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VII. USE OF ECT IN SPECIAL POPULATIONS A. The Elderly ECT may be used with the elderly, regardless of age. Efficacy does not diminish with advancing age. While all somatic treatments, including ECT, are associated with increased risk in the elderly, particularly those with concurrent physical illness, clinical experience suggests that ECT may be generally less risky than pharmacotherapy in this group. Dosages of anticholinergic, anesthetic, and relaxant agents may need modification on the basis of physiologic changes associated with aging. The stimulus intensity should be selected with the awareness that seizure threshold generally increases with age. Decisions regarding ECT technique should be guided by the possibility that ECT-induced cognitive dysfunction may be greater with the elderly. B. Pregnancy Pregnant patients are not to be treated with ECT at PPC 2. All women, of child bearing age, prior to the first treatment, must have blood drawn and analyzed for quantitative HCG, beta-subunit, to confirm a non pregnant status, unless there exists documentation attesting to the patient's past surgical sterilization. Subsequent B-HCG assays will be checked when clinically indicated. C. Concurrent Medical Illness The anticipated effects of the patient's medical status, including current medications, upon the risks and benefits of ECT should play a part in the decision to administer ECT. 3. The evaluation of medical conditions and their interaction with ECT should incorporate pertinent laboratory tests and consultations with specialists when indicated. Modifications in the ECT procedure should be utilized as a means to lower morbidity and/or to augment efficacy. Such modifications may include changes in ECT technique, the use of pharmacologic agents and/or PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 14 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) administration of ECT in a different hospital or clinic location and with the presence of additional medical personnel or monitoring procedures. |
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