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 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