PC01 – Electroconvulsive Therapy: A Core Review of Current Practice
Wednesday, Oct. 18
14:00 – 17:00 (3 hrs)
Meeting Room: Junior Ballroom C (3rd floor – North Tower)
Caroline Gosselin*, MD, FRCPC; Caroline Gosselin, MD FRCPC; Peter Chan, MD FRCPC; Lisa McMurray, MD FRCPC
CanMEDS Roles:
- Medical Expert
- Health Advocate
- 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 anaesthetics, 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 session 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. Recommendations for anesthetics will be discussed. The evidence behind and indications for bifrontal, bitemporal, and right and left unilateral electrode placements will be reviewed, including for patients with intracranial metal. 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 practice, 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:
- Hermida AP, Mohsin M, Pinheiro AP, et al. The cardiovascular side effects of ECT and their management. J ECT 2022;18:1.
- Peterchev AV, Rosa MA, Deng ZD, et al. Electroconvulsive therapy stimulus paramenters: rethinking dosage. J ECT 2010;26:3.
