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Technology Appraisal Guidance 59
Guidance on the use of electroconvulsive therapy
Issue date: April 2003
Review date: November 2005
To order copies
Copies of this guidance can be obtained from the NHS Response Line by telephoning 0870 1555
455 and quoting ref: N0205. A patient version of this document can be obtained by quoting ref:
N0207. A bi-lingual patient leaflet is also available, ref: N0208.…read more

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1 Guidance 5
2 Clinical need and practice 7
3 The technology 9
4 Evidence and interpretation 11
5 Recommendations for further research 18
6 Implications for the NHS 19
7 Implementation and audit 19
8 Related Guidance 21
9 Review of Guidance 22
Appendix A: Appraisal Committee
Appendix B: Sources of Evidence
Appendix C: Information for Patients
Appendix D: Staging Systems…read more

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1.1 It is recommended that electroconvulsive therapy (ECT) is
used only to achieve rapid and short-term improvement of
severe symptoms after an adequate trial of other treatment
options has proven ineffective and/or when the condition is
considered to be potentially life-threatening, in individuals
· severe depressive illness
· catatonia
· a prolonged or severe manic episode.
1.…read more

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Clinical status should be assessed following each ECT session
and treatment should be stopped when a response has been
achieved, or sooner if there is evidence of adverse effects.
Cognitive function should be monitored on an ongoing basis,
and at a minimum at the end of each course of treatment.
1.7 It is recommended that a repeat course of ECT should be
considered under the circumstances indicated in 1.…read more

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Clinical need and practice
2.1 This appraisal considers electroconvulsive therapy (ECT) in
the treatment of: depressive illness, schizophrenia, catatonia
and mania.
2.2 Depressive illness is associated with discrete episodes that are
characterised by feelings of sadness, despair, loss of interest
in daily life and discouragement. The severity of depressive
illness is determined by the number, intensity and frequency
or persistence of depressive symptoms and the presence of
specific symptoms such as delusions, hallucinations and
suicidal ideation.…read more

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Depressive illness, schizophrenia and mania are frequently
chronic, relapsing conditions and are associated with
considerable suicide risk. Diagnosable depressive disorders
are implicated in between 40% and 60% of suicide attempts.
The 2000 ONS Psychiatric Morbidity Survey found that in
individuals with a current depressive episode, 5% reported a
suicide attempt within the past year. Common estimates are
that 10% of people with schizophrenia will eventually have a
completed suicide, and that attempts are made at two to
five times that rate.
2.…read more

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The technology
3.1 During ECT, an electric current is passed briefly through the
brain, via electrodes applied to the scalp, to induce
generalised seizure activity. The individual receiving
treatment is placed under general anaesthetic and muscle
relaxants are given to prevent body spasms. The ECT
electrodes can be placed on both sides of the head (bilateral
placement) or on one side of the head (unilateral
placement).…read more

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However, this should not detract from the fact that a
number of individuals find their memory loss extremely
damaging and for them this negates any benefit from ECT.
3.6 Advance directives are statements made by an individual
that express decisions about the healthcare they wish to
receive, in anticipation of a time when they may not be
competent to make or communicate such decisions.…read more


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