Electroconvulsive therapy in a major teaching hospital: diagnoses and indications

The use of ECT over an eleven year period in the University of Alberta Hospitals is reviewed. Five percent of patients received ECT, the mean number of treatments per course was 5.2, and the most frequent type of treatment was bilateral ECT. Discharge diagnoses showed that three-quarters of the patients had affective psychoses and one-fifth were schizophrenic. All patients had had a mandatory consultation before treatment and the most frequent reasons for choosing ECT were given as: failed antidepressant treatment, previous good response to ECT, failure to respond to other treatment, uncontrollable delusions or psychotic behavior, acute suicidal risk requiring a rapid response, and adverse reaction to medication. The mandatory consultation process has worked well and has helped to clarify the situations where ECT may be used with benefit. It is hoped that this may assist those who may be responsible for defining guidelines for the use of ECT.