Abstract
Background: In 1990, the American Psychiatric Association (APA) developed comprehensive practice recommendations on electroconvulsive therapy (ECT), covering indications, assessment and management of risk factors, consent, treatment procedures, logistical factors, documentation, outcome evaluation, and post-ECT management, as well as training and both initial and ongoing determination of clinical competency. Over the ensuing decade, there have been considerable advances in the practice of ECT and related areas. For this reason, the APA Committee on ECT (composed of R. Weiner (chair), C. E. Coffey, L. Fochtmann, R. Greenberg, K. Isenberg, C. Kellner, L. Moench, and H. Sackeim) was tasked with the work of revising these recommendations. The product, which included opportunity for input by a wide variety of other sources, including individual experts and professional groups in a number of relevant fields, U.S. regulatory bodies, and major U.S. mental health consumer organizations, is being published by APA in Spring, 2000.
Results: ECT remains a highly viable treatment in mood disorders, as well as, to a lesser degree, for carefully selected cases within the schizophrenic spectrum and certain medical conditions. The most notable risk of ECT is amnesia, an area relevant to consent, treatment procedures, and monitoring of outcome. Considerable information is now available with respect to the use of ECT in the medically compromised population, for which there appears to be increased utilization. In terms of ECT technique, the use of features such as brief-pulse stimuli and EEG monitoring have become standard, although there continue to be indications for both unilateral and bilateral stimulus electrode placement. In this regard, it is important to provide a sufficiently suprathreshold stimulus with the unilateral technique. Recent data indicate a compelling need for aggressive post-ECT management to minimize risk of relapse/recurrence, including the availability of continuation ECT as a treatment option. Finally, increased attention must be placed on the training of psychiatrists in ECT, as well other disciplines involved in the ECT treatment team as a means to help ensure clinical competence.