hizophrenia 3 themostcontroversialtreatm
roduceageneralizedseizure2 treatmentfors
istoryofabusec unfavorablemediapresentat
ciallegalattentionf unevendistributionam
everementalillness i e acutemania somesc
ionsd compellingtestimonyofpatientse spe
1 applicationofabriefelectricstimulustop
ongpractitionersandfacilitiesg unevenacc
entinpsychiatrya thenatureofECTitselfb h
essbypatients
             
    rtheinstitutionalizedchronicallyill2 use
    swereunavailable ledtoaperceptionofECTas
    riouslyillinmentalinstitutionsb usedfora
    fectiveandevenharmfule usedasameansofman
    ychopharmacologicalmedicationsandwiththe
    hdosesandforlongperiodsoftimed ofteninef
    agingunrulypatientsforwhomothertreatment
    varietyofdisordersc frequentlygiveninhig
    anabusiveinstrumentofbehavioralcontrolfo
    ions3 nowusedmainlyingeneralhospitalpsyc
    developmentofjudicial regulatoryrestrict
    1 1940sand1950sa administeredtothemostse
    haswanedwiththeintroductionofeffectiveps
    hiatricunitsandinpsychiatrichospitals
             
    isn ttherepotentialformisuseandabuse 4
   1 isitbeingusedwhenalternativetreatmenti
   spossible 2 isittrulyeffectiveovertime 3
   uldcurtailingusedeprivecertainpatientsof
   isitsuseaviolationofpatients rights 5 wo
   potentiallyeffectivetreatment
             
ousintheshortterm3 ECTastreatmentfordelu
streatmentforendogenous melancholicdepre
ortdurationofillness amoreacuteonset and
erapidonsetofactionthanantidepressantsd
ning2 ECTastreatmentfordepressiona themo
entofdepressionb relapseratesarehighunle
sionaldepressiona highlyeffectiveb super
ectiveforthosepreviouslyunresponsivetoan
italizationwithoutsomatictherapyc whenfo
skofrelapse6 ECTastreatmentforschizophre
tidepressantsc long termefficacyisunknow
iortoantidepressantsorneurolepticsc effe
n5 ECTastreatmentforacutemanicepisodea e
llowedbylithiummaintenance noincreasedri
noteffectiveformilddepressions i e dysth
ymicoradjustmentdisorder e onlyadvantage
ssiona effectiveshort termtreatmentb eff
tshouldbetriedb effectiveforthosewithash
notintermsofqualityoflifeorsocialfunctio
ssmaintenanceantidepressantsareusedc mor
ctiveforthosepreviouslyunresponsivetotre
1 measuredonlyintermsofsymptomreduction
steffectivetreatmentforshort termmanagem
niaa neurolepticsarethefirsttreatmenttha
atmentd long termefficacyisunknown4 ECTa
quallyeffectiveaslithiumb superiortohosp
moreintenseaffectivesymptoms
             
feasible decreaseordiscontinuemedication
ond EKGe laboratorytests2 whenclinically
singECT19 requireperiodicinspectionofECT
t4 evaluateandmonitorcardiacconditions5
yplacingabloodpressurecuffonanarmorlegan
lspecificallytrainedandcertifiedintheuse
ndreviewcommitteesinhospitalsandcentersu
aforECTadministrationandrecoverya haveap
eb includeequipmentandmedicationstousein
sthataffecttheseizurethresholdbeforebegi
beforetreatmentb belithium free3 getseve
rehypertensionundercontrolbeforetreatmen
propriatehealthcareprofessionalsavailabl
sethelowestamountofelectricalenergytoind
ts12 rememberthatabriefpulsestimulusresu
ltsinfewercognitivedeficitsthanthesinewa
educatethepatientandfamilypriortoobtaini
atnondominantunilateralECTresultsinshort
erconfusionalperiodsandfewermemorydefici
icalexaminations18 establishregulationsa
1 performapretreatmentmedicalexamination
ngwritteninformedconsent6 designateanare
ofbriefanestheticprocedures8 includetrai
nednursingpersonnelonthetreatmentteam9 u
dinflatingitabovesystolicpressurepriorto
tment continuepatientsonantidepressantme
theeventofcomplications7 useaprofessiona
dicationorlithium15 includeECTeducationi
uceanadequateseizure10 rememberthatbilat
eralECTisoftenmoreeffective11 rememberth
nmedicalschoolcurricula16 includeECTtrai
nningECTtreatmenta discontinueMAOI2weeks
theinjectionofamusclerelaxer14 aftertrea
ludequestionsaboutECTinoralandwrittenmed
vestimulus13 monitorseizureswithanEEGorb
a historyb physicalc neurologicexaminati
ninginpsychiatricresidencyprograms17 inc
equipment
             
        ure andpulseratethroughoutprocedure7 pla
        tilatoryassistancewithapositivepressureb
        withoneelectrodefrontatemporallyandthese
        ffasting2 giveatropineoranotheranticholi
        aperipheralveinuntilafterrecovery4 provi
        sareusuallyeffective9 theusualfrequencyi
        nergicagentpriortotreatment3 placeanIVin
        detheanestheticmethohexitalandthensuccin
        ylcholineformusclerelaxation5 provideven
        1 beginintheearlymorningafter8to12hourso
        cestimuluselectrodesbifrontotemporallyor

        agusing100 oxygen6 monitorEKG bloodpress
        condontheipsilateralside8 6to12treatment
        s3timesweeklyintheUS 2timesweeklyintheUK
             
      dividuals notforinstitutions7 foracutema
      eatment10 forseveredepressionorpsychosis
      sconsent1 risksandbenefitschangeinnature
      duringthe1sttrimesterofpregnancy11 after
      asbeenestablisheda delusionalandsevereen
      out4 whenabsolutelynecessarytopreserveli
      entions8 afterconsiderationofonesemotion
      apacitychangesduringtreatment3 ECTresult
      fthepossiblerisksandbenefitsinvolvedc wh
      asedintracranialpressureb space occupyin
      entifyandclarifytheoptionsthatthepatient
      procedured whenthephysicianhasstrovetoid
      dogenousdepressionsb acutemaniac certain
      schizophrenicsyndromes2 aftercomplexcons
      nicepisodecharacterizedbycertainsymptoms
      enthepatientunderstandsthecharacterofthe
      shavebeenfullyconsidered tested andruled
      lhistoryofunresponsivenessf personalhist
      1 onlyinthoseconditionsforwhichefficacyh
      fe5 whenthereisariskofsuicidenotmanageab
      lebyanyothermeans6 onlyforthebenefitofin
      individualcase3 afterallotheralternative
      oryofdebilitatingsideeffects12 whenthepa
      sinmemorylosssocontinuousconsentisessent
      medicalcomplicationse deaththroughexhaus
      alsufferingorextremeincapacitation9 when
      medicalconditionsprecludetheuseofothertr
      certainconditionshavebeenruledouta incre
      glesionsinthebrainc recenthistoryofmyoca
      iderationofadvantages disadvantagesinthe
      psychomotoragitationd highriskforserious
      treatmentoptionsb whenthepatientisawareo
      tionf nonresponsetopharmacologicalinterv
      rdialinfarctiond largeaneurysmse persona
      tienthasfreelygiveninformedconsenta when
      ialf acourtmustissueconsentforanincompet
      a cloudedsensoriumb dehydrationc extreme
      thepatientisawareofallothertreatment non
      aloneisentitledtoexercisee whenthephysic
      ianinitiatesperiodicreviewsofthepatient
      throughouttreatment2 thepatient smentalc
      entpatient
             
   andresultingmemorydeficits3 delineatethe
   ismsunderlyingthetherapeuticeffectsofECT
   nt5 identifypatientsubgroupsforwhomECTis
   1 anationalsurveya assemblethebasicfacts
   aboutECTuseb studypatientattitudesandres
   ponsestoECT2 identifythebiologicalmechan
   sandcognition4 determinethemodeofelectro

   long termeffectsofECTonaffectiveillnesse
   deplacementandstimulusparametersthatmaxi
   mizeefficacyandminimizecognitiveimpairme
   particularlybeneficialortoxic