Practice parameter for use of electroconvulsive therapy with adolescents.
Practice parameter for use of electroconvulsive therapy with adolescents.
American Academy of Child and Adolescent Psychiatry - Medical Specialty Society
Summary,
GUIDELINE OBJECTIVE(S)
* To provide the reader with a review of literature pertinent to the use of electroconvulsive therapy (ECT) for the treatment of adolescents
* To provide guidelines for the safe administration of electroconvulsive therapy and the recognition of possible side effects
* To address ethical and legal issues in the treatment of adolescents with electroconvulsive therapy
TARGET POPULATION
Adolescents with severe neuropsychiatric illnesses
Note: This guideline does not address the use of electroconvulsive therapy (ECT) in preadolescent children because of insufficient data and clinical experience.
INTERVENTIONS AND PRACTICES CONSIDERED
Assessment/Evaluation
1. Psychiatric evaluation with clinical interview
2. Review of past treatments with documentation of previous pharmacotherapy
3. Physical examination
4. Laboratory investigation
* Complete blood count
* Differential white blood cell count
* Thyroid function tests
* Liver function tests
* Urinalysis and toxicology screen
* Electrocardiogram
* Electroencephalogram
* Computed tomography or magnetic resonance imaging of the brain
* Serum or urine pregnancy tests for all female patients
5. Pre- and post-treatment cognitive assessment
6. Obtaining informed consent
7. Obtaining a second opinion
8. Monitoring concurrent treatment
9. Monitoring during and after electroconvulsive therapy (ECT):
* Seizure duration
* Airway patency
* Agitation
* Vital signs
* Adverse effects (i.e., impairment of memory and new learning, tardive seizures, prolonged seizures, and risks associated with general anesthesia)
Management/Treatment
1. Electroconvulsive therapy
* Anesthesia (i.e., methohexital)
* Muscle relaxation (i.e., succinylcholine)
* Prevention of vagally induced bradycardia and arrhythmias (intravenous atropine or glycopyrrolate)
* Ventilation with 100% oxygen
* Unilateral electrode application to the nondominant hemisphere (preferred method)
MAJOR OUTCOMES CONSIDERED
* Remission of symptoms
* Rate of response
* Adverse effects of treatment
