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The Practice of Electroconvulsive Therapy, Second Edition

Recommendations for Treatment, Training, and Privileging (A Task Force Report of the American Psychiatric Association)

American Psychiatric Association

  • ISBN 978-0-89042-206-9
  • Item #2206

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Since the development of pharmacoconvulsive therapy in 1934 and of electroconvulsive therapy (ECT) in 1938, ECT has proven far more valuable than just the intervention of last resort. In comparison with psychotropic medications, we now know that ECT can act more effectively and more rapidly, with substantial clinical improvement that is often seen after only a few treatments. This is especially true for severely ill patients—those with severe major depression with psychotic features, acute mania with psychotic features, or catatonia. For patients who are physically debilitated, elderly, or pregnant, ECT is also safer than psychotropic medications.

The findings of the American Psychiatric Association (APA) Task Force on ECT were published by the APA in 1990 as the first edition of The Practice of Electroconvulsive Therapy, inaugurating the development of ECT guidelines by groups both within the United States and internationally. Since then, advances in the use of this technically demanding treatment prompted the APA to mandate a second edition.

The updated format of this second edition presents background information followed by a summary of applicable recommendations for each chapter. This close integration of the recommendations with their justifications makes the material easy to read, understand, and use. To further enhance usability, recommendations critical to the safe, effective delivery of treatment are marked with the designation should to distinguish them from recommendations that are advisable but nonessential (with the designations encouraged, suggested, considered).

The updated content of this second edition, which spans indication for use of ECT, patient evaluation, side effects, concurrent medications, consent procedures (with sample consent forms and patient information booklet), staffing, treatment administration, monitoring of outcome, management of patients following ECT, and documentation, as well as education, and clinical privileging.

This volume reflects not only the wide expertise of its contributors, but also involved solicitation of input from a variety of other sources, including applicable medical professional organizations, individual experts in relevant fields, regulatory bodies, and major lay mental health organizations. In addition, the bibliography of this second edition is based upon an exhaustive search of the clinical ECT literature over the past decade and contains more than four times the original number of citations.

Complemented by extensive annotations and useful appendixes, this remarkably comprehensive yet practical overview will prove an invaluable resource for practitioners and trainees in psychiatry and related disciplines.


  • Introduction
  • Chapter 1. Indications for ECT use
  • Chapter 2. Medical conditions associated with substantial risk
  • Chapter 3. Use of ECT in special populations
  • Chapter 4. Adverse effects
  • Chapter 5. Pre-ECT evaluation
  • Chapter 6. Use of medications during the ECT course
  • Chapter 7. Consent for ECT
  • Chapter 8. Staffing
  • Chapter 9. Location, equipment, and supplies
  • Chapter 10. Treatment procedures
  • Chapter 11. Evaluation of outcome
  • Chapter 12. Treatment following completion of the index ECT course
  • Chapter 13. Documentation
  • Chapter 14. Education and training in ECT
  • Chapter 15. Privilege in ECT
  • Appendix A: Individuals and groups providing input to the document revision process
  • Appendix B: Sample ECT consent documents
  • Index

Any practitioner of ECT must own this book, and be thoroughly familiar with its contents. As an outgrowth of work done by the APA Taskforce on ECT, it presents 'standard of practice' recommendations on this procedure. In its second edition, it is highly current. Even psychiatrists who do not personally conduct ECT treatments will find it useful as a reference.—Doody Publishing, 1/1/2002

[I]t is an invaluable source of information with an extensive list of references.—Susan M. Benbow, International Journal of Geriatric Psychiatry, 1/1/2002

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