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THE PRACTICE OF ELECTROCONVULSIVE THERAPY RECOMMENDATIONS FOR TREATMENT, TRAINING, AND PRIVILEGING SECOND EDITION

A TASK FORCE REPORT OF THE AMERICAN PSYCHIATRIC ASSOCIATION 2001

SUMMARY

• ECT should not be reserved for use only as a "last resort"
• Some medical conditions substantially increase the risk of ECT treatment
• Elderly patients maybe at greater risk for more persistent confusion and greater memory deficits during and after ECT
• Few studies address the use of ECT in children and adolescents
• To some extent, medical adverse events can be anticipated
• ECT facilities should be appropriately equipped and staffed with personnel to manage potential clinical emergencies
• Each facility should have a minimal set of procedures that are to be undertaken in all cases
• It is incumbent on facilities using ECT to implement and monitor compliance with reasonable and appropriate policies and procedures
• The patient should provide informed consent for ECT unless he or she lacks capacity
• There is no clear consensus about what constitutes the capacity to consent
• There may be concern that the attending physician is biased toward finding that capacity to consent exists when the patient's decision agrees with his or her own
• Continued use of certain ECT devices is not justified, including sine wave, constant voltage and constant energy devices
• Patients should be monitored during ECT
• Continued therapy has become the rule in contemporary practice ... the risk of relapse after ECT is very high...the need for aggressive continuation therapy ... is compelling and it should be instituted as soon as possible
• After ECT, concern over recurrence of illness is so great- -that maintenance therapy should be initiated in virtually all patients receiving continuation therapy
• The absence of controlled studies of the efficacy or safety of long-term maintenance ECT
• The patient's medical record is a legal document ... the clinical record should contain a summary of major consent related discussions
• The practice of ECT is a highly technical and sophisticated medical procedure
• ECT training in residency programs in the U.S. ranges from excellent to totally absent. In many cases, the training is no more than minimal
• No national accrediting body presently provides assurance of clinical competency in ECT
• It is clear that general privileging in psychiatry will riot suffice and that specific privileges to administer ECT should be required

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