ECT is now restricted to disorders such as major depression with psychotic symptoms and psychomotor inhibition but only when drug treatment is contra-indicated, ineffective, or precluded by its side effects. The only other approved indications for ECT in the updated regulations are for drug-resistant manic psychoses, malignant neuroleptic syndrome, and malignant catatonia, although the ministry's guidelines themselves admit that evidence of ECT's efficacy for these conditions is "limited and questionable". ECT has been expressly discouraged for schizophrenia--an indication in the former 1996 guidelines--and is now banned as a means of achieving "rapid remission of symptoms" in psychiatric disease. ECT can now only be legally done in approved inpatient institutions (public and private) by both a psychiatrist and an anaesthetist. Also, the patient's written informed consent is now mandatory, unlike before.

The psychiatric community is still split over ECT's place in modern psychiatric therapy. Some welcomed the guidelines as justly rectifying the previous regulations, which allowed too much space for ECT in psychiatric therapy. Whereas others deplored the way the new guidelines had made use of ECT in Italy almost impossible.

Bruno Simini