The ECT Handbook

 

Description:

The fourth edition of this popular Handbook provides the latest guidance on prescribing and administering electroconvulsive therapy (ECT). Leading researchers and practitioners review new research on ECT and related treatments, including their efficacy in children and adolescents, and in those with bipolar disorder and neurological conditions. With a focus on safe provision and minimisation of side effects, it provides the reader with practical, evidence-based advice. The book has been substantially revised: references have been updated throughout; related treatment modalities such as rTMS, tCDS and ketamine are covered in greater depth; and current administrative and legal framework guidelines are clearly outlined. An essential reference manual for consultant and trainee clinical psychiatrists, as well as ECT practitioners. This guide will benefit clinical teams looking after complex cases of depression, as well as those involved in the care of other people for whom ECT may be recommended.

 

Table of Contents:

 

Chapter 1 The Place of ECT and Related Treatments in Contemporary UK Psychiatry

ECT

Depression

NICE Guidelines on Use of ECT in Depression

Royal College of Psychiatrists' Position Statement on ECT for Depression

Bipolar Disorder

Mania

Bipolar Depression

Schizophrenia

Catatonia

Severe mental illness in pregnancy and the puerperium

Transcranial Magnetic Stimulation

Ketamine

Transcranial Direct Current Stimulation

Neurosurgery for Mental Disorder

References

Chapter 2 Mechanism of Action of ECT

Introduction

Current Concepts of the Pathophysiology of Depression

Developments from Brain Imaging

Cellular Pathology

Amino Acid Neurotransmitters

Inflammation

Therapeutic Efficacy of ECT in Relation to Mechanism

ECT and Structural Imaging

ECT and Functional Imaging

ECT, GABA and Glutamate

ECT and Inflammation

ECT and Monoamines

Conclusions

References

Chapter 3 ECT in the Treatment of Depression

Efficacy of ECT in Depression

Comparison of ECT and rTMS

Comparison of Bilateral and Unilateral ECT

Dose of Electrical Stimulus

Pulse Width

Frequency of ECT

Number of ECT Sessions

The Place of ECT in the Treatment of Depression

Types of Depression that Respond to ECT

Predictors of Response and Non-Response

Relapse Post-ECT

ECT as an Emergency Treatment in Depression

The Use of ECT in Treatment-Resistant Depression

The Use of ECT as Treatment for Depression in Different Populations

Summary: Clinical Implications

The Royal College of Psychiatrists ECT and Related Treatment Committee's 2017 Position Statement

References

Chapter 4 ECT in Mania (and Mixed States)

Efficacy of ECT in Acute Mania

Randomised Trial Evidence

Non-Randomised Data

Efficacy in Acute Mixed Affective Episodes

Incident Mania

Electrode Placement and Stimulation Parameters

ECT for Mania and Concomitant Medication

Recommendations

References

Chapter 5 Electroconvulsive Therapy in Bipolar Disorder Depression

Efficacy of ECT in BD Depression

When Should ECT Be Used in Bipolar Disorder Depression?

General Treatment Principles

Psychotropic Drug Treatment during a Course of ECT

Treatment-Induced Switch to Mania

Recurrence and Relapse

Cognitive Side Effects of ECT in Bipolar Disorder Depression

Recommendations

References

Chapter 6 ECT in Older Adults

Efficacy

Safety

Practical Considerations

Recommendations

Acknowledgements

References

Chapter 7 ECT in People with an Intellectual Disability

Introduction

Diagnostic Issues

Epidemiology of Psychiatric Disorders in People with an Intellectual Disability

Use of ECT in People with Intellectual Disability and Mood Disorders

ECT in People with an Intellectual Disability, Autism and Catatonia

Use of ECT in People with an Intellectual Disability and Severe Challenging Behaviour

ECT Used in Other Situations

Observations on Use of ECT by Psychiatrists Working with People with an Intellectual Disability

Conclusion

Recommendations

Acknowledgement

References

Chapter 8 ECT in Pregnancy and Postnatally

ECT during Pregnancy

ECT in the Postnatal Period

Key Points

References

Chapter 9 Electroconvulsive Therapy in Children and Adolescents

Introduction

Epidemiology

Indications for Use

Mood Disorders

Psychotic Disorders

Catatonia

Neuroleptic Malignant Syndrome

Side Effects

Prognosis

Consent, Capacity and Legal Considerations

Patients, Carers and Clinicians' Views

Gaps in the Evidence and Research Recommendations

References

Chapter 10 The Use of ECT in the Treatment of Schizophrenia

History

Chemically Induced Seizures

Electrically Induced Seizures

Current Usage

Efficacy and Effectiveness

ECT in Treatment-Resistant Schizophrenia

ECT in Combination with Clozapine

Speed of Response

Electrode Placement

Frequency of Treatment

Duration of Acute Treatment

Continuation and Maintenance Treatment

Continuation ECT

Maintenance ECT

Adverse Effects and Risks

Legal Considerations

Discussion

Recommendations

Acknowledgements

References

Chapter 11 The Use of ECT in the Treatment of Catatonia

Classification and Diagnosis

History

Current Usage

Efficacy and Effectiveness

Randomised Controlled Trials

Prospective Uncontrolled Studies

Retrospective Studies

Systematic Reviews

Electrode Placement

Frequency of Treatment

Duration of Acute Treatment

Co-administration of Benzodiazepines

Continuation and Maintenance Treatment

Discussion

Recommendations

Acknowledgements

References

Chapter 12 ECT in Neuropsychiatric Disorders

Parkinson's Disease

Movement Disorder

Depression

Psychosis

Other Conditions

Practical Considerations

Epilepsy

Seizures

Status Epilepticus

Depression

Stroke

Huntington's Disease

Catatonia

Neuroleptic Malignant Syndrome

Multiple Sclerosis

Encephalitis

Dementia

Behavioural Disturbance

Depression

Psychosis

Delirium

Tardive Dyskinesia

Other conditions

Summary

References

Chapter 13 Cognitive Side-Effects of ECT

Importance of Cognitive Side-Effects

Types of Adverse Cognitive Side-Effects

Immediate Cognitive Effects

Lithium and ECT

Post-ictal Delirium

Subacute and Longer-term Cognitive Side-Effects

Anterograde Amnesia

Non-memory Cognitive Side-Effects

Retrograde Amnesia

Subjective Memory Difficulty

Assessment

Retrograde Amnesia Assessment

Prevention

Primary Prevention

Secondary Prevention

Key Points

References

Chapter 14 Non-cognitive Adverse Effects of ECT

Introduction

Assessment Before ECT

Consent

Mortality Rate

Cardio-Pulmonary Adverse Effects

Suicide

Prolonged Seizures

Mania

Other Non-cognitive Adverse Effects

Regular Review

Recommendations

References

Chapter 15 Transcranial Magnetic Stimulation

Introduction

Putative Mechanism of Action

Clinical Guidance and Approvals

Indications

Efficacy in Depression

Contraindications

Patient Selection

Overview of rTMS Administration

Safety

rTMS in Pregnancy and in Older People

Patients' Experience of TMS

Training for rTMS Administration

Introduction

Setting Up a Training Course

What Should Be Covered in a Training Course?

rTMS Administration

Setting Up the Machine

Efficacy and Safety

Applied Aspects

Summary

References

Chapter 16 Neurosurgery for Mental Disorder

'Neuromodulation'

Vagus Nerve Stimulation

Technical Aspects

Outcome Studies

Place for VNS in the Management of Refractory Depression

Deep Brain Stimulation

Technical Aspects

Outcome Studies

Place for DBS in the Management of Refractory Depression

Ablative (Lesion) Neurosurgery for Mental Disorder

Technical Aspects

Outcome Studies

Place for Ablative Neurosurgery in the Management of Refractory Depression

Summary

References

Chapter 17 Ketamine for Psychiatric Disorders

Introduction

Clinical Effect

Other Compounds and Routes

Esketamine

Mechanism of Antidepressant Action

Ketamine and ECT

Adverse Effects

Abuse Potential

Cognitive Impairment

Cardiovascular Effects

Bladder

Formulations and Licensing

Ketamine in Other Disorders

Obsessive Compulsive Disorder

Post-Traumatic Stress Disorder

Eating Disorders

Anxiety Disorders

Ketamine Clinics and Guidance

Registries and Monitoring

The Future

Summary

References

Chapter 18 The ECT Accreditation Service (ECTAS)

References

Chapter 19 The Scottish ECT Accreditation Network (SEAN)

Patient-Centred

Safe

Effective

Equitable

References

Chapter 20 Medical Training for Psychiatrists in ECT

Developing and Maintaining Service Delivery

Training and Supervision

Achieving and Maintaining Appropriate Service Standards

Key Points

References

Chapter 21 Nursing Care of the Patient Receiving ECT and the Roles of the ECT Nurse

Introduction

Providing Education to Patients, Carers and Other Health Care Workers

Inpatient and Day Patient ECT

Accompanying and Providing Emotional Support to Patients and Carers

Preparing the Patient for ECT Treatment

Nursing Care in the ECT Treatment Room

Recovery Care and Discharge from the ECT Clinic

ECT in Theatres and the Role of the ECT Nurse in the Theatre Environment

The ECT Nurse Specialist and Managing the ECT Clinic

Clinics Practising Nurse-Administered ECT

Nurse Training and Development

Clinical Governance in ECT

Conclusion

Acknowledgements

References

Chapter 22 Practical Aspects of ECT

Introduction

Treatment Room

Equipment

Trolley

Disposal

ECT Equipment

Rationalisation and Closure of ECT Suites Nationally

Staffing: General

Nursing Staff

Medical Staff

Prescription and Monitoring

How Often Should ECT Be Prescribed?

WHO Checklist

Sign In

Psychiatric Issues

Anaesthetic Issues

Sign Out

Electrode Placement

Bilateral Electrode Placement

Unilateral Electrode Placement

Bilateral Versus Unilateral ECT

Right versus Left Unilateral ECT

What About Bifrontal ECT?

What Does Changing the Pulse Width Do?

Stimulus Dosing

Measuring Impedance

Is a Seizure Necessary for ECT to Be Effective?

Why Should the Seizure Threshold Be Measured?

How to Establish the Seizure Threshold

What if the Seizure Threshold Is too High?

Xanthines

What if the Seizure Is too Long?

Seizure Adequacy

What if the Seizure Becomes too Short during the ECT Course?

Post-ECT Clinical Monitoring

The Course of Treatment

Continuation and Maintenance ECT

Key Points

References

Chapter 23 Anaesthesia for Electroconvulsive Therapy

Introduction

Practice Guidelines

Role of the Lead Anaesthetist

Patient Evaluation

Investigations

Monitoring

Anaesthesia

Induction Agents

Inhalational Induction agents

Alfentanil, Remifentanil, Fentanyl

Muscle Relaxants

Drugs to Modify the Autonomic Effects of ECT

Acute Physiological Effects of ECT

Adverse Effects of ECT

Cardiovascular

Musculo-Skeletal

Cognitive

Key Points

Acknowledgements

References

Chapter 24 Dental Issues Related to ECT

Dental Issues for Psychiatrists

The Risks

Risk Awareness

Risk Identification

Risk Management

Dental Issues for Anaesthetists

Brief Review of Specific Dental Restorations and Associated Risks

Veneers

Crowns

Bridges

Implants

Intraosseous Denture Supports

Clinical Situations that Require Different Management Strategies

The Fully Dentate Patient

The Mouth with Complex Restorations

The Edentulous Patient

The Partially Dentate Patient

Key Points

References

Chapter 25 Interactions between ECT and Prescribed Medication

Introduction

Methods and General Considerations

Anaesthetics and Related Medication

Psychotropic Medication

Antidepressants

Antipsychotics

Lithium

Anticonvulsant Drugs

Anxiolytics and Hypnotics

Acetylcholinesterase Inhibitors

Other Medication

Conclusions

References

Chapter 26 Seizure Monitoring in ECT

Motor Activity

Observation

The Hamilton 'Cuff' Technique

Electromyography (EMG)

Optical Motor Sensor (OMS)

Practice Points

Cardiovascular Response

Electroencephalography (EEG)

EEG Electrode Placement

Establishing a Baseline EEG

Ictal and Postictal EEG Phases

Phase 1: Electrodecremental Phase

Phase 2: Recruiting Rhythm

Phase 3: Polyspike Activity

Phase 4: Theta and Delta Activity

Phase 5: Seizure Termination

Phase 6: Postictal Suppression

Phase 7: Return to Baseline

EEG Artefacts

Muscle Artefact

Movement Artefact

Electrode Artefact

Electrocardiographic Artefact

Determining Seizure Adequacy

Conclusion

References

Chapter 27 Safe ECT Practice in People with a Physical Illness

Physiological Effects of ECT

Coexisting Medical or Surgical Conditions

Cardiovascular Disease

Arrhythmias and Cardiac Conduction Abnormalities

Hypertension

Myocardial Infarction

Pulmonary Embolism and Anticoagulation

Cardiac Failure

Cerebral Aneurysm

Abdominal Aortic Aneurysm

Valvular Heart Disease

Neurological Conditions

Cerebrovascular Disease

Parkinson's Disease

Auto-immune Encephalitis

Tardive Dyskinesia

Intracranial Foreign Objects

Other Medical Conditions

Gastrointestinal Disorders

Endocrine Disorders

Respiratory Disorders

Other Conditions

Minimising Risk

Balance of Risks and Benefits

Recommendations

References

Chapter 28 Capacity, Consent and the Law

Capacity: the Principles

The Informal Patient: Seeking Consent

Assessing Capacity

Capacity Law

England and Wales

Mental Capacity Act 2005 (MCA)

Mental Health Act 1983 (MHA)

Mental Capacity Act or Mental Health Act?

Emergency Treatment

Suggested Procedure for Consent for People under 18

Scotland

Informal Patients Capable of Giving Consent

Patients Incapable of Giving Informed Consent

Adults with Incapacity (Scotland) Act 2000

Mental Health (Care and Treatment) (Scotland) Act 2003

Short-term Detention Certificate/Compulsory Treatment Order

Advance Statements

Northern Ireland

Republic of Ireland

Acknowledgements

References

Chapter 29 Patients', Carers' and the Public's Perspectives on ECT and Related Treatments

Patients' Perspectives

Carers' Experiences

Conclusions

References

Index

 

An aparitie	30 Jun. 2019
Autor	I. Nicol Ferrier
Dimensiuni	15.49 x 1.52 x 23.37 cm
Editura	Cambridge University Press
Format	Paperback
ISBN	9781911623168
Limba	Engleza
Nr pag	292