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from VII - Treatment
Published online by Cambridge University Press: 02 January 2018
Setting
This audit is relevant to all psychiatric specialties but particularly older-adult services, where electroconvulsive therapy (ECT) may be more widely used.
Background
Although ECT is an effective treatment, it has the potential for serious adverse effects. The National Institute for Health and Clinical Excellence (NICE) (2003) has produced guidance relating specifically to the indications for ECT, the risks and benefits of treatment, consent, cessation of treatment and repeat courses of ECT.
Standards
The audit standards were taken from the NICE guidance (NICE, 2003):
ᐅ ECT should be used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with severe depressive illness, catatonia or a prolonged/severe manic episode.
ᐅ The decision whether ECT is clinically indicated should be based on assessment of the risks and potential benefits to the individual. These include anaesthetic risks, comorbidities, anticipated adverse events (especially cognitive impairment) and the risks of not having treatment.
ᐅ Valid consent should be obtained in all cases.
ᐅ Clinical status should be assessed following each ECT session. Treatment should be stopped when a response has been achieved, or sooner if there is evidence of adverse effects. Cognitive function should be monitored on an ongoing basis, and as a minimum at the end of each course of treatment.
ᐅ A repeat course of ECT should be considered only for individuals who have severe depressive illness, catatonia or mania and who have previously responded well to ECT. During an acute episode, if the patient has not previously responded, a repeat trial of ECT should be undertaken only after all other options have been considered and following discussion of the risks and benefits.
ᐅ ECT is not recommended as a maintenance therapy in depressive illness.
ᐅ ECT is not recommended for the general management of schizophrenia.
Method
Data collection
Information collected was obtained from medical notes and included:
ᐅ diagnosis
ᐅ reason for ECT
ᐅ risks and benefits of ECT
ᐅ consent for ECT
ᐅ cessation of ECT
ᐅ repeat courses of ECT
ᐅ use of ECT as maintenance therapy for depression or management of schizophrenia.
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