Electroconvulsive Therapy in Children and Adolescents

CanJPsychiatry 2015;60(1):35–38
Book Reviews/Revues de livre
Violence
Stahl’s Illustrated Violence: Neural Circuits,
Genetics and Treatment
Stephen M Stahl, Debbi Ann Morrissette. Cambridge (GB):
Cambridge University Press; 2014. 120 p. Can$50.00
Reviewer rating: Excellent
Review by Jan Volavka, MD
Big Sky, Montana
especially suitable for psychiatrists in training. However,
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is an up-to-date reference list for readers interested in
more detailed information. The price of the book appears
reasonable.
Reference
1. Morrissette DA, Stahl SM. Treating the violent patient with
psychosis or impulsivity utilizing antipsychotic polypharmacy and
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This slim paperback presents, in a
condensed form, the most important
facets of current knowledge
about causes and treatment of
violence. Epidemiology, genetics,
and neurobiology of violence are reviewed. The book
was developed primarily for prescribers specializing
in psychiatry, and most of the text is concerned with
psychopharmacology of violence. Detailed theoretical
information, including pharmacokinetics and molecular
mechanisms of action, is provided for agents used in the
treatment of violence. Dosing and adverse effects are also
covered.
Electroconvulsive Therapy
Particular attention is focused on the subpopulation of
patients who are persistently aggressive and treatment
resistant. This is a small but clinically challenging
group. The authors build a theoretical rationale for using
either high-dose antipsychotic (AP) monotherapy or
polypharmacy in such patients. When they say highdose, they really mean it: for example, for olanzapine, it
is 80 mg/day (the maximum dose recommended by the
manufacturer and approved for marketing is 20 mg/day).
They state, appropriately, that the dosing of APs above
standard therapeutic levels warrants informed consent and
increased patient monitoring. More information, including
some limited evidence supporting this type of treatment,
can be found elsewhere.1
In the last decade, child and
adolescent psychiatry has progressed
tremendously in the standardization
of clinical assessment and treatment. Much effort has
been dedicated to generate robust empirical evidence to
support treatments and interventions, leading to a sizable
body of literature, yet there remains skepticism and even
downright antipathy to some of these interventions such as
electroconvulsive therapy (ECT). These negative opinions
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people is worsened to some extent by the paucity of
large randomized clinical trials and major issues around
stigma and ethics despite the publication of practice
parameters for the use of ECT in adolescents in 2004.1
The decision whether ECT is clinically indicated should
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to the individual, including the risks associated with the
anesthetic, current comorbidities, anticipated adverse
events such as cognitive impairment, and the risks of not
having treatment.2
The book differs from other available materials on this
topic by its full-colour schematic images that illustrate
each paragraph of the text. Each paragraph describes
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relation between catechol-O-methyltransferase (COMT)
gene, polymorphism, and aggression. Each paragraph
and its illustration are presented on a single page. This
arrangement makes for easy reading. It also results in
an unusual allocation of space. Thus clozapine, the gold
standard of anti-aggressive medications, is given the same
space (1 page) as drugs whose anti-aggressive effects have
yet to be fully demonstrated.
The book is written quite concisely and the text is
simple to understand. The authors are competent
in neurobiological, genetic, and particularly in
psychopharmacological aspects of violence. Overall, the
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www.TheCJP.ca
Electroconvulsive Therapy in Children and
Adolescents
Neera Ghaziuddin, Garry Walter, editors. London (GB):
Oxford University Press; 2013. 316 p. £37.50
Reviewer rating: Good
Review by Pappu S Reddy, MBBS,
MRCPsych (UK) and Nasreen
Roberts, MBBS, FRCPC
Kingston, Ontario
This book consists of 12 chapters written by
internationally renowned experts at the forefront of
research and clinical use of ECT. The chapters on the
history of ECT, the role of stigma, ethical aspects, and the
guide to using ECT in minors present a balanced view of
the clinical utility and adverse effects of its use in children
and adolescents. The authors review epidemiologic data,
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people, and suggest clinical strategies that are entirely
relevant to current clinical practice. Each chapter starts
with key points and ends with self-assessment questions.
The Canadian Journal of Psychiatry, Vol 60, No 1, January 2015 : 35