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Psychiatric, anesthetic, and procedural characteristics of modified electroconvulsive therapy courses in adolescents treated in a tertiary child and adolescent psychiatry service: a 15-year retrospective cohort study
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DOI：10.1186/s12888-026-08520-0.png)
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Abstract
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Evidence on electroconvulsive therapy (ECT) in adolescents is largely retrospective and rarely reports psychiatric outcomes together with anesthetic and procedural characteristics. We characterized modified ECT courses in a tertiary child and adolescent psychiatry service. This retrospective cohort included adolescents aged 13–18 years treated with modified ECT from 2010 to 2025; the ECT course was the unit of analysis. Illness severity was rated with the Clinical Global Impression-Severity (CGI-S) scale at admission and discharge. The primary outcome was a composite of any documented hemodynamic event, prolonged seizure, or recovery/behavioral event; short or absent seizures were analyzed separately as a technical seizure-adequacy outcome. Logistic models used standard errors clustered by patient. Among 156 ECT courses in 150 adolescents (1,465 sessions), diagnoses were schizophrenia spectrum (46.2%), bipolar spectrum (23.1%), neurodevelopmental (18.6%), and depressive disorders (12.2%). Median CGI-S decreased from 5.0 at admission to 3.0 at discharge, with a study-defined decrease of at least 2 points in 152 courses (97.4%) and a discharge CGI-S of 2 or less in 60 (38.5%). The primary composite event occurred in 63 courses (40.4%), involving one event domain in 49 (31.4%) and two or more in 14 (9.0%). Short or absent seizures occurred in 42 courses (26.9%); theophylline use was associated with higher odds of this outcome, most plausibly reflecting confounding by indication. Estimates for age, bipolar spectrum disorder, and succinylcholine dose were imprecise and hypothesis-generating. In this severe tertiary cohort, ECT-centered inpatient care was associated with substantial within-course global improvement, and acute course-level events were common but usually confined to a single domain. Acute anesthesia- or procedure-related events and technical seizure adequacy should be reported separately, and exploratory dose or medication associations should not be interpreted causally.
Keywords:
Electroconvulsive therapy
Adolescents
Child and adolescent psychiatry
Anesthesia
Neuromuscular blockade
Seizure adequacy
Clinical Global Impression
Retrospective cohort
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