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Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

  • G. Shaikh, R. Ireland, M. McBreen and R. Ramana
Abstract
Aims and method

To audit the clinical practice of seizure threshold estimation and subsequent stimulus dose adjustment in the electroconvulsive therapy (ECT) clinic. Case notes of patients who had ECT over a six-month period were audited. Results were discussed at an audit meeting and guidelines and training modified appropriately prior to the second cycle of the audit.

Results

Initial dose titration was poor in the first period, but improved in the second. The majority of patients were insufficiently stimulated after missed seizures in both periods and stimulus doses were not being reduced following prolonged seizures.

Clinical implications

The audit identified the need for continuing supervision of trainees in addition to clear training and guidelines.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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References
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Ottoson, J. O. (1960) Experimental studies of the mode of electroconvulsive therapy. Acta Psychiatrica Scandinavica, 35 (suppl. 145), 1 141.
Pippard, J. (1992) Audit of electroconvulsive treatment in two National Health Service regions. British Journal of Psychiatry, 160, 621 637.
Royal College of Psychiatrists (1995) The ECT Handbook . The Second Report of the Royal College of Psychiatrists, Special Committee on ECT. Council Report CR39. (ed. Freeman, C. P.). London: Royal College of Psychiatrists.
Sackeim, H. A., Decina, P., Prohovnik, I., et al (1987) Seizure threshold in electroconvulsive therapy: affects of age, sex, electrode placement and number of treatments. Archives of General Psychiatry, 44, 355 360.
Sackeim, H. A., $ Devanand, D. P. & Prudic, J. (1991) Stimulus intensity, seizure threshold and seizure duration, impact on efficacy and safety of electroconvulsive therapy. Psychiatric Clinics of North America, 14, 803 839.
Sackeim, H. A., Prudic, J., Devanand, D. P., et al (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive side-effects of electroconvulsive therapy. New England Journal of Medicine, 328, 839 846.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Audit of a recently introduced stimulus dosing policy in an electroconvulsive therapy clinic

  • G. Shaikh, R. Ireland, M. McBreen and R. Ramana
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