The decision to use ECT: A retrospective study

Bailine, Samuel H.; Rau, John H.

doi:10.1016/0010-440x(81)90085-7

Cited by 10 publications

(4 citation statements)

References 11 publications

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“…Recent literature has focused on ECT as an addon treatment for patients with treatment-resistant schizophrenia, including clozapine-resistant patients (28,29). While there is considerable clinical trial, case series, and case report material to support the use of an acute course of ECT in patients with schizophrenia (30)(31)(32)(33)(34)(35)(36), the totality of the evidence has been inadequate to convince either the US FDA (18) or the Cochrane Database that ECT should be among the standard treatments: 'Moderate-quality evidence indicates that relative to standard care, ECT has a positive effect on mediumterm clinical response for people with treatment-resistant schizophrenia. However, there is no clear and convincing advantage or disadvantage for adding ECT to standard care for other outcomes' (37).…”

Section: Schizophreniamentioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

142

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When to consider electroconvulsive therapy (ECT) Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT).Objective: To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. Method: We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. Results: ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. Conclusion: ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia. Clinical recommendations for ECT• ECT should be prescribed earlier in the course of a severe depressive episode, not necessarily withheld until after numerous medication trials • ECT may be considered a first-line (primary) treatment for certain urgently ill patients, including those who are very suicidal, psychotic, or physically debilitated from depression Diagnostic indications for ECT • In many Western countries, severe and treatment-resistant depression is the main indication for ECT • Schizophrenia is the number one indication for ECT worldwide, but is little used for this indication in Western countries • ECT is an effective treatment for treatment-resistant mania • Delirious mania is an urgent indication for ECT • ECT is effective for treatment-resistant schizophrenia, including clozapine-resistant illness • Catatonia is very responsive to ECT • Both the motor and behavioural symptoms of Parkinson's disease respond to ECT Predictors of ECT response • Older age, psychotic symptoms, and shorter episode duration are predictors of better ECT response • Melancholic features and greater baseline depressive symptom severity are likely associated with better ECT response 304 ECT technique • Bilateral, bifrontal, and right unilateral electrode placement are all effective ECT techniques • Less urgently ill patients are often treated initially with right unilateral electrode placement • Brief and ultrabrief pulse width stimuli, now commonly used, are associated with a more benign cognitive effect profile • There is no a priori fixed number of ECT in an acute course: patients should continue treatment with ECT until they remit or a plateau has been reached, or tolerability issues require interruption of the course • Tapering of acute courses of ECT should be considered for most patients (e.g., approximately weekly treatments for several weeks past remission) • Continuation/Maintenance (C/M) ECT should be considered for patients with a history of severe, recurrent episodes who have failed to remain well on medications Additional comments • ECT is underutilized because of stigma, lack of knowledge about it, and bureaucratic restrictions • ECT is among the safest procedures performed under general anesthesia • Cognitive adverse effects are markedly decreased with modern ECT techniques, largely transient, and should not deter seriously ill patients from considering ECT.

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Section: Schizophreniamentioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

142

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“…(Breakey and Dunn, 2004, Kramer, 1985, 1990, 1999, Morrissey et al , 1981, Olfson et al , 1998, Thompson et al , 1994) Contemporary speculation about the cause of this difference largely focused on de facto racial segregation of black Americans into lower quality hospitals. (Asnis et al , 1978, Bailine and Rau, 1981, Kramer, 1990) This inference was supported indirectly by data demonstrating that psychiatric treatment of blacks has been disproportionately conducted in public facilities(Milazzo-Sayre et al , 2000), and that ECT availability was substantially lower in public than private hospitals during the period. (Asnis et al , 1978, Hermann et al , 1998, Kramer, 1990, Mills et al , 1984, Reid et al , 1998, Thompson et al , 1994) Despite these suggestive findings, the influence of hospital ECT availability on racial patterns in care has never been examined and no recent national data on racial differences in receipt of ECT exist.…”

Section: Introductionmentioning

confidence: 95%

Racial differences in the availability and use of electroconvulsive therapy for recurrent major depression

Case

Bertollo

Laska

et al. 2012

Journal of Affective Disorders

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Background Black Americans with depression were less likely to receive electroconvulsive therapy (ECT) than whites during the 1970’s and 80’s. This pattern was commonly attributed to treatment of blacks in lower quality hospitals where ECT was unavailable. We investigated whether a racial difference in receiving ECT persists, and, if so, whether it arises from lesser ECT availability or from lesser ECT use within hospitals conducting the procedure. Methods Black or white inpatient stays for recurrent major depression from 1993-2007 (N=419,686) were drawn from an annual sample of US community hospital discharges. The marginal disparity ratio estimated adjusted racial differences in the probabilities of (1) admission to a hospital capable of conducting ECT (availability), and (2) ECT utilization if treated where ECT is conducted (use). Results Across all hospitals, the probability of receiving ECT for depressed white inpatients (7.0%) greatly exceeded that for blacks (2.0%). Probability of ECT availability was slightly greater for whites than blacks (62.0% versus 57.8%), while probability of use was markedly greater (11.8% versus 3.9%). The white versus black marginal disparity ratio for ECT availability was 1.07 (95% confidence interval 1.06-1.07) and stable over the period, while the ratio for use fell from 3.2 (3.1-3.4) to 2.5 (2.4-2.7). Limitations Depressed persons treated in outpatient settings or who receive no care are excluded from analyses. Conclusions Depressed black inpatients continue to be far less likely than whites to receive ECT. The difference arises almost entirely from lesser use of ECT within hospitals where it is available.

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“…Despite recent developments in psychopharma‐cology, electroconvulsive therapy (ECT) still has an important place in the treatment of affective disorders 1 . Reviews of the patterns of ECT use have indicated that this treatment is more frequently used for older patients 2,3 . Because preexisting medical conditions 4,5 or other factors may increase the risk from ECT for geriatric patients, medical problems developing during a course of ECT were studied in a population of geriatric psychiatric patients and compared with those occurring in a control group of younger adult psychiatric patients.…”

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confidence: 99%

Medical Problems of Geriatric Psychiatric Patients and Younger Controls During Electroconvulsive Therapy

Alexopoulos¹,

Shamoian

Lucas³

et al. 1984

J American Geriatrics Society

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Medical problems occurring during electroconvulsive therapy were studied in a population of 293 psychiatric inpatients who received 2,809 treatments. Geriatric patients (N = 199) developed significantly more medical problems that required medical treatment or temporary discontinuation of electroconvulsive therapy than did younger controls (N = 94). The most important of these were cardiovascular in nature. Despite their increased frequency, the majority of medical problems that occurred were reversible. Electroconvulsive therapy therefore appeared to be a safe procedure for elderly psychiatric patients.

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The decision to use ECT: A retrospective study

Cited by 10 publications

References 11 publications

When to consider electroconvulsive therapy (ECT)

When to consider electroconvulsive therapy (ECT)

Racial differences in the availability and use of electroconvulsive therapy for recurrent major depression

Medical Problems of Geriatric Psychiatric Patients and Younger Controls During Electroconvulsive Therapy

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