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Electroconvulsive therapy: International guidelines, clinical governance and patient selection

Published online by Cambridge University Press:  13 June 2014

Gavin Rush ,
Okka Kimmich  and
James V Lucey
Gavin Rush*
Affiliation:
Cavan Mental Health Service, Cavan General Hospital, Co. Cavan, Ireland
Okka Kimmich
Affiliation:
Charité -, UniversitätsmedizinBerlin, Schumannstr.20/21, 10117 Berlin, Germany
James V Lucey
Affiliation:
St Patrick's Hospital, Dublin 8, Ireland
*
Correspondence Email: [email protected]
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Abstract

Recent reports from the Inspector of Mental Health Services have highlighted marked variations in electroconvulsive therapy (ECT) prescriptions nationally. This article reviews six international guidelines in order to assess the question of which patients should be referred for ECT treatment and at what stage in their illness. The guidelines display a general consensus in terms of the acutely and severely ill, but differ dramatically in terms of access to ECT outside this category, such as the moderately depressed patient who is treatment resistant but non-psychotic and non-suicidal and who requests ECT due to a previous good response.

The American Psychiatric Association guidelines strongly support the early consideration and use of ECT, highlighting the dangers associated with increased length of illness for individual prognosis. The National Institute of Clinical Excellence (UK) guidelines are the strictest, reserving ECT for the severely ill exclusively and only in cases with a demonstrable failure of alternative treatments. This confusion may ultimately need to be addressed by the Mental Health Commission as data relating to variations in practice may result in inappropriate reductions in access to an established treatment.

Keywords

Electroconvulsive therapyDepressionGuidelines.
Type
Review
Information
Irish Journal of Psychological Medicine , Volume 24 , Issue 3 , September 2007 , pp. 103 - 107
Copyright
Copyright © Cambridge University Press 2007

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References

1.UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799–808.Google Scholar
2.Electroconvulsive therapy for schizophrenia. Cochrane Database of Systematic Reviews. 2006; 4.Google Scholar
3.Daly, A, Walsh, D, Moran, R, O'Doherty, YK. Activities of the Irish Psychiatric Services 2003. Health research Board (Ireland), 2004.Google Scholar
4.Mental Health Commission, Annual Report 2004, Including the Report of the Inspector of Mental Health Services. 2004Google Scholar
5.Eranti, S, McLoughlin, D. Electroconvulsive therapy – state of the art. Br J Psychiatry 2003; 182:8–9.Google Scholar
6. Mental Health Commission Rules (Ireland) Rules Governing the use of Electroconvulsive Therapy. (Reference Number: R-S59(2)/01/2006.)Google Scholar
7.Caird, H, Worrall, A, Lelliott, P.The Electroconvulsive Therapy Accreditation Service. Psychiat Bull 2004; 28: 257–259.Google Scholar
8.The Practice of Electroconvulsive Therapy. Recommendations for Treatment, Training and Privileging. 2nd Ed. A Task Force Report of the American Psychiatric Association. 2001.Google Scholar
9.National Institute of Clinical Excellence Technology Appraisal 59. Guidance on the use of Electroconvulsive Therapy. London: NICE, 2003.Google Scholar
10.World Health Organisation. ICD-10 Classification of Mental and Behavioural Disorders. WHO: Geneva, 1992.Google Scholar
11.Royal College of Psychiatrists ECT handbook. The Third Report of the Royal College of Psychiatrists' Special Committee on ECT (Council Report CR128). London: Royal College of Psychiatrists, 2005.Google Scholar
12. Stellungnahme zur Elektrokrampftherapie (EKT) als psychiatrische Behandlungsmassnahme (Statement on ECT as a psychiatrie treatment measure). Bundesärztekammer 2004.Google Scholar
13.Canadian Psychiatric Association. Position Paper on Electroconvulsive Therapy. 1992.Google Scholar
14.The Royal Australian and New Zealand College of Psychiatrists. Clinical Memorandum #12. Electroconvulsive Therapy. Guidelines on the administration of electroconvulsive therapy (ECT). February 2005.Google Scholar
15.Rush, G, McCarron, S, Lucey, JV. Patient attitudes to electroconvulsive therapy. Psychiat Bull 2007; 31: 212–214.Google Scholar
16.A Vision for Change. Report of the Expert Group on Mental Health Policy. Department of Health and Children (Ireland). 2006.Google Scholar
17.The Lourdes Hospital Inquiry. An Inquiry into peripartum hysterectomy at Our Lady Of Lourdes Hospital, Drogheda. Department of Health and Children (Ireland), 2006.Google Scholar
18.Scally, G, Donaldson, L.Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998; 317: 61–65.Google Scholar
19.Mental Health Commission, Annual Report 2005, Including the Report of the Inspector of Mental Health Services. (Ireland), 2005.Google Scholar