Indications for electric convulsion therapy and its use by senior psychiatrists

A survey by questionnaire of all senior psychiatrists in the Wessex Region showed that they considered depressive psychosis to be the major indication for electric convulsion therapy (ECT). A good clinical response was thought to be predicted by the presence of psychomotor retardation, depressive delusions, depressed mood, early morning wakening, diurnal variation, loss of appetite, and agitation. ECT was judged to be extremely useful for treating mania and acute undifferentiated, catatonic, and paranoid schizophrenia; of some use in hypochondriasis; but of little value or contraindicated when there was severe, depersonalisation, or hysterical symptoms. Only 40% of the psychiatrists favoured unilateral ECT, and the variation in electrode placements used by different psychiatrists was surprising. Eighty per cent of the respondents used courses averaging six to eight treatments given over two or three weeks. Results obtained in this study, based on clinical judgment, differed from research findings, which emphasises the need for further study of this important treatment.