood disorders, catatonia, psychotic spectrum disorders, and self-injurious behaviors. A course of ECT includes a few brief well-monitored electricallyinduced brain convulsive activity of the anesthetized patient, often followed by a rapid at times lifesaving response. Stigma and ignorance about the use of ECT especially in treating children and adolescents is a widely prevalent problem; thus depriving many sufferers from the probable benefits of this therapeutic modality. The use of ECT is complex and demands taking into account ethical questions, patients’ rights, and following legal regulations that vary between different places in the world. ECT requires a well-coordinated professional team with expertise in the field. It demands updated equipment, prudent patient selection, a comprehensive treatment plan, and psychiatric, cognitive, and physical monitoring during and after the treatment course. This chapter presents current evidence about the use of ECT, underscoring clinical knowledge and guidelines in the field.