Should psychiatrists administer anesthesia for ECT?

Article Abstract:

Electroconvulsive therapy (ECT) is a psychiatric treatment that uses electric shock to produce convulsions in the patient. ECT is used for patients with severe depression with suicidal tendencies. Current use of ECT is normally accompanied by concurrent electrocardiographic monitoring of the induced seizures, and anesthesia. There is still considerable controversy over whether the psychiatrist who prescribes the therapy should administer the anesthesia to the patient; some believe the presence of an anesthesiologist should be mandatory. This issue is somewhat clouded by public misconceptions and general negative perceptions of the ECT procedure. This study examined the validity of requiring an anesthesiologist to provide anesthesia for ECT. The nine-year experience of ECT in one institution was reviewed. Over 8,000 ECT treatments were evaluated. The results of a survey of 61 psychiatrists and 41 anesthesiologists were also reviewed. Eighty-one percent of the psychiatrists stated that the presence of an anesthesiologist was unnecessary, but 82 percent of the anesthesiologists responded that ECT was not safe if conducted by a psychiatrist alone. In 98.8 percent of the cases reviewed, a psychiatrist administered anesthesia. There were no deaths and very few complications as a result of the ECT. All of the psychiatrists involved in the cases that were reviewed had received training in administration of anesthesia for ECT. The authors have noted that the medical training of psychiatrists does not always provide proper training in the administration of anesthesia. This problem needs to be addressed, and better controls for certification are needed to ensure that the psychiatrist is fully qualified to dispense this treatment without assistance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Anesthesia

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Absence of cognitive impairment after more than 100 lifetime ECT treatments

Article Abstract:

Electroconvulsive therapy (ECT; also known as electroshock therapy) is a controversial treatment for depression and other psychiatric disorders. One of the problems that has been linked to its repeated use is cognitive impairment, such as memory loss. In many cases, it seems as if the memory loss corrects itself after several weeks time, but a small minority of patients may suffer more permanent cognitive damage which they attribute to ECT. Neurological examinations, however, often do not reveal significant damage that can be attributed to the treatment even in these cases. In the present investigation, 10 patients who had received more than 100 ECT treatments each were identified. They represented fewer than 1 percent of the patients who had been administered the treatments during the 25 years from 1965 to 1990. Eight of the 10 agreed to participate in the study, and they were matched with eight patients who had never received the treatments. Patients in both groups completed a memory questionnaire, and they were asked for their general perceptions of the effects of ECT, medications, and psychotherapy. Depression was evaluated, as was evidence of other psychopathology. All other variables (such as age, sex) were matched and therefore did not affect the results. Cognitive functioning did not differ between the two groups on any measure. Therefore, patients given repeated exposure to ECT treatments did not have measurable cognitive impairment in long-term follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Memory, Shock therapy

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Refusal of medical treatment: psychiatric emergency?

Article Abstract:

An intern sent an emergency call to the psychiatric consultation service at an academic medical center concerning a suicidal patient on the pediatric nephrology unit. This clinical case highlights the roles of the psychiatrists consulting to a nonpsychiatric medical unit. The consultation allowed the primary physicians to provide and the patient to receive the proper medical care he required.

Care and treatment, Analysis, Evaluation, Psychiatric services, Mental health services, Suicidal behavior, Medical consultation

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