ࡱ> G bjbjَ .*3]8,,8 ~d("$!#X# |# pbdpppp8XRppJ@"X CpB14 July, 2006 SUBMISSION 2002/162 Petition of Helen Smith This submission is provided on behalf of the Paediatric Society of New Zealand. There has also been consultation with the Royal Australian and New Zealand College of Psychiatrists, Faculty of Child & Adolescent Psychiatrists, New Zealand. Depression in children and adolescents is best treated by cognitive behaviour therapy and by addressing life stresses. However, some older adolescents have more severe depression, which may be part of a bipolar affective disorder illness. (The majority of people with bipolar affective disorder will have first symptoms starting from age 15-19 years.) ECT is seldom used in adolescents with depression ECT is seldom used child & adolescent psychiatry - Ministry of Health figures of 5 people aged less than 20yrs 2003-2204, less than 2% of total. To my knowledge ECT has not been used with children in New Zealand over at least the past 20 years. In my previous role as Clinical Director at the Child & Family Unit, Starship Hospital, one of three inpatient units for children and adolescents in New Zealand, about 1 adolescent per year received ECT out of approximately 100 admissions pa. ECT is used for the treatment of severe depression in adolescents. Its previous mis-use as a means of behaviour control is not part of current treatment. Adolescents treated with ECT generally have bipolar affective disorder with psychotic depressive symptoms. Bipolar affective disorder has a mortality rate of 11-15% from suicide, a rate that most people would consider means that BPAD is a life-threatening condition. ECT is sometimes considered as a treatment option for older adolescents with severe depression in the following circumstances: 1. Failure of a range of other treatments, including cognitive behaviour therapy, family therapy, at least two classes of antidepressants and antipsychotics and Imminent threat to life from current symptoms. This usually includes inability to eat and drink due to mental state, extreme agitation, psychotic depressive symptoms and severe suicidal impulses. Adolescents who receive ECT are treated under the Mental Health (Compulsory Assessment and Treatment) Act 1992, (revised 1999) because they generally lack the capacity to provide informed consent due to mental illness. This requires two child and adolescent psychiatrists to review the adolescent and determine the best treatment for them. ECT is not given to any adolescent without this procedure. There are no controlled trials of ECT in adolescents. However, with the above restrictions on its use it forms part of treatment guidelines for severe, life-threatening depression in adolescents in other countries, eg: UK NICE Guidelines Depression in Children and Young People HYPERLINK "http://www.nice.org.uk/page.aspx?o=cg028fullguideline"http://www.nice.org.uk/page.aspx?o=cg028fullguideline, American Academy of Child & Adolescent Psychiatry Practice Parameters HYPERLINK "http://www.aacap.org/clinical/parameters/summaries/ect_summ.htm"http://www.aacap.org/clinical/parameters/summaries/ect_summ.htm. and Australian review of ECT in adolescents, Walter, G., Rey, J. M., & Mitchell, P. B. (1999). Practitioner review: electroconvulsive therapy in adolescents. Journal of Child Psychology & Psychiatry & Allied Disciplines, 40(3), 325-334. There are no specific trials of effects of ECT on memory in adolescents. This is of course of concern, and implies that ECT should only be used in circumstances in which it can be justified as a life-saving procedure. There is a small Australian study, which asked parents of 28 adolescents who received ECT about their views on its helpfulness. 17 of 28 parents thought that it had been helpful. Walter, G., Koster, K., & Rey, J. M. (1999). Views about treatment among parents of adolescents who received electroconvulsive therapy. Psychiatric Services, 50(5), 701-702. Summary ECT is seldom used for adolescents with depression. It is not used with children in New Zealand. However, it is an important part of treatment for the rare young people who are severely, psychotically depressed with life-threatening illness who do not respond to other treatments. In these circumstances it may be compared to other life-preserving treatments which may cause significant side effects. ECT is given to adolescents in New Zealand only if the assessment of two child & adolescent psychiatrists concurs and under the legal protections of the Mental Health Act. Leah Andrews Senior Lecturer, Child & Adolescent Psychiatrist Department of Psychological Medicine University of Auckland Private Bag 92 019 Auckland Phone (09) 373 7599 Ext 84549 Fax (09) 373 7493 Mobile -274 522 404     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz PAGE  PAGE 2  Health of our children: Wealth of our nation =X @ -./de;<-t G_pxKLMOPƼƪ j0JU5B*CJOJQJB*CJOJQJ5B*CJ(OJQJ5B*CJ$OJQJ 5OJQJj5OJQJUmH6jU0JjU jU0JCJ0J0J5;=>?./0W X z ?  & Fh$=>?./0W X z ? hC,-w   nopqz !8KTr#7LMNZeijmno       V hC,-w   nopqz !8h & F8KTr $ !Sn# $ !Sn# x$ $ #7LMNOXYZeijklm $h !n#h&`#$ !4$$\+#D$ $  $ !Sn#PVWXZ[abcdeh jUmH0JmH j0JU0J mno$ ! !,&P . A!"#$%n DyK yK lhttp://www.nice.org.uk/page.aspx?o=cg028fullguidelineDyK yK http://www.aacap.org/clinical/parameters/summaries/ect_summ.htm [^@^ Normal$ d*$a$ @CJOJQJ_HmH sH tH 00 Heading 1$@&500 Heading 2$@&>* Heading 3p$$ \R" b2> Y!r"B%(*-0R3"68;>bA2DGI*$@&a$56@CJ00 Heading 4$@&CJ44 Heading 5$@&5CJ44 Heading 6$@&5CJ:: Heading 7$$@&a$5CJ66 Heading 8$$@&a$5<A@< Default Paragraph FontFF Address$a$5OJQJhmH sH tH u0@0 Header  !CJ0 @0 Footer  !CJ(U@!( Hyperlink>*B*8V@18 FollowedHyperlink>*B* RBBR Body Text$ p@ *$1$a$@htH uN>RN Title$ p@ *$1$a$5CJ0htH u.Pb. Body Text 2CJbCrb Body Text Indent($ 0*$^`a$@CJ4Q4 Body Text 3$a$CJ W@ Strong5hJh Subtitle,$ d*$^`a$56@CJmH sH u&)@&  Page Number225* P  8m . d ; XX!!@  @v  ^( =z43 t CE%"  S"8   BCqDELFVSS?-;lbn2qk\D@ORQ8Q* gw  W <b14\5q<O>B 1 8w1N/ : f 1  y?  u M  4  `6U:LsNA_cknkAehS)8Z' sZ' *b?@`CE%"   TB CnDExFf%Ip,0A  K *   8 h  L  D kk nPn&k X>>@@`4B "H2   #  #$H2   # | \  3  "\  3  "bB  c $DjJ"0( ? 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A!"#$%n  14 July, 2006 SUBMISSION 2002/162 Petition of Helen Smith This submission is provided on behalf of the Paediatric Society of New Zealand. There has also been consultation with the Royal Australian and New Zealand College of Psychiatrists, Faculty of Child & Adolescent Psychiatrists, New Zealand. Depression in children and adolescents is best treated by cognitive behaviour therapy and by addressing life stresses. However, some older adolescents have more severe depression, which may be part of a bipolar affective disorder illness. (The majority of people with bipolar affective disorder will have first symptoms starting from age 15-19 years.) ECT is seldom used in adolescents with depression ECT is seldom used child & adolescent psychiatry - Ministry of Health figures of 5 people aged less than 20yrs 2003-2204, less than 2% of total. To my knowledge ECT has not been used with children in New Zealand over at least the past 20 years. In my previous role as Clinical Director at the Child & Family Unit, Starship Hospital, one of three inpatient units for children and adolescents in New Zealand, about 1 adolescent per year received ECT out of approximately 100 admissions pa. ECT is used for the treatment of severe depression in adolescents. Its previous mis-use as a means of behaviour control is not part of current treatment. Adolescents treated with ECT generally have bipolar affective disorder with psychotic depressive symptoms. Bipolar affective disorder has a mortality rate of 11-15% from suicide, a rate that most people would consider means that BPAD is a life-threatening condition. ECT is sometimes considered as a treatment option for older adolescents with severe depression in the following circumstances: 1. Failure of a range of other treatments, including cognitive behaviour therapy, family therapy, at least two classes of antidepressants and antipsychotics and Imminent threat to life from current symptoms. This usually includes inability to eat and drink due to mental state, extreme agitation, psychotic depressive symptoms and severe suicidal impulses. Adolescents who receive ECT are treated under the Mental Health (Compulsory Assessment and Treatment) Act 1992, (revised 1999) because they generally lack the capacity to provide informed consent due to mental illness. This requires two child and adolescent psychiatrists to review the adolescent and determine the best treatment for them. ECT is not given to any adolescent without this procedure. Page 2. There are no controlled trials of ECT in adolescents. However, with the above restrictions on its use it forms part of treatment guidelines for severe, life-threatening depression in adolescents in other countries, eg: UK NICE Guidelines Depression in Children and Young People HYPERLINK "http://www.nice.org.uk/page.aspx?o=cg028fullguideline"http://www.nice.org.uk/page.aspx?o=cg028fullguideline, American Academy of Child & Adolescent Psychiatry Practice Parameters HYPERLINK "http://www.aacap.org/clinical/parameters/summaries/ect_summ.htm"http://www.aacap.org/clinical/parameters/summaries/ect_summ.htm. and Australian review of ECT in adolescents, Walter, G., Rey, J. M., & Mitchell, P. B. (1999). Practitioner review: electroconvulsive therapy in adolescents. Journal of Child Psychology & Psychiatry & Allied Disciplines, 40(3), 325-334. There are no specific trials of effects of ECT on memory in adolescents. This is of course of concern, and implies that ECT should only be used in circumstances in which it can be justified as a life-saving procedure. There is a small Australian study, which asked parents of 28 adolescents who received ECT about their views on its helpfulness. 17 of 28 parents thought that it had been helpful. Walter, G., Koster, K., & Rey, J. M. (1999). Views about treatment among parents of adolescents who received electroconvulsive therapy. Psychiatric Services, 50(5), 701-702. Summary ECT is seldom used for adolescents with depression. It is not used with children in New Zealand. However, it is an important part of treatment for the rare young people who are severely, psychotically depressed with life-threatening illness who do not respond to other treatments. In these circumstances it may be compared to other life-preserving treatments which may cause significant side effects. ECT is given to adolescents in New Zealand only if the assessment of two child & adolescent psychiatrists concurs and under the legal protections of the Mental Health Act. Leah Andrews Senior Lecturer, Child & Adolescent Psychiatrist Department of Psychological Medicine University of Auckland Private Bag 92 019 Auckland Phone (09) 373 7599 Ext 84549 Fax (09) 373 7493 Mobile -274 522 404     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz PAGE  PAGE 1   Health of our children: Wealth of our nation 33 4667,9:==========h>?"ABDD@EdFfFhFh & F & FhhFjG.I0I2I4IFI JlLMMMMDNNNNN0OTO|OOOOOOOOOOOOOPPPPPP6PTPjPPPPP4$$\+#D$ $  $ !Sn# $ !Sn# x$ $ OOOOPPPPPPPPPPQQQQQQQQQʾ jUmH0JmH0J j0JU5B*CJOJQJB*CJOJQJ 5OJQJ5B*CJ(OJQJ5B*CJ$OJQJPPPPPQQQ Q"Q$Q&Q(Q*QQQQQ$ ! $h !n#h&`#$ !,&P . 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Body Text 2CJbCrb Body Text Indent($ 0*$^`a$@CJ4Q4 Body Text 3$a$CJ W@ Strong5hJh Subtitle,$ d*$^`a$56@CJmH sH u&)@&  Page Number225\ !BCD345\]D  z U > ?  0GZc2F[\]itxy|}~    @@@@@@@@@@@@@@@@@@@@@  POQ , 8m3hFOPQ)*+- @ v M XX!!@  @v  ^( =z43 t CE%"  S"8   BCqDELFVSS?-;lbn2qk\D@ORQ8Q* gw  W <b14\5q<O>B 1 8w1N/ : f 1  y?  u M  4  `6U:LsNA_cknkAehS)8Z' sZ' *b?@`CE%"   TB CnDExFf%Ip,0A  K *   8 h  L  D kk nPn&k X>>@@`4B "H2   #  #$H2   # | \  3  "\  3  "bB  c $DjJ"0( ? B S  ? =^tuD$t#u yz|yz|DeniseC:\Documents and Settings\Denise\WORK\PSNZ Docs\Submissions and Position Statements\Submission 2002.162 Petition of H Smith.DOC|} D~NsrtZ*PpTVxGzflت?m "W 1 P v  {n -  :. CB|0 B1 J3ѪnV 3 `-J &X /W\PT] qc  r\4:u [ ^`.^`.^`.^`. ^`OJQJo( ^`OJQJo( ^`OJQJo( ^`OJQJo(hh^h`. hh^h`OJQJo(* hh^h`OJQJo(0^`0o(. hh^h`OJQJo(hh^h`o(. hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo(hh^h`.hh^h`.0^`0o(.?^`?o(.?^`?o(. hh^h`OJQJo(ll^l`o(. hh^h`OJQJo( hh^h`OJQJo(?^`?o(. hh^h`OJQJo( hh^h`OJQJo(&XP rV 3B1CB|0~}| :.mJ3"[T]qc-J 1{n -v :u/W\8"D"@h ^`OJQJo(@"` qryz{|P.*P0*P8*P=Q=P=P=P=P=P=PMPzOP|OPOPOPOPOPOPOPOPOQQPQP QP"QP$QP&QPQPQGzTimes New Roman5Symbol3& zArial?Bodoni BookEAGaramond BoldA& Arial Narrow"1h[t&&a !#4dD 14 July, 2006racpDeniseG bjbjَ .\3]80LL)~("I(K(K(K(K(K(K($R+F-Xo(ePT|o(bp8XRI(I(Jh%@"I( $@|(BRoot Entry F"Ȧ$Data F1Table$WordDocument~.\ e !"#$%&'()*+,-./0GLMNOPQRSTUVWXYZ[\]^_`abcdfKhijklmnopqrstuvwxyz{|}SummaryInformation(DocumentSummaryInformation8PCompObjj0Tableg- _PID_HLINKSAN{3898F8FA-DBC0-4974-9F39-C2DB076EEE90}AX ?@http://www.aacap.org/clinical/parameters/summaries/ect_summ.htmD6http://www.nice.org.uk/page.aspx?o=cg028fullguideline  FMicrosoft Word Document MSWordDocWord.Document.89q՜.+,D՜.+,< hp  racpw   14 July, 2006 Title(RZ _PID_GUID Oh+'0t  $ 0 < HT\dl14 July, 2006o4 Jracply,acp Normal.dot0Denised4niMicrosoft Word 8.0@캃@8:Q@*{!@xEa Paediatric Society of New Zealand: Submissions
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Submissions

The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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