Electroconvulsive therapy: contemporary standards of practice.
Electroconvulsive therapy (ECT) has retained an important but controversial position in contemporary psychiatric therapeutics. Out-dated standards of clinical practice regarding its technical administration, clinical indications, and dosage continue to influence the present use of ECT. Insofar as present knowledge permits, this paper describes optimum clinical standards for the use of ECT in contemporary practice. Where knowledge is insufficient to permit articulation of absolute standards, guidelines for its clinical use are presented. Particular emphasis is placed upon a narrow definition of the clinical indications for ECT, clearly linked to its demonstrated effectiveness and potential benefit in excess of its risks to any given patient. The technical administration of the procedure is described in detail with particular emphasis on the pre-treatment protocol, including consent, and the treatment dosage, including stimulus waveform, electrode placement, and number of treatments per course. The major deficiencies in knowledge are identified.
D000647:Amnesia / Q000209:etiology; D003866:Depressive Disorder / Q000628:therapy; D004553:Electric Conductivity; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000592:standards*; D004569:Electroencephalography; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D028642:Persons with Psychiatric Disorders; D033242:Minors; D011786:Quality Control; D018570:Risk Assessment; D012559:Schizophrenia / Q000628:therapy