gc08-7 - ELECTROCONVULSIVE THERAPY Jonathan T. Stewart, MD...

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1 ELECTROCONVULSIVE THERAPY Jonathan T. Stewart, MD Professor in Psychiatry and Geriatric Medicine University of South Florida College of Medicine Chief, Geropsychiatry Section Bay Pines VA Medical Center ECT: HISTORY ± Hippocrates (ca. 400 BC) ± von Meduna (1930’s) ± Cerletti and Bini (1938) ± Modified ECT (1950’s) ± Monitored ECT (1980’s) ± Brief-pulse waveform (1980’s)
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2 INDICATIONS ± Major depression (unipolar or bipolar) Good prognosis: anorexia, psychomotor retardation, catatonia, mood-congruent delusions, older age Poor prognosis: hysterical phenomena, somatization, chronic pain The decision to proceed with ECT is a qualitative one, not a quantitative one ± Mania ± Catatonic schizophrenia OTHER INDICATIONS ± Parkinson’s disease (refractory illness, on-off) ± Refractory epilepsy or status epilepticus ± Neuroleptic malignant syndrome ± Agitation in dementia? ± Failure to thrive?
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3 “Look at a patient lying long in bed. What a pathetic picture he makes! The blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting from his seat, the urine leaking from his distended bladder, and the spirit evaporating from his soul.” --RAJ Asher, 1947 USE IN MAJOR DEPRESSION ± First line for: Urgent need to treat Previous good response Psychotic or catatonic features ± Second or third line otherwise, NOT treatment of last resort
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4 MECHANISM OF ACTION ± Unclear, but clearly due to the seizure, clearly
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gc08-7 - ELECTROCONVULSIVE THERAPY Jonathan T. Stewart, MD...

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