Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study.

BACKGROUND: Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7% and 15.6%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges. OBJECTIVE: This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases. METHODS: A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53% (89/168) female and 47% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes. RESULTS: A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=-0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23% of the IGDS score variance: stroke acceleration (ß=.33; P<.001), time interval between keys (ß=-0.26; P=.01), word spacing (ß=-0.25; P<.001), deletion (ß=-0.24; P<.001), and horizontal length of strokes (ß=0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD. CONCLUSIONS: The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures.

Virtual Schooling and Pediatric Mental Health During the COVID-19 Pandemic.

In this single-site, retrospective, descriptive chart review and survey, we investigated changes in pediatric behavioral health needs during the COVID-19 pandemic and the relationship between virtual schooling and hospitalized children's mental health. Subjects included patients aged 6 and 18 years during the 2015 to 2019 and 2020 to 2021 school years who received inpatient mental health care. Parents of patients admitted in 2020 to 2021 were surveyed regarding their child's schooling. We additionally described and compared subjects using descriptive data, including proxies for illness severity, and assessed how these outcomes changed during the pandemic and correlated with school modality. During the pandemic, the distribution of diagnoses changed, and some markers of severity increased. Patients in exclusively virtual school had higher rates of mood and anxiety disorders and tic disorders, and lower rates of eating and disruptive behavior disorders, than patients with recent in-person school. Further study is needed regarding the impact of virtual schooling on pediatric mental health.

Rapid psychiatric readmission in youth: A five-year retrospective Cohort Study.

This study describes predictors of psychiatric readmission among youth, including rapid readmission within 30 days of discharge. A retrospective chart review identified demographic features, diagnoses, and reasons for initial admission among 1324 youth admitted to the child and adolescent psychiatric emergency unit at a Canadian children's hospital. 22% of youth had at least one readmission and 8.8% had at least one rapid readmission during the five-year period. Personality disorder (HR=1.64, 95% CI=1.07, 2.52) and self-harm concerns (HR=0.65, 95% CI=0.48, 0.89) predicted odds of readmission Reducing readmission is an important goal, particularly for youth with personality concerns.

Service Use as a Predictor of Change in Mental Health Problems Among Children: A Prospective Cohort Study.

OBJECTIVE: Psychosocial interventions for children's mental health problems typically differ in several characteristics, such as therapist training, content, motivation for treatment, and extent of comorbid conditions among patients, depending on whether the interventions take place in clinical research studies or in real-life settings. Accordingly, the effects found in research studies may not be generalizable to typical service provision. The authors sought to examine the potential associations between receiving usual care and later psychiatric symptoms, impairment, and potential improvements in social skills. METHODS: Participants (N=996) drawn from the 2003-2004 birth cohorts in Trondheim, Norway, included children who received usual care and those who did not receive any services (as a control group). The children were assessed with biennial clinical interviews from ages 4 to 14 years. Random intercept, cross-lagged panel models were combined with propensity scoring to adjust for measured time-varying and all unmeasured time-invariant confounders. RESULTS: Usual care was not associated with alterations in social skills or impairment due to mental health problems. Similarly, usual care provided to 7- to 12-year-olds did not predict changes in the number of symptoms of psychiatric disorders. However, usual care received at ages 0-4 and 5-6 predicted a slight increase in the number of psychiatric symptoms 2 years later. No significant associations between usual care and improved outcomes were detected. CONCLUSIONS: These observational findings reveal the need to implement existing evidence-based approaches in usual care and to develop evidence-based approaches to the complex cases often seen in specialty and community care systems.

[Child Oriented FamilyTherapy as a Key Component in Young Children's Psychiatric Treatment]. / Kinderorientierte Familientherapie als Baustein der tagesklinischen Behandlung im Kindesalter.

The Child Oriented FamilyTherapy (COF) is a new therapeutic method aiming towards infants in the playing age group and their families. COF is - originally invented in Scandinavia - spreading over Germany since the beginning of the 21st century. The prevalence for psychiatric disorders in toddlers, preschoolers and young infants in Germany lies between 14 and 22 %. Treatment in an outpatients' clinic with partial hospitalization is indicated whenever the psychosocial resources are too low or the symptoms are too severe to be treated in an ambulant environment. The outpatients' department for pediatric psychiatry in Gelsenkirchen is the first institution in its field to use COF as one module to treat their young patients and their families. Due to the setting adjustments of the original method are necessary, for example a conceptualization of disease, the use of COF as a diagnostic method and the embedding of COF in an underlying treatment plan.

Polygenic risk scores for antisocial behavior in relation to amygdala morphology across an attention deficit hyperactivity disorder case-control sample with and without disruptive behavior.

Antisocial and aggressive behaviors show considerable heritability and are central to disruptive behavior disorders (DBDs), but are also frequently observed in attention deficit hyperactivity disorder (ADHD). While the amygdala is implicated as a key neural structure, it remains unclear whether common genetic variants underlie this brain-behavior association. We hypothesized that polygenic (risk) scores for antisocial and aggressive behaviors (ASB-PRS) would be related to amygdala morphology. Using the Broad Antisocial Behavior Consortium genome-wide association study (GWAS; mostly population based cohorts), we calculated ASB-PRS in the NeuroIMAGE I ADHD case-control sample with varying levels of DBD symptomatology (n=679 from 379 families, aged 7 - 29). We first investigated associations of several ASB-PRS p value thresholds with the presence of DBD symptoms and self-reported antisocial behavior (ASB) to determine the threshold for further analyses. This PRS was then related to amygdala volume and shape using regression and vertex-wise analyses. Our results showed associations of ASB-PRS with the presence of DBD symptoms, self-reported ASB, and left basolateral amygdala shape, independent of ADHD symptom severity and ADHD-PRS, with a relative outward displacement of the vertices. No associations of ASB-PRS, DBD symptoms or self-reported ASB with amygdala volume were found. Our results indicate that genetic risk for antisocial and aggressive behaviors is related to amygdala shape alterations, and point to genetic sharing across different DBD and ASB and aggression-related phenotypes as a spectrum of genetically related quantitative traits. Additionally, our findings support the utility of vertex-based shape analyses in genetic studies of ASB, aggression, and DBDs.

Admission Medication Reconciliations in Pediatric Patients Admitted to an Inpatient Psychiatry Unit.

OBJECTIVE: Medication errors resulting in adverse drug events may occur during transition of care. Most can be prevented with a medication reconciliation. California Senate Bill 1254 requires a pharmacist to perform an admission medication reconciliation (AMR) to obtain an accurate medication list for each high-risk patient upon hospital admission. Adult patient literature reveals that antidepressant, antipsychotic, and mood-stabilizing drugs are high-risk medications likely to cause errors. Therefore, the purpose of this analysis is to determine if pediatric psychiatry inpatients should be considered high risk, meriting an additional AMR by the pharmacy team. METHODS: This was a retrospective, single-center analysis of pediatric patients admitted to the inpatient psychiatry unit at Rady Children's Hospital, San Diego between January 1 and 31, 2021. All newly admitted patients had an AMR performed by the medical team (physician-led AMR). High-risk patients (prescribed a high-risk medication or 3 or more medications of any kind prior to admission) had an additional AMR by the pharmacy team (pharmacy-led AMR). Differences between these 2 AMRs were examined. RESULTS: Of the 58 patients admitted during the study period, 39 (67.2%) were identified as high risk, warranting an AMR by the pharmacy team. From the 170 medications reviewed, 51 differences (30%) were found between physician-led and pharmacy-led AMR, with 4 (2.4%) of the differences involving high-risk medications. No medications were incorrectly ordered, and no adverse drug events occurred. CONCLUSIONS: Given that physician-led and pharmacy-led AMRs of high-risk prescription medications were only marginally different and no medications were incorrectly ordered, the existing AMR methodology used by psychiatrists at our institution is effective at creating a safe medication list.

Report from the field: A model of behavioral health integration with pediatric providers.

Children with mental health needs are currently not able to access adequate resources. This report from the field describes the ongoing implementation of an integrated behavioral health model in the state of Texas. The Child Psychiatry Access Network (CPAN) leverages primary care providers (PCPs) in the treatment and management of childhood psychiatric disorders. Data are reported as of November 2021 from consultations placed by PCPs over the preceding 17 months. During that time period, following consultation with the CPAN team, over 90% of PCPs were comfortable delivering the recommended mental health care directly to their patients. This suggests that CPAN is a feasible integrated behavioral health approach to address the shortage of child and adolescent psychiatrists.

Psychiatric Consequences of Skin Conditions: Multiple Case Study Analysis with Literature Review.

This review of current literature demonstrates the psychological implications of skin conditions. Skin conditions of varying severity can impact the quality of patients' lives and have psychiatric consequences. This impact provides a need for healthcare providers to consider the psychological implications of one's skin conditions and their effect on quality of life. The psychological challenges that arise from varying skin conditions show the potential need for both dermatological and psychiatric interventions. The following literature review details the psychiatric consequences of skin conditions under various conditions. It first looks at literature highlighting the psychiatric consequences experienced through various age ranges, from adults to adolescents and children. The paper then explores multiple skin conditions and their psychological effect before highlighting some of the interactions that stress has on the skin that could further exacerbate one's condition. Finally, it examines how patients characterize their experience with their skin condition and goes into some clinical case studies of patients with psychological implications as a result of their skin disorder. The paper also highlights the magnitude of dermatologic patients experiencing psychological conditions in conjunction with their skin conditions.

Disentangling the heterogeneity of emotional dysregulation in referred youth using the Child Behavior Checklist attending to age and sex effects.

PURPOSE: To assess the utility of the Child Behavior Checklist (CBCL) to identify meaningful subtypes of emotional dysregulation in an outpatient pediatric psychiatry clinic. METHODS: The sample consisted of 417 newly referred youth 6-18 years of age. Parents completed the CBCL and rating scales measuring executive function deficits, social functioning, and quality of life. Patients were stratified into subtypes of emotional dysregulation and compared on clinical correlates based on the A-A-A profile consisting of the CBCL Anxious/Depressed, Aggressive Behavior, and Attention Problems (A-A-A) scales. RESULTS: 67% of youth had emotional dysregulation (CBCL A-A-A T-score ≥ 180) and of these, 39% had a positive CBCL-Bipolar (BP) profile (A-A-A T-score ≥ 210), 24% had depression without the BP profile (CBCL Anxious/Depressed and/or Withdrawn/Depressed T-scores ≥70 and A-A-A T-score ≥ 180 and ã€ˆ210), and 37% had emotional impulsivity (A-A-A T-score ≥ 180 and <210) with normal CBCL Anxious/Depressed and Withdrawn/Depressed T-scores. Patients with the CBCL-BP profile were significantly more impaired on all measures of social and executive functioning compared to the other two groups. LIMITATIONS: Since our findings relied on the CBCL, other instruments may have led to different results. Because we included youth from a single clinic, largely Caucasian and referred, our findings may not generalize to other ethnic groups or settings. CONCLUSIONS: The CBCL can aid in the identification of subtypes of emotional dysregulation affecting youth seeking mental health services.

Tics of Trauma: Unique Case of Trauma-Associated Psychogenic Tics in an Adolescent Patient.

Tic disorders are a common psychiatric diagnosis in adolescents. While often a primary disorder, there have been few reports of trauma-associated secondary psychogenic tics. In this case, we detail a 16-year-old girl with a history of trauma who initially presented with depression and trauma-related anxiety. During the course of treatment, she also developed verbal and motor tic-like symptoms that worsened with stress and court proceedings. We classify these new symptoms as psychogenic tics secondary to the trauma associated with sexual abuse. We explore the implication of psychiatric comorbidities, socio-legal stressors, and medication changes in the patient's new-onset motor and vocal tics. This case points toward a need for consideration of this unique psychiatric manifestation of trauma-associated tics in adolescents with a history of sexual abuse and with otherwise normal neurological and physical examinations.

Energy Drink Use in Adolescents With and Without ADHD: Trends and Influences.

OBJECTIVE: We sought to determine the frequency, reasons for, and factors associated with energy drink consumption in adolescents with or without attention deficit hyperactivity disorder (ADHD). DESIGN: Anonymous surveys were completed by 115 adolescents and their parents prior to appointments at two separate outpatient clinics (pediatric and psychiatric) over a three-month period. Trained staff provided surveys to be completed by adolescents and their parents on a voluntary basis, and all data was self-reported. Care was given to ensure adolescents and their parents completed surveys independently from each other. RESULTS: A total of 114 adolescent surveys and 100 parent surveys were included in analysis. There was a statistically significant association between parent and adolescent consumption of energy drinks. The mean number of energy drinks consumed in the past month was lower among adolescents than among parents. The most common reason among all respondents for energy drink consumption was to promote wakefulness. CONCLUSION: This survey found that adolescents with parents who consumed energy drinks were more likely to drink energy drinks themselves. Trends indicate that consumption of energy drinks is increasing in the adolescent population, with potential for serious adverse events resulting from high caffeine content, warranting the need for public health awareness.

Pre-operative Anxiety in Pediatric Surgery Patients: Multiple Case Study Analysis with Literature Review.

Pre-operative anxiety affects millions of pediatric surgery patients each year and can have both short and long-term adverse effects in the post-operative period. As a result, it is particularly important for healthcare providers and others involved in the child's care, such as the parents, to be aware of interventions that can be used to reduce the onset of pre-operative anxiety and, thus, the likelihood of negative post-operative changes. The purpose of this paper is to familiarize the reader with the issue of pre-operative anxiety through a review of the literature and analysis of case studies. First, the paper looks at the causes of pre-operative anxiety and its effect on the development of maladaptive behavioral, emotional, and physiological changes. It then discusses the ways pre-operative anxiety can be measured and current methods for reducing the post-operative adverse outcomes associated with it. After doing so, it proposes the need for additional research and the use of precision medicine by physicians.

Can the Child Behavior Checklist (CBCL) help characterize the types of psychopathologic conditions driving child psychiatry referrals?

BACKGROUND: Little is known about the scope of problems driving referrals to child and adolescent psychiatry services. Identifying the full range of mental disorders affecting a particular child can help triage the child to a clinician with the appropriate level of expertise. The Child Behavior Checklist (CBCL) is an easy-to-use assessment tool that may provide invaluable information regarding the severity of the presenting complaints and also aid in the referral process. OBJECTIVE: To assess the utility of the CBCL to gain insights into the type of clinical problems driving referrals of youth to an outpatient pediatric psychiatry clinic. METHOD: The sample consisted of 418 newly referred youth 4-18 years of age of both sexes. Parents completed the CBCL assessing psychopathology and competence. Rates of patients with elevated T-scores on each scale were calculated for the whole group and stratified by sex and age (≤12 versus >12). RESULTS: The CBCL identified high rates of psychopathology affecting referred youth. It also provided information on the type of suspected disorders affecting a particular child as well as their severity, critical information to guide likely differing clinical needs and therapeutic approaches. It also helped identify a high number of youth affected with multiple psychopathological conditions, likely to require a high level of clinical attention. Overall, males were significantly more impaired than females but there were no major differences between children and adolescents. CONCLUSIONS: The CBCL can aid in the identification of individual and comorbid mental disorders affecting youth seeking mental health services by providing specific information about the presence and the severity of specific suspected disorder. These findings have implications for prioritizing scarce resources in child mental health and for improved consideration of the complexity of clinical presentations to pediatric psychiatry programs of any type.

Depressive and Anxiety Symptoms among Pediatric In-Patients with Dengue Fever: A Case-Control Study.

BACKGROUND: Psychiatric symptoms have been reported in adult patients with dengue fever (DF); however, information on pediatric patients remains inadequate. We sought to identify the prevalence and predictors of depressive and anxiety symptoms and identify other psychiatric symptoms among pediatric patients with DF. This case-control study involved pediatric in-patients (n = 225) who had clinical or serologic-confirmed DF and healthy school-based controls (n = 260). Participants completed the Revised Child Anxiety and Depression Scale (RCADS). RESULTS: The prevalence of depressive (13.3%) and anxiety (34.2%) symptoms among pediatric patients with DF was significantly (p < 0.001) higher than that among controls (3.5% and 16.2%, respectively). Multiple linear regression analysis found that age, family history of DF, ≤2 days of hospitalization, myalgia, and arthralgia were predictors of increased depressive and anxiety symptoms among the patients. Further, 26.7% of pediatric patients reported irritability, agitation, visual hallucinations, and aggressiveness. CONCLUSION: Pediatric patients present depressive and anxiety symptoms whose levels were associated with social and clinical factors. However, whether these symptoms are present only during the infection or may still persist after recovery or are brought by children's adverse reactions to hospitalization are unknown, and thus, further studies are needed.

Caracterización de las interconsultas de psiquiatría realizadas en el Hospital Pediátrico Docente "Juan Manuel Márquez" / Characterization of psychiatric interconsultations carried out at "Juan Manuel Márquez" Pediatric Teaching Hospital

RESUMEN Introducción: La relación entre las diferentes especialidades es necesaria para elevar la calidad de la atención a los pacientes. Objetivo: Describir las características de las interconsultas de psiquiatría realizadas en el Hospital Pediátrico Juan Manuel Márquez entre enero de 2017 y junio de 2018. Material y Métodos: Se realizó un estudio descriptivo, longitudinal prospectivo, entre enero 2017 y junio 2018, a partir de 154 solicitudes de interconsultas de psiquiatría (escritas). Se constituyeron además en unidades de análisis los pacientes interconsultados. Los datos fueron recogidos en una planilla, y se analizaron descriptivamente con el software SPSS 21.0. Las correlaciones consideraron p< 0,05 como valor de significación. Resultados: Se verificó aumento semestral sostenido en la solicitud de interconsultas. Miscelánea fue el servicio que más solicitudes hizo (51,9%). El 81.9% de las solicitudes expresaba los motivos de interconsulta, la valoración por intento suicida fue el más frecuente (40,8%). El diagnóstico más frecuente fue Trastorno de Adaptación (35.7%). El 94.8% de los casos fueron vistos el mismo día de la solicitud. Las interconsultas paralelas (66.9%) fueron las más realizadas. Conclusiones: La imagen de la psiquiatría de interconsulta y enlace está cambiando al interior de la cultura hospitalaria, pero aún persisten claras evidencias de las carencias que tienen los médicos de otras especialidades en relación con la interpretación de las manifestaciones psicopatológicas de sus pacientes y la asociación con las patologías de base.

ABSTRACT Introduction: The relationship between different specialties is necessary to give better care to patients. Objective: To describe the characteristics of psychiatric interconsultations carried out at "Juan Manuel Marquez" Pediatric Teaching Hospital from January, 2017 to June, 2018. Materials and Methods: A descriptive prospective cross-sectional study was conducted between January 2017 and June 2018 on the basis of 154 written requests for psychiatric interconsultations. The patients consulted were also considered as units of analysis. The data were collected on a list and analyzed descriptively using SPSS version 21.0 software. The correlations considered p< 0.005 as significance value. Results: A sustained increase in the semester was determined in the request for interconsultations. The miscellaneous service made more requests (51.9%). The reasons for consultation were expressed in 81.9% of the requests, and the assessment for suicide attempt was the most frequent (40.8%). The most frequent diagnosis was Adjustment Disorder (35.7%). Also, 94.8% of the cases were seen the same day. Parallel consultations (66.9%) were the most performed. Conclusions: The image of consultation-liaison psychiatry is changing in the interior environment of hospital culture, but there is still clear evidence of the deficiencies that doctors from other specialties have in relation to the interpretation of psychopathological manifestations of their patients and their association with the underlying pathologies.

Reducing seclusion and restraints on the inpatient child and adolescent behavioral health unit: A quality improvement study.

BACKGROUND: The utilization of seclusion and restraint during psychiatric inpatient treatment increases the risk of trauma, humiliation, physical injuries, psychological distress, and even death. Compared to adult patients, pediatric patients are more likely to be placed in seclusion and restraints. In a short-term child and adolescent behavioral health unit, the average seclusion and restraint rate was 0.031. The hospital's goal was to achieve a zero seclusion and restraint rate. PURPOSE: The purpose of this project was to decrease the rate of seclusion and restraints at the study site. METHOD: A quality improvement study was implemented based on a bundled intervention strategy. The intervention included a decision-making algorithm for initiation of seclusion and restraints, behavioral modification plans for patients at risk of seclusion and restraints, and a patient-debriefing tool to be used post a seclusion and restraint event. Post implementation, data were collected over a 3-month period. RESULTS: The implementation of a seclusion and restraint decision-making algorithm, behavioral modification, and patient debriefing successfully decreased the seclusion and restraint rate by 55% on an inpatient pediatric behavioral health unit. CONCLUSION: Although, the project resulted in a successful reduction in the rates for seclusion and restraint, continued quality improvement efforts are indicated to achieve zero restraint/seclusions on the unit.

Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder.

STUDY OBJECTIVES: Sleep-related slow-wave activity (SWA) has been recognized as a marker of synaptic plasticity. In children affected by attention deficit hyperactivity disorder (ADHD), SWA is mainly located in the central rather than frontal regions, reflecting a maturational delay. A detailed subjective and objective sleep investigation, including a full night video-polysomnography (PSG-HD-EEG), was performed on 30 consecutive drug naïve outpatients with a diagnosis of ADHD. They received a diagnosis of sleep disorders in 29/30 cases, and most of them had a past history of sleep problems. They had a higher apnea-hypopnea index at PSG, and slept less than 9 hr at actigraphy. We aimed to describe the SWA behavior in the same group of children with ADHD. MATERIALS AND METHODS: The full-night PSG-HD EEG of children with ADHD was compared with the one of the 25 healthy controls. The scalp SWA mapping, the decrease of SWA during the night, and the EEG source of SWA were analyzed. RESULTS: At scalp topography, the focus of SWA was observed over the centro-parietal-occipital regions in participants with ADHD (p < 0.01), which remained significant in the subgroups divided between subgroups according to the sleep diagnosis (p < 0.01). The physiological decrease in SWA was more evident in control participants. The source analysis revealed a greater delta power over the posterior cingulate in participants with ADHD (p < 0.01). CONCLUSIONS: Our results confirm static and dynamic changes in SWA behavior in children with ADHD, which may reflect a maturational delay occurring at a vulnerable age, as a consequence of chronic sleep deprivation.

Pediatric Electroconvulsive Therapy: An Anesthesiologist's Perspective.

Proper planning and communication between psychiatry and anesthesiology teams is vital to conferring the greatest therapeutic benefit to children presenting for electroconvulsive therapy while minimizing risk. Anesthesia for the child undergoing electroconvulsive therapy should ideally provide deep hypnosis, ensure muscle relaxation to reduce injury, have minimal effect on seizure dynamics, and allow for rapid recovery to baseline neurologic and cardiopulmonary status. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment.