Symptom change during inpatient treatment and residual symptom burden at discharge in adolescents receiving electroconvulsive therapy for severe mania or psychosis: a retrospective cohort study

Background Electroconvulsive therapy (ECT) is an important treatment option for severe adolescent psychosis and mania, but diagnosis-specific clinical outcomes remain incompletely characterized. We examined symptom improvement and residual burden at discharge, contrasting the clinical outcome profiles of adolescents with psychosis-spectrum disorders and bipolar mania. Methods This retrospective observational cohort included 85 adolescents receiving a first eligible acute ECT course (≥4 sessions) during inpatient care in 2012–2025: 48 with psychosis-spectrum disorders and 37 with bipolar I disorder presenting with acute manic symptoms. Paired admission and discharge Positive and Negative Syndrome Scale (PANSS) or Young Mania Rating Scale (YMRS) scores were analyzed separately. Seventy-two patients were included in an earlier institutional report of anesthetic, procedural, and global clinical outcomes. Post-hoc analyses used four assessments in 41 patients; pre-course and post-course ratings were not timed at fixed intervals from ECT sessions. Results Both groups showed substantial improvement. Mean reductions were 45.56 PANSS points (95% confidence interval, 39.00–52.13) and 30.08 YMRS points (26.44–33.73). Residual psychopathology remained common in the psychosis-spectrum group, including among patients meeting the response criterion; 60.4% had discharge PANSS scores ≥75. In the bipolar group, 91.9% met the ≥50% YMRS reduction criterion and 81.1% had low manic symptom severity at discharge (YMRS ≤12). Floor correction increased the proportion meeting the ≥50% PANSS reduction criterion from 18.8% to 41.7%. In the four-assessment subset, the largest mean reductions occurred between pre-course and post-course assessments: 23.05 PANSS points and 23.10 YMRS points; median within-patient ratios of course-linked to admission-to-discharge change were 42.9% for PANSS and 84.0% for YMRS. Conclusions The findings support the clinical effectiveness of ECT as part of inpatient treatment for severe adolescent psychosis or mania. Substantial improvement was accompanied by different residual symptom burdens, informing continuing care needs. PANSS response classification depended on floor correction. Concurrent treatment and the absence of a control group prevent isolation of ECT’s contribution. Sustained recovery was not assessed. Further prospective studies should examine the durability of improvement and whether discharge symptom burden predicts relapse or functional recovery.