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Ill. INDICATIONS FOR USE A. General Statement Referrals for ECT are based upon a combination of factors, including the patient's diagnosis, nature and severity of symptomatology, treatment history, consideration of anticipated risks and benefits of viable treatment options, and patient preference. At present there are no diagnoses which should automatically lead to treatment with ECT. In most cases, ECT is used following treatment failure on psychotropic agents, although specific criteria do exist for use of ECT as a first line treatment. B. Primary Use of EC Situations where ECT may be used prior to a trial of psychotropic agents include, but are not necessary limited to the following: 1 where a need for rapid definitive response exists on either medical or psychiatric grounds 2. when the risks of other treatments outweigh the risks of ECT 3. when a history of poor drug response and/or good ECT response exists for previous episodes of the illness 4. patient preference PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 7 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) C. Secondary Use of ECT In other situations, a trial of an alternative therapy should be considered prior to referral for ECT. Subsequent referral for ECT should be based on at least one of the following: 1.treatment failure (taking into account issues such as choice of agent, dosage, and duration of trial); 2. adverse effects which are unavoidable and which are deemed less likely and/or less severe with ECT; 3. deterioration of the patient's condition to the point that there is a need for rapid definitive response on either medical or psychiatric grounds. D. Major Diagnostic Indications Diagnoses for which either compelling data are present for the efficacy of ECT, or a strong consensus exists in the field supporting such use. 1. Mood Disorders a) ECT is an effective treatment for patients with Major Depressive Disorder (all subtypes), and Bipolar Disorder, depressed. It is also particularly effective for psychotic subtypes of depression b) ECT is an effective treatment for all subtypes of mania. Schizophrenia and Other Psychotic Disorders: ECT is an effective treatment for schizophrenia and other psychotic disorders in the following situations: a. Catatonla b. When affective symptomatology is prominent c. When there is a history of favorable response to ECT d. Paranoia e. When pharmacologic treatments have been ineffective E. Other Diagnostic Indications There are conditions for which efficacy data for ECT are only suggestive, or where only a partial consensus exists in the field supporting its use. In such cases, ECT should be recommended only after standard treatment alternatives have been unsuccessful. Such conditions include but are not limited to: 1 .Catatonia due to medical conditions PILGRIM PSYCHIATRIC CENTER Issue Date: 1011/97 Revision Date: 2/20/2001 Reviewed Date:2/2012001 I Page 8 of 58 Facility Policy Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) 2. Obsessive compulsive disorder 3. Parkinson's disease 4.Organic mental syndromes with symptomatology similar to functional diagnoses. |
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