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XIII. MANAGEMENT OF, THE PATIENT'S POST ECT COURSE: CONTINUATION/ MAINTENANCE ECT A. General Considerations Continuation/Maintenance therapy, typically consisting of psychotropic medication and/or ECT, is indicated for most patients following completion of the ECT course. ECT is defined as continuation/maintenance ECT when: a. The intent of treatment changes from managing acute symptoms to preventing relapse/ recurrence. b. Treatment frequency declines to once a week or less. Decisions not to recommend continuation therapy should be documented. 2. The choice of medication used during the conituation/maintenace phase of treatment should be determined by the nature of the underlying illness, a PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 26 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) consideration of adverse effects, and response history. 3. Continuation therapy should begin as soon as possible after termination of the ECT course, although the presence of adverse ECT effects, e.g. delirium, may necessitate a delay. Indications for continuation/maintenance ECT include but are not limited to the following: a. A history of relapse/recurrence while receiving adequate pharmacotherapy. b. Inability to tolerate or medical contraindications to pharmacotherapy. C. A previous history of good response to continuation, maintenance ECT. d. Patient preference. Depending on the patient's clinical status, continuation/maintenance ECT may be administered on an inpatient or outpatient (short stay ECT) basis. 6. The frequency of administered treatments will typically be titrated to the clinical response in the following manner: a. When continuation/maintenance ECT directly follows an acute course of ECT, the interval between treatments will be progressively lengthened until a monthly or other regular interval is established, or until the patient manifests prodromal symptoms suggesting incipient relapse. b. If the patient shows signs of relapse, the interval between treatments will be shortened to minimize return of psychiatric symptoms. B. Assessments and Documentation The decision regarding the onset, continuation and termination of continuation/maintenance ECT should be made by the Treating Psychiatrist in consultation with the AMD and the Director of ECT. This should be documented in a progress note in the ECT section of the medical record, prior to the initiation of continuation/maintenance ECT. Except as noted below, policies and procedures for continuation/maintenace ECT are identical to those defined for an acute course of ECT. PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Reviewed Date:2/2012001 Page 27 of 58 Facility Policy Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) a. The informed consent for continuation/maintenance ECT will be valid for a 6 month period. b. Physical examination and appropriate laboratory evaluation, including B-HCG (when indicated), CBC, and SMA 20 should be performed at least every 3 months, or sooner when clinically indicated. Every month, the AMD should review the efficacy/risk of continuation/maintenance ECT with the Treating Psychiatrist and Director of ECT. The treating Psychiatrist will document the rationale for continuing or discontinuing this treatment in a progress note, to be placed in the ECT section of the medical record. d. Assessment of cognitive function should be documented at least every three treatments. EKG should be obtained at least every 12 month |
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