The Clarke Institute experience with electroconvulsive therapy: II. Treatment evaluation and standards of practice

Contemporary standards of practice of electroconvulsive therapy with respect to the treatment procedure, clinical indications, and dosage (number of treatments per course) are summarized. The actual clinical practice at one psychiatric hospital over a 16-year period, comprising 22,647 treatments, was compared to those standards. The most significant findings in this series were the over-representation of patients with a diagnosis of schizophrenia and the absence of any clinically significant difference in the treatment dosage for schizophrenia and affective disorders. The significance of these findings is discussed with respect to their identification of patient subgroups that warrant case auditing. In addition, the results are used as a basis for a critical examination of the rationale for the presently recommended maximum treatment dosages.