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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: grush@eircom.net
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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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