Rey J M, Walter G
Department of Psychological Medicine, University of Sydney, N.S.W., Australia.
Am J Psychiatry. 1997 May;154(5):595-602. doi: 10.1176/ajp.154.5.595.
Pharmacological treatments for certain psychiatric disorders in young people are often ineffective and may cause major side effects; thus, it is important to investigate other treatments. This article reviews the literature on the efficacy and safety of ECT in this age group and examines the evidence for the suggestion that it may be used inappropriately.
All studies published in English and other languages on the use of ECT in persons 18 years of age or younger were obtained. The reports were systematically reviewed and rated according to the quality of the information in several domains, yielding an overall quality score for each study. Individual cases from each report were then examined and grouped according to diagnosis and response to ECT.
Sixty reports describing ECT in 396 patients were identified; most (63%) were single case reports. The overall quality was poor but improved in the more recent studies. There were no controlled trials. Rates of improvement across studies were 63% for depression, 80% for mania, 42% for schizophrenia, and 80% for catatonia. Serious complications were very rare, whereas minor, transient side effects appeared common.
ECT in the young seems similar in effectiveness and side effects to ECT in adults. However, this conclusion is qualified by the lack of systematic evidence. More research and education of professionals and the public are needed. It is suggested that ECT registers be set up, that surveys and controlled trials be conducted, and that seizure thresholds, the optimal anesthetic, effects of concurrent medications, and cognitive consequences of ECT in the young be investigated.
针对年轻人某些精神障碍的药物治疗往往无效，且可能会引发严重的副作用；因此，研究其他治疗方法具有重要意义。本文回顾了有关该年龄组电休克治疗（ECT）疗效和安全性的文献，并审视了其可能被不当使用这一说法的证据。
获取了所有以英文及其他语言发表的关于18岁及以下人群使用ECT的研究。对这些报告进行系统回顾，并根据几个领域信息的质量进行评分，得出每项研究的总体质量得分。然后检查每份报告中的个体病例，并根据诊断和对ECT的反应进行分组。
共识别出60篇描述396例患者接受ECT治疗的报告；其中大部分（63%）为单病例报告。总体质量较差，但在较新的研究中有改善。没有对照试验。各项研究中，抑郁症的改善率为63%，躁狂症为80%，精神分裂症为42%，紧张症为80%。严重并发症非常罕见，而轻微、短暂的副作用似乎很常见。
年轻人接受ECT治疗的有效性和副作用似乎与成年人相似。然而，由于缺乏系统性证据，这一结论存在局限性。需要开展更多研究，并对专业人员和公众进行教育。建议建立ECT登记系统，开展调查和对照试验，并研究年轻人的癫痫发作阈值、最佳麻醉方法、同时使用药物的影响以及ECT的认知后果。
