Electroconvulsive Therapy for Bipolar Affective Disorder with Mixed Features and Psychotic Behavior

Indications for ECT in Bipolar Mixed States with Psychotic Features

The American Academy of Child and Adolescent Psychiatry indicates that ECT is appropriate for patients with severe, persistent bipolar disorder with mixed features and psychotic symptoms 2
Mixed states with psychotic features are specifically mentioned as appropriate candidates for ECT by the American Academy of Child and Adolescent Psychiatry 1, 3
Psychotic symptoms in bipolar disorder, including delusions and hallucinations, often respond well to ECT, according to the American Academy of Child and Adolescent Psychiatry 4, 5

Symptoms must be severe, persistent, and significantly disabling, as stated by the American Academy of Child and Adolescent Psychiatry 2
Life-threatening symptoms that warrant ECT include refusal to eat or drink, as indicated by the American Academy of Child and Adolescent Psychiatry 1
Severe suicidality is a life-threatening symptom that warrants ECT, according to the American Academy of Child and Adolescent Psychiatry 2
Uncontrollable mania and florid psychosis are also life-threatening symptoms that warrant ECT, as stated by the American Academy of Child and Adolescent Psychiatry 2, 3

ECT is generally considered after failure to respond to at least two adequate trials of appropriate medications, as recommended by the American Academy of Child and Adolescent Psychiatry 1, 2
For bipolar disorder, a trial of a mood stabilizer alone or in combination with an antipsychotic should be attempted before ECT, according to the American Academy of Child and Adolescent Psychiatry 2
ECT may be considered earlier in cases where the patient cannot tolerate psychopharmacological treatment, as indicated by the American Academy of Child and Adolescent Psychiatry 6
ECT may also be considered earlier in cases where the patient is too incapacitated to take medication, as stated by the American Academy of Child and Adolescent Psychiatry 3

For adolescents with bipolar disorder, ECT should only be considered for well-characterized bipolar I disorder with severe episodes, as recommended by the American Academy of Child and Adolescent Psychiatry 7
ECT should not be used for bipolar disorder NOS or atypical presentations of juvenile mania, according to the American Academy of Child and Adolescent Psychiatry 7