Electroconvulsive Therapy: Biological Foundations and Clinical Applications

by Richard Abrams

In this third edition of his indispensable textbook on ECT, Dr. Richard Abrams draws upon more than 30 years of clinical and research experience to provide a unique guide to the theory and practice of ECT that stresses both its medical physiology and its application to the high-risk patient.Important new material has been added on the nature of the electrical stimulus and the relation of stimulus parameters and dosage to the physiology of the cerebral neuron and the quality of the treatment. Extensive detail is now provided on the latest approaches to the complex subject of EEG monitoring, with specific instructions on assessing the therapeutic impact of an induced seizure. The relative roles of unilateral and bilateral ECT are re-examined in light of this new approach, leading to updated recommendations for maximizing the therapeutic yield of ECT in the treatment-resistant patient.The section on management of cardiovascular risks and complications--especially in the geriatric patient--has been thoroughly updated to emphasize the role of beta-blockers. The widespread use of caffeine for lengthening seizures is critically reassessed, and new recommendations have been added concerning the anesthetic agent propofol and the pre-anesthetic atropine. Techniques of stimulus titration are now extensively covered, with new information and recommendations regarding the utility as well as potential risks of this procedure. Clinical entities recently appearing in the literature, such as myocardial stunning and nonconvulsive status epilepticus, are critically evaluated, as is the role of isoflurane anesthesia as a potential replacement for ECT. Of particular importance to clinicians are Dr. Abrams updated and exquisitely detailed step-wise guide to the practical administration of ECT, and his advice on the optimal handling of its medico-legal aspects, based on his extensive experience as an expert witness.In this lucid and comprehensive work, Dr. Abrams traces the historical development of convulsive therapy and explores its physiological, ethical, biochemical, political, neuroanatomical, and clinical aspects. He covers such diverse topics as the prediction of treatment response, the results of sham ECT studies, patients attitudes towards the treatment, neuropsychological and cognitive effects, the nature of the ECT stimulus, medico-legal considerations, and theories concerning its mechanism in action. In full accordance with the American Psychiatric Associations guidelines for the practice of ECT, this essential resource remains the primary reference and guide for those who prescribe, perform, or assist with ECT.

270 pages, Hardcover

First published May 19, 1988

Reviews

[Beth · Rating 3 out of 5]

I read this as a historian rather than as a clinician, so my comments are few. A useful overview of the clinical aspects of ECT, and a good source for the major studies in the field.