ECT in an acutely psychotic pregnant woman with actively aggressive (homicidal) impulses

The specific use of ECT to control homicidal impulses in a pregnant, acutely psychotic schizophrenic patient is described, with no adverse effects to the mother or the baby. Besides the relative safety of the procedure during pregnancy, the need for monitoring foetal effects is stressed. Although literature is abundant on various aspects of ECT (1-3) there has been little written on its use in pregnancy (4-6) for its value in treating severe depressive illness or certain types of schizophrenia; without adverse effect to the mother and the baby, and where there is a risk-benefit advantage to its use. Nineteen hundred and eighty-four marked 50 years in the history of the use of convulsive therapy (Metrazol) since its introduction into the realm of psychiatry by the Hungarian psychiatrist, Ladislas Meduna. Electro-convulsive therapy (ECT) has been the subject of much controversy among the lay public and some professionals alike in recent years, even though it is generally considered to be one of the most effective treatments available in psychiatry. The Canadian Psychiatric Association (7), the American Psychiatric Association (8), and the Royal College of Psychiatrists (U.K.) (9) have made their position clear on the issue. In a recent Canadian survey of the use of ECT, Smith concluded, "Some of the reported rates are below the predicted minimum levels" indicating that "certain patients have been deprived of the most effective treatment available" (10).