The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A Task Force Report of the American Psychiatric Association, 2nd ed.
The second edition of this APA Task Force Report updates the report on ECT originally released in 1990. ECT remains a treatment modality that generates strong emotional reactions, intermittent legislative action, and ambivalence within the medical community itself. If debate about the practice continues to generate more heat than light, this text represents a sincere and scholarly attempt to correct this.
The basic format of the text has not changed from the 1990 edition. It provides a background discussion of selected ECT topics and a set of formalized recommendations in outline form. However, each of these has been expanded to reflect new insights into clinical aspects of treatment. For example, the increasing attention being paid to ECT as a continuation and maintenance treatment for the prevention of relapse and recurrence is reflected in the development of specific recommendations for these modalities, accompanied by model consent forms that reflect the change in focus from acute to maintenance care. Recommendations for stimulus dosing in the chapter on treatment procedures are based on empirical data published in 2000. The expanding indications for ECT in mood disorders, schizophrenia, and other medical disorders are described in the second chapter. A section on the selection of inpatient versus outpatient ECT reflects careful consideration of patient interests in the current managed care climate. The references cited for each section are updated, and there are four times as many as in the last report.
The authors are balanced when discussing areas of controversy within the ECT field, and they are scrupulous in their efforts to be comprehensive. In addition to the obvious topics, i.e., how to perform the treatment and whom one should treat, they discuss the process of obtaining consent, the appropriate equipping and staffing of an ECT suite, appropriate documentation, and the critical issues of education, privileging, and training of ECT practitioners.
Everyone involved in the selection, referral, or treatment of patients with ECT should obtain the report. It will stand as a practical first-line reference regarding most clinical questions and practical issues that might arise for some time. Everyone who intends to perform ECT in the immediate future, and for several years to come, should read it carefully.
There is always the risk, in publishing a task force report, that one will be “preaching to the choir,” in this case, reinforcing beliefs and behaviors in a group that is already striving to use ECT responsibly and with the soundest possible empirical basis. Although the Task Force may not persuade ECT opponents to modify their position or correct all outmoded attitudes and practices, this report defines modern ECT treatment with clarity, conciseness, and careful science. Those already “in the choir” can be proud of their efforts.
