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The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.

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IntroductionA small subset of patients with above average admissions to psychiatric inpatient units is recognized in clinical practice. These frequent users tend to be younger and to have a diagnosis of schizophrenia or affective disorder. Social conditions and the severity of the illness seem to be associated with this increased number of admissions.Aims/ObjectivesTo study demographic and clinical characteristics of frequent and non-frequent users of a psychiatric inpatient unit.MethodsRetrospective data of all the patients admitted to a psychiatric inpatient unit from January 2004 to December 2008 were reviewed. Frequent-users were defined as patients with 3 or more admissions over that period of time, and non-frequent users as those with less than 3 admissions. The two groups were compared in terms of age, gender, ethnicity, psychiatric diagnosis and compulsory admissionsResultsIn a total of 2018 admissions and 1348 patients, the frequent-user group represented 10.2% (n = 137) of the patients and 28.9%(n = 584) of the admissions. Frequent-users were significantly younger (39.5 vs. 44.5 years, p = .001), more frequently black (22.6 vs. 19.4%, p < .001) and compulsorily admitted (27.7 vs. 14%, p < .001) than non-frequent users. Patients with bipolar disorder (p = .001), schizophrenia (p = .003) belonged significantly more to frequent-users group, while unipolar depressive patients (p = .016) and other diagnosis (p = .011) was more significantly represented in the non-frequent users group. Frequency of admission did not differ with gender.ConclusionsThe results concerning age and psychiatric diagnosis are consistent with previous studies. Compulsory admissions and black ethnicity were significantly higher among frequent- users.

IntroductionDecision capacity (DC) is a complex construct, whose assessment poses huge challenges to Liaison Psychiatrist (LP).Objectives/aimsAssess factors related to DC in patients with somatic disorders admitted in medical and surgical departments of a general hospital.MethodsClinical records of patients who were submitted to a DC assessment at Hospital Fernando Fonseca (Portugal), from 1st January 2012 to 31st December 2014 were retrospectively analysed. Collected data were statistically analysed with SPSS®. Univariable analysis was performed, in order to determine factors related to DC.ResultsData from 35 patients subject to DC evaluation were considered, of whom 42.4% were considered unable to give consent to medical and/or surgical procedures. Most of these assessments were related to patients who refused treatment. Patients unable to decide were predominantly male and mainly affected by organic mental or neurocognitive disorders (P < 0.05). There were no statistical significant differences in the age of those considered able or unable to decide. After PL intervention, 40% of those considered unable to decide changed their decision. However, it was not significantly related to the ability to give consent.ConclusionsNeurocognitive disorders are common diagnosis found in patients admitted in somatic departments with no DC. Frequent change in decision after LP intervention may reflect not only cognitive fluctuations, but also a possible influence of LP intervention on patients’ choices. Appropriate standardized measures are useful tools in assessing patients with cognitive impairment, reducing evaluation differences between professionals, and in order to increase LP decisions credibility.Disclosure of interestThe authors have not supplied their declaration of competing interest.