The Practice of Electroconvulsive Therapy - Recommendations for the Practice of Electroconvulsive Therapy

Written by Juli Lawrence

Because of the possible problems with confusion and memory, it is important that I not make any important personal or business decisions during the ECT course or immediately following the course. This may mean postponing decisions regarding financial or family matters. After the treatment course, I will begin a "convalescence period," usually one to three weeks, but which varies from patient to patient. During this period I should refrain from driving, transacting business, or other activities for which impairment of memory may be problematic, until so advised by my doctor.

The conduct of ECT at this facility is under the direction of Dr. _________________. I may contact him/her at (phone number: ________________) if I have further questions.

I understand that I should feel free to ask questions about ECT at this time or at any time during the ECT course or thereafter from my doctor or from any other member of the ECT treatment team. I also understand that my decision to agree to ECT is being made on a voluntary basis, and that I may withdraw my consent and have the treatments stopped at any time.

I have been given a copy of this consent form to keep.

Patient:

Date Signature

Person Obtaining Consent:

Date Signature

Sample Patient Information Sheet

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a safe and effective treatment for certain psychiatric disorders. ECT is most commonly used to treat patients with severe depression. It is often the safest, fastest, and most effective treatment available for this illness. ECT is also sometimes used in the treatment of patients with manic illness and patients with schizophrenia. Treatment for depression has improved remarkably over the past 25 years. The techniques of administering ECT have also improved considerably since its introduction. During ECT, a small amount of electrical current is sent to the brain. This current induces a seizure that affects the entire brain, including the parts that control mood, appetite, and sleep. ECT is believed to correct biochemical abnormalities that underlie severe depressive illness. We know that ECT works: 80% to 90% of depressed people who receive it respond favorably, making it the most effective treatment for severe depression.

Your physician suggests that you be treated with ECT because you have a disorder that (s) he believes will respond to ECT. Discuss this with your doctor. Before ECT begins, your medical condition will be carefully assessed with a complete medical history, physical examination and laboratory tests including blood tests and an electrocardiogram (ECG).

ECT is given as a course of treatments. The number needed to successfully treat a severe depression ranges from 4 to 20. The treatments are usually given 3 times a week: Monday, Wednesday, and Friday. You must not eat or drink anything after midnight prior to your scheduled treatment. If you smoke, please try to refrain from smoking on the morning prior to your treatment.

Before your receive the treatment, a needle will be injected into a vein so that medications can be given. Although you will be asleep during the treatment, it is necessary to begin to prepare you while you are still awake. Electrodes are placed on your head for recording your EEG (electroencephalogram or brain waves). Electrodes are placed on your chest for monitoring your ECG (cardiogram or heart rhythm). A blood pressure cuff is wrapped around your wrist or ankle for monitoring your blood pressure during the treatment. When everything is connected, the ECT machine is tested to ensure that it is set properly for you.

CONTINUING EDUCATION COURSES

FOR PSYCHIATRISTS Duke University

Visiting Fellowship: 5-day course for one or two students, designed to provide advanced training and skills in modern ECT administration. 40 CME credits.

Mini-Course: 1.5 day course designed to enable practicing clinicians to upgrade their skills in ECT. 9 CME credits.
Director: C. Edward Coffey, M.D. 919-684-5673

SUNY at Stony Brook

5-day course for four to six students, designed to provide advanced training and skills in modern ECT. 27 CME credits.
Director: Max Fink, M.D. 516-444-2929

American Psychiatric Association

At annual meetings of the APA, one-day courses are usually presented for classes of students up to 125. These are lecture/demonstrations and aim to provide discussions of such topics as treating the high-risk patient, technical aspects of treatment, and theories of ECT action. For details, see annual course offerings of APA.

Individual preceptorships

From time to time, other experienced clinicians accept visitors for varying lengths of stay at their clinics.

FOR NURSES

Courses for nurses are available at both Duke University and SUNY at Stony Brook. For information, contact Martha Cress, R.N., or Dr. Edward Coffey at Duke University, or Dr. Max Fink at SUNY at Stony Brook.

FOR ANESTHESIOLOGISTS

The courses for psychiatrists at SUNY at Stony Brook include special sessions for anesthesiologists.

Appendix D

Addresses of Present ECT Device Manufacturers in the United States and Major Characteristics of Models Offered as of February 1990

The present devices of these manufacturers meet the recommended standards of the APA Task Force on Electroconvulsive Therapy. In addition, the manufacturers distribute educational materials (books and videotapes), which are useful in learning about ECT.

ELCOT Sales, Inc.
14 East 60th Street
New York, NY 10022
212-688-0900

MECTA Corp.
7015 SW. McEwan Road
Lake Oswego, OR 97035
503-624-8778

Medcraft
433 Boston Post Road
Darien, CT 06820
800-638-2896

Somatics, Inc.
910 Sherwood Drive
Unit 17
Lake Bluff, IL 60044
800-642-6761

next: Time to Abandon Electroconvulsion as a Treatment in Modern Psychiatry
~ depression library articles
~ all articles on depression