Clinical manual of electroconvulsive therapy (original) (raw)

Electroconvulsive therapy: current status

Electroconvulsive therapy (ECT) can differ in its application in three ways: electrode placement, frequency of treatments and electrical waveform of the stimulus. Seizure threshold and dosing affects efficacy, speed of clinical response and cognitive deficits. Proposed mechanisms are psychological theories, structural theories, electrophysiology and neurophysiology, biochemical theories and molecular theories. In animal models, there is synaptic plasticity in hippocampus, mossy fibre sprouting, alterations in cytoskeletal structure, promotion of neurogenesis and suppression of apoptosis. Biochemical theories include the monoamine hypothesis, beyond monoamines, vascular endothelial growth factor and brain derived neurotrophic factor. It has generally low risk and one of the safest procedures performed under general anaesthesia. ECT can be given safely to patient with epilepsy; can be given in healed skull and brain trauma, neurologically stable patient after a cerebrovascular accident. Primary use is in rapid definitive response required on medical or psychiatric grounds, risks of alternative treatments outweigh benefits, past history of poor response to psychotropics or good response to ECT and patient preference. ECT is the most effective treatment in depression. Schizophrenia is the second most common diagnostic indication. Some individuals consider ECT to have been a beneficial and lifesaving treatment while others reported feelings of terror, shame and distress. Written, informed consent of the patient is important before ECT is administered. With the development of new techniques for application of ECT its public perception regarding its use has improved in a positive sense.

Efficacy of electroconvulsive therapy: Too Brief Or Not Too Brief?: Too Brief Or Not Too Brief?

2015

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Medication management during electroconvulsant therapy

Electroconvulsive therapy (ECT) has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords.

Challenges during Electroconvulsive Therapy—A Review

Journal of Neuroanaesthesiology and Critical Care, 2021

Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders pr...

The present status of electroconvulsive therapy: a systematic review

Medical Journal of Australia, 1999

B efore the introduction of physical therapies in the 1930s, the only treatment available for severe mental illness was institutional confinement and sedation. I Of the physical therapies, insulin coma therapy is now no longer used and psychosurgery is used only rarely," but electroconvulsive therapy (ECT) remains an important treatment, mostly for patients suffering from depressive disorders. ECT involves the electrical induction of a brief generalised seizure of adequate intensity after administration of a short-acting general anaesthetic and muscle relaxant (Box 1). Given the considerable morbidity and increased rate of mortality (including suicide)! associated with the depressive disorders, which represent, in fact, a greater disease burden than cardiovascular and cerebrovascular disease, it is timely to review the current practice of ECT. 5 Methods We performed a systematic review of recently published primary research related to the current practice of ECT. We searched the MEDLINE database for all English language articles published in 1987-1998, using the term "electroconvulsive therapy" together with "clinical indications", "electrical dose", "electrode placement", "anaesthesia", "side effects", "maintenance treatment" and "training". Results Of 115 references identified by the MEDLINE search, only 11 were reports of randomised controlled trials (RCTs) of ECT;6-16 the result of one meta-analysis was found after a manual search." A further 24 reports were evaluated which reported data from open, retrospective and descriptive studies, or were post-hoc evaluations of one of the RCTs identified. Studies were excluded if they did not report primary research or were unrelated to the aspects of ECT practice in which we were interested. 18 A manual search was also undertaken of the key specialty journal, Convulsive Therapy (since renamed Journal ofBCT), which was listed in MEDLINE for only a part of the period under review, as well as personal libraries and bibliographies of published articles. A few key

A desirable convulsive threshold. Some reflections about electroconvulsive therapy (ect)

European journal of analytic philosophy

Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. In many circumstances, drugs constitute the best allies of psychotherapeutic interventions. A robust scientific literature is oriented on finding the best strategies to improve therapeutic efficacy through different modes and timing of combined interventions. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches of medicine. An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. In this paper I corroborate the idea that therapists should provide drug-resistant patients with every effective and available treat...

Regressive and Intensive Methods of Electroconvulsive Therapy: A Brief Historical Note

Journal of Ect, 2007

In the 1940s, regressive and intensive methods were developed to increase the therapeutic effects of electroconvulsive therapy. The diagnostic indications, methods of application, effectiveness, complications, and mortality of these techniques are briefly discussed here. An attempt is also made to evaluate the risks and benefits of these methods from a historical perspective.