Academic journal article Hong Kong Journal of Psychiatry

Continuation and Maintenance Electroconvulsive Therapy: A Selective Review of the Literature

Academic journal article Hong Kong Journal of Psychiatry

Continuation and Maintenance Electroconvulsive Therapy: A Selective Review of the Literature

Article excerpt

ABSTRACT

Electroconvulsive therapy is still one of the most efficient and safe therapeutic interventions in psychiatry that is widely used all over the world. In addition to its steady popularity in clinical practice, electroconvulsive therapy has been the focus of intensive research efforts. As a consequence, electroconvulsive therapy is becoming more sophisticated and safe without loosing efficacy. One of the more innovative applications is continuation and maintenance electroconvulsive therapy, which has received increasing attention in the British and American psychiatric literature during the past decade. In this review, the current literature on continuation and maintenance electroconvulsive therapy will be summarised with special reference to the methodology, indications, standard of practice, and efficacy. This review is selective because it is based exclusively on English language papers accessed through electronic databases (MEDLINE, EMBASE, PsycINFO) and by cross-referencing publications acquired during the literature search.

Keywords: Affective Disorders; Continuation and Maintenance Treatment; Electroconvulsive Therapy; Schizophrenia

INTRODUCTION

Electroconvulsive therapy (ECT) is still one of the most efficient and safe therapeutic interventions in psychiatric practice (Abrams, 1992). Since its inception more than 50 years ago, hundreds of scientifically sound studies have proven its efficacy in the treatment of several major psychiatric disorders. Despite its fearful reputation as a brutal and inhumane method, spread by its opponents who are driven by ideological and not scientific principles (Fink, 1991), ECT is widely used all over the world. In addition to its growing popularity in clinical practice, ECT has been the focus of intensive research efforts in the past two decades. As a consequence, the method for conducting ECT is becoming more sophisticated and safe without loosing its efficacy. An innovative application of ECT is continuation and maintenance ECT (ECT-C and ECT-M, respectively), which has received increasing attention in the British and American psychiatric literature during the past decade. The rationale for extending ECT is simple--although some psychiatric conditions, particularly depression, respond well to a course of ECT, relapse may occur within months, even with prophylactic drug treatment. ECT-C or ECT-M may reduce the relapse rate in such cases.

The aim of this paper is to review the most recent literature on ECT-C and ECT-M with special reference to the methodology, indications, standard of practice, and efficacy. To the best of our knowledge, ECT-C and ECT-M are not practised in Hong Kong on a regular basis. In order to stimulate interest and possibly research in this area in Hong Kong, this review will focus on the usefulness and applicability of ECT-C and ECT-M in clinical practice.

Available electronic databases (MEDLINE, 1966-1998; EMBASE, 1989-1998; PsycINFO, 1967-1998) were screened for English language publications on ECT-C and ECT-M, supplemented by cross-referencing papers obtained during the literature search. Since there have been relatively few reports with sound methodology, textbooks, review papers, case series and single case reports have also been taken into consideration when summarising the literature.

This literature review is selective in the sense that it included only English language papers and the main focus was the practical implications of ECT-C and ECT-M. For a more comprehensive, although in some aspects now outdated, review of this topic other sources are available (Monroe, 1991; Stephens et al. 1993).

DEFINITIONS

To enhance communication between clinicians, the following definitions concerning ECT-C and ECT-M have been agreed upon and are fairly consistently used in the literature:

* Index-episode ECT refers to the ECT course used to treat the acute stage of an illness (Stephens et al. …

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