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A comparison of stimulus dosing methods for electroconvulsive therapy

  • J. Laidlaw (a1), P. Bentham (a1), G. Khan (a1), V. Staples (a1), A. Dhariwal (a1), B. Coope (a1), E. Day (a1), C. Fear (a2), C. Marley (a1) and J. Stemman (a1)...
Extract
Aims and Methods

A prospective study comparing initial electroconvulsive therapy treatment doses determined by empirical dose titration with estimates derived from two simple dose prediction methods and a fixed-dose regimen (275 mC).

Results

Thirty-three patients had seizure thresholds between 25 mC and 403 mC. The dose titration method led to a mean initial treatment dose of 195 mC that was intermediate between those predicted by the age method (275 mC) and the half-age method (137 mC). Estimates were within acceptable limits in 33% of cases for the age method, 64% for the half-age method and 40% for the fixed-dose method.

Clinical Implications

Either dose prediction or dose titration methods may be more appropriate in different clinical situations. The half-age method appears to be a more accurate predictor of optimum initial treatment dose.

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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.
References
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AMERICAN PSYCHIATRIC ASSOCIATION (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: American Psychiatric Association.
BENTHAM, P., CALLINAN, L., RODRIGUEZ-FERERRA, S., et al (1998) Electroconvulsive therapy audit. Journal of Clinical Effectiveness, 3, 7274.
ENNS, M. & KARVELAS, L. (1995) Electrical dose titration for electroconvulsive therapy; a comparison of dose prediction methods. Convulsive Therapy, 11, 8693.
FARAH, A. & MCCALL, W.V. (1993) Electroconvulsive therapy stimulus dosing; a survey of contemporary practices. Convulsive Therapy, 9, 9094.
PETRIDES, G. & FINK, M. (1996) The ‘half-age’ stimulation strategy for ECT dosing. Convulsive Therapy, 12, 138146.
PIPPARD, J. (1992) Audit of electroconvulsive therapy in two National Health Service regions. British Journal of Psychiatry, 160, 621637.
ROYAL COLLEGE OF PSYCHIATRISTS (1995) The ECT Handbook. The Second Report of The Royal College of Psychiatrists Special Committee on ECT. Council Report CR39. London; Royal College of Psychiatrists.
SACKEIM, H. A., PRUDIC, J., DEVANAND, D. P., et al (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine, 328, 839848.
SWARTZ, C. M. & ABRAMS, R. (1989) ECT Instruction Manual (3rd edn). Lake Bluff, IL: Somatics Inc.
WEINER, R. D. (1997) Stimulus dosing with ECT: to titrate or not to titrate –that is the question. Convulsive Therapy 13, 79.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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A comparison of stimulus dosing methods for electroconvulsive therapy

  • J. Laidlaw (a1), P. Bentham (a1), G. Khan (a1), V. Staples (a1), A. Dhariwal (a1), B. Coope (a1), E. Day (a1), C. Fear (a2), C. Marley (a1) and J. Stemman (a1)...
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