C08 – Electroconvulsive Therapy: A Core Review of Current Practice
Friday, Oct. 28
14:30 – 16:30 (2 hrs)
Meeting Room: Sheraton Hall B (Lower Concourse)
Peter Chan*, MD, FRCPC; Caroline Gosselin, MD, FRCPC
CanMEDS Roles:
- Scholar
- Medical Expert
- Collaborator
At the end of this session, participants will be able to: 1) Describe indications and assess risk when selecting electroconvulsive therapy (ECT) for patients and obtaining consent; 2) Formulate how ECT technique, including ECT device parameters, can affect clinical outcome; and 3) Explain the role of maintenance ECT, various anesthetics, and medications in ECT outcome.
Electroconvulsive therapy (ECT) continues to provide a life-saving and effective mode of treatment for a host of serious psychiatric syndromes. This course offers a comprehensive review of core practice principles for both novice and more experienced ECT providers. Indications, pre-ECT work-up, and the process of consent will be outlined. Since ECT outcome is closely tied to anesthetic technique, recommendations for anesthetics will be discussed. The evidence behind and indications for bifrontal, bitemporal, and right and left unilateral electrode placements will be reviewed. Discussion will further focus on various dosing protocols in use, including titration techniques with ultrabrief or brief pulse width settings, and age or gender-based dosing formulas. The EEG parameters that are markers of a therapeutic seizure will be taught. Strategies to minimize adverse effects and maintain symptom recovery will be offered, including the effects of concurrent medication use and the benefits of maintenance ECT. These university-based ECT clinicians, who are involved in active ECT practise, teaching, and research, provide this course through both didactic and small-group hands-on sessions. The rotating small-group sessions are divided into EEG interpretation, device parameters, and electrode placement/skin preparation.
References:
- Kellner CH, Greenberg RM, Murrough JW, et al. ECT in treatment-resistant depression. Am J Psychiatry 2012;169:1238–44.
- Tess AV, Smetana GW. Medical evaluation of patients undergoing electroconvulsive therapy. N Engl J Med 2009;360:1437–44.
