ECT

Question 1

MUST

Answer 1

 Expertise with ECT technique and understanding its role in clinical practice
 Understanding of risks and benefits of various stimulus electrode placements (keeping the pulse
delivery program constant

Question 2

MUST

Answer 2

Ability to justify the use of ECT in treatment-resistant depression
 Ability to empathise with patient concerns about ECT
 Ability to describe the practical treatment details involved in ECT
 Ability to provide reassurance around cognitive dysfunction caused by ECT

Question 3

ECT dosing

Answer 3

to achieve this station the candidate must accurately describe the details of the tracings making specific reference to the range of parameters needed for clinical decision making (most importantly, post-ictal suppression) on the tracing.
With regards to making a decision on the next treatment, it is expected that the candidate will take into consideration clinical response including cognitive parameters, and will recommend a review of current medications. Other considerations will include:
- Termination of unilateral ECT course
- Complications
- Patient’s preference and capacity to consent
The principles of treatment and approach to decision making is similar across different services, although there are no absolute rules. From Electroconvulsive Therapy Manual (Victoria):
1. Determininganadequateseizure:
The minimum requirements for a therapeutic seizure have not been universally agreed. However, current literature indicates that adequate seizures are determined by a compilation of:
 the clinical response
 an EEG seizure duration of 25 seconds or more
 a motor seizure with muscular activity noted
 good post-ictal suppression (87 per cent has been suggested)
 the quality, amplitude and left-right synchronisation of the EEG recording.
2. Reviewofthestimulusdose:
The dose should be reviewed after each treatment on the basis of the person’s clinical response. An increase in dose may be indicated either:
 if the treatment response is poor
 if generalised seizures of sufficient duration are not achieved
 when a reduction in the length of the seizure occurs; seizure threshold rises by an average of 80 per cent
during a course of treatment (range 25–200 per cent), thus seizure duration shortens.
A decrease in dose may be indicated either:
 if the person is experiencing adverse cognitive side effects (in instances like this it may be beneficial
to consider less frequent treatments, for example, twice weekly)  where prolonged seizures occur.