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Electroconvulsive therapy for psychotropic-refractory bipolar affective disorder and severe self-injury and aggression in an 11-year-old autistic boy

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Abstract

We report the successful use of electroconvulsive therapy in a 11-year-old boy with autism and a 4-year history of psychotropic-resistant bipolar affective disorder associated with dangerous episodes of self-injurious and aggressive behaviors placing his caregivers and himself at significant safety risk. Extensive behavioral and medication interventions in both inpatient and outpatient settings had been ineffective, and the boy was at risk for acute physical injury and restrictive out-of-home placement. An acute course of eight bilateral electroconvulsive therapies resulted in significant mood stabilization and significant improvement of self-injury and aggression. Maintenance electroconvulsive therapy and psychotropic interventions were then pursued.

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References

  1. Borthwick-Duffy SA (1994) Epidemiology and prevalence of psychopathology in people with mental retardation. J Consult Clin Psychol 62:17–27

    Article  CAS  PubMed  Google Scholar 

  2. Paclawskyj TR, Kurtz PF, O’Connor JT (2004) Functional assessment of problem behaviors in adults with mental retardation. Behav Modif 28:649–667

    Article  PubMed  Google Scholar 

  3. American Academy of Mental Retardation (2000) Treatment of psychiatric and behavioral problems in mental retardation. Am Acad Ment Retard 105:165–199

    Article  Google Scholar 

  4. Reinblatt S, Rifkin A, Freeman J (2004) The efficacy of ECT in adults with mental retardation experiencing psychiatric disorders. J ECT 20:208–212

    Article  PubMed  Google Scholar 

  5. Wachtel L, Griffin M, Reti I (2009) Electroconvulsive therapy in a man with autism experiencing severe depression, catatonia and self-injury. J ECT 26:70–73

    Article  Google Scholar 

  6. Wachtel L, Kahng S, Dhossche D, Cascella N, Reti I (2008) Electroconvulsive therapy for catatonia in an autistic girl. Am J Psychiatry 165:329–333

    Article  PubMed  Google Scholar 

  7. Wachtel L, Contrucci-Kuhn S, Griffin M, Thompson A, Dhossche D, Reti I (2009) ECT for self-injury in an autistic boy. Eur Child Adolesc Psychiatry 18:458–463

    Article  PubMed  Google Scholar 

  8. Rey J, Walter G (1997) Half a century of ECT use in young people. Am J Psychiatry 154:595–602

    CAS  PubMed  Google Scholar 

  9. Aziz M, Maixner D, DeQardo J, Aldridge A, Tandon R (2001) ECT and mental retardation: a review and case report. J ECT 17:149–152

    Article  CAS  PubMed  Google Scholar 

  10. Aman M, Singh N, Stewart A, Field C (1985) The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. Am J Ment Defic 89:485–491

    CAS  PubMed  Google Scholar 

  11. Scahill L, McDougle C, Williams S, Dimitropoulos A, Aman M, McCracken J, Tierney E, Arnold L, Cronin P, Grados M, Ghuman J, Koenig K, Lam K, McGough J, Posey D, Ritz L, Swiezy N, Vitiello B (2006) Children’s Yale-Brown Obsessive Compulsive Scale modified for pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry 45:1114–1123

    Article  PubMed  Google Scholar 

  12. Dhossche D, Reti I, Shettar S, Wachtel L (2010) Tics as signs of catatonia: ECT response in two adolescents. J ECT 26(4):266–269

    Google Scholar 

  13. Dhossche D, Wing L, Ohta M, Neumarker K-J (eds) (2006) Catatonia in autism spectrum disorders. Elsevier Academic Press, San Diego

  14. Wachtel L, Griffin M, Dhossche D, Reti I (2010) Brief report: ECT for malignant catatonia in an autistic adolescent. Autism 14:349–358

    Google Scholar 

  15. Zaw F, Bates G, Murali V, Bentham P (1999) Catatonia, autism, and ECT. Dev Med Child Neurol 41:843–845

    Article  CAS  PubMed  Google Scholar 

  16. Dhossche D, Shah A, Wing L (2006) Blueprints for the assessment, treatment, and future study of catatonia in autism spectrum disorders. Int Rev Neurobiol 72:267–284

    Article  PubMed  Google Scholar 

  17. Fink M, Taylor MA, Ghaziuddin N (2006) Catatonia in autistic spectrum disorders: a medical treatment algorithm. Int Rev Neurobiol 72:233–244

    Article  PubMed  Google Scholar 

  18. Wachtel L, Dhossche D (2010) Self-injury in autism as an alternate sign of catatonia: implications for electroconvulsive therapy. Med Hypotheses 75:111–114

    Google Scholar 

  19. Bates W, Smeltzer D (1982) Electroconvulsive treatment of psychotic self-injurious behavior in a patient with severe mental retardation. Am J Psychiatry 139:1355–1356

    CAS  PubMed  Google Scholar 

  20. Fink M (1999) Electroshock: healing mental illness. Oxford University Press, London

    Google Scholar 

  21. Arora M, Praharaj S, Prakash R (2008) Electroconvulsive therapy for multiple major self-mutilations in bipolar psychotic depression. Turk J Psychiatry 19:1–4

    Google Scholar 

  22. Black D, Wilcox J, Stewart M (1985) The use of ECT in children: case-report. J Clin Psychiatry 46:98–99

    CAS  PubMed  Google Scholar 

  23. Cizadlo B, Wheaton A (1995) Case study: ECT treatment of a young girl with catatonia. J Am Acad Child Adolesc Psychiatry 34:332–335

    Article  CAS  PubMed  Google Scholar 

  24. Willoughby C, Hradek E, Richards N (1997) Use of electroconvulsive therapy with children: an overview and case report. J Child Adolesc Psychiatr Nurs 10:11–17

    Article  CAS  PubMed  Google Scholar 

  25. Esmaili T, Malek A (2007) Electroconvulsive therapy (ECT) in a six-year-old girl suffering from major depressive disorder with catatonic features. Eur Child Adolesc Psychiatry 16:58–60

    Article  PubMed  Google Scholar 

  26. Bush G, Fink M, Petrides G, Dowling F, Francis A (1996) Catatonia: I: rating scale and standardized examination. Acta Psychiatr Scand 93:129–136

    Article  CAS  PubMed  Google Scholar 

  27. Gedye A (1989) Extreme self-injury attributed to frontal lobe seizures. Am J Ment Retard 94:20–26

    CAS  PubMed  Google Scholar 

  28. Gedye A (1989) Episodic rage and aggression attributed to frontal lobe seizures. J Ment Defic Res 33(Pt 5):369–379

    PubMed  Google Scholar 

  29. Shorter E, Healy D (2007) Shock therapy: a history of electroconvulsive treatment in mental illness. Rutgers University Press/University of Toronto Press, Piscataway

    Google Scholar 

  30. Cohen D, Taieb O, Flament M, Benoit N (2000) Absence of cognitive impairment at long-term follow-up in adolescents treated with ECT for severe mood disorder. Am J Psychiatry 157:460–462

    Article  CAS  PubMed  Google Scholar 

  31. Taieb O, Flament M, Chevret S, Jeammet P, Allilaire J, Mazet P, Cohen D (2001) Clinical relevance of electroconvulsive therapy (ECT) in adolescents with severe mood disorder: evidence from a follow-up study. Eur Psychiatry 17:1–7

    Google Scholar 

  32. Wachtel L, Hermida A, Dhossche D (2010) Maintenance electroconvulsive therapy in autistic catatonia: a case series review. Prog Neuropsychopharmacol Biol Psychiatry 34:581–587

    Article  PubMed  Google Scholar 

  33. Ottosson J-O, Fink M (2004) Ethics of electroconvulsive therapy. Brunner-Routledge, New York

    Google Scholar 

  34. Ghaziuddin N, Kaza M, Ghazi N, King C, Walter G, Rey J (2001) Electroconvulsive therapy for minors: experiences and attitudes of child psychiatrists and psychologists. J ECT 17:109–117

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank J.’s parents for kindly agreeing to share their child’s story.

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Authors and Affiliations

  1. Kennedy Krieger Institute, 707 North Broadway St, Baltimore, MD, 21209, USA

    Lee E. Wachtel

  2. Belmont Center for Comprehensive Treatment, 4200 Monument Road, Philadelphia, PA, 19131, USA

    Richard Jaffe

  3. Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA

    Charles H. Kellner

Authors
  1. Lee E. Wachtel
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  2. Richard Jaffe
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  3. Charles H. Kellner
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Correspondence to Lee E. Wachtel.

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Wachtel, L.E., Jaffe, R. & Kellner, C.H. Electroconvulsive therapy for psychotropic-refractory bipolar affective disorder and severe self-injury and aggression in an 11-year-old autistic boy. Eur Child Adolesc Psychiatry 20, 147–152 (2011). https://doi.org/10.1007/s00787-010-0155-z

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  • DOI: https://doi.org/10.1007/s00787-010-0155-z

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