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IX. FREQUENCY AND NUMBER OF TREATMENTS DURING AN ACUTE COURSE OF ECT During an acute course of ECT, treatments are administered usually at a frequency of two treatments per week (on non-consecutive days). The transient use of daily treatments, regardless of electrode placement, may be useful early in the treatment course when a rapid onset of response is important, as in severe mania, catatonia, high suicidal risk, or severe malnutrition. Prolonged use of daily treatments, e.g., "regressive ECT" is PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Issuing Office: Clinical Services Reviewed Date:2/20/2001 Page 16 of 58 Subject: ELECTROCONVULSIVE THERAPY (ECT) associated with increased cognitive dysfunction and should be avoided. 3. A reduction in treatment frequency should be considered if delirium or severe cognitive dysfunction occurs. 4. The total number of ECT treatments administered should be a function of the patient's response and the severity of adverse effects. At PPC, an acute course of treatment is defined as the administration of up to 25 ECT. For ECT responders, the treatment course should be ended as soon as it is clear that a maximum response has been reached. Response should be determined by changes in target symptoms, with assessment made between each ECT treatment. 6. In the absence of any discernible clinical improvement after 6-10 treatments, the indication for continued ECT should be reassessed. Consideration may be given at such times to modifying the ECT technique, e.g., a change from unilateral to bilateral electrode placement, an increase in stimulus dosage levels, or the use of drugs to potentiate the ictal response. 7. Repeated courses of ECT are sometimes necessary. The decision to re administer a course of ECT within six months should take into account the presence, severity, and persistence of cognitive deficits associated with prior ECT, since cumulative effects may occur, particularly with bilateral electrode placement. |
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