Electroconvulsive Therapy

By Richard Abrams

Book Overview

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.

• Format: Hardcover
• Language: English
• ISBN: 0195109449
• ISBN13: 9780195109443
• Release Date: January 1997
• Publisher: Oxford University Press
• Length: 382 Pages
• Weight: 1.40 lbs.
• Dimensions: 8.5" x 1.1" x 5.9"

Customer Reviews

great technical book

this is a medical book, providing the informations necessary for the good practice of ECT. there is no room for ideology in this type of text. all a doctor can expect. Helbert Campos, psychiatrist, Brazil

No anecdotal information should serve as evidence.

I... that Dr. Abrams is an expert in ECT and his book is well written. However I would argue that the critique on not being "balanced with dissenting voice" has no scientific/logic base. Our society is so poisened by political demands (correctness) that the scientific truth is often submerged by mass desire. When we evaluate a medical procedure, we must base our argument on scientific data. I have read literature in this field extensively, and I have not yet found any solid research data showed that ECT imposed danger of "permanent memory loss, organic brain dysfunction, and even death". To me, case reports are no data, anecdotal opinion is no data. For only the sake of discussion, please consider this: if we did ECT on 1000 patients, and 2 of them dead, 3 of them got brain injury, and the families of these 5 patients went to the press. All we may hear now is that ECT killed or damaged people. However, the hidden truth might be: without ECT 10% of the 1000 patients would have killed themselves, 20% would have health damage out of malnushiment due to financial difficulty (e.g., loss job), alcohol and substance, other medical conditions that were worsened by depression, and 5% of them were killed by chemical treatment, and etc. ECT may have dramatically improved the life quality of 70% of this 1000 patients. We will never know the truth if we stop at the anecdotal information provided by the 5 cases. Anecdotal, according to American Heritage Dictionary, means: based on personal observation, case study reports, or random investigations rather than systematic scientific evaluation. I am not a zealous advocator of ECT, but I trust only scientific evidence. If anyone would tell me ECT caused brain damage, please show me the scientific evidence. Don't tell me you or your uncle or your sister was damaged by ECT. Don't tell me how many psychiatrists admitted the "downside" of ECT. Show me the well designed research, show me the well controlled data.Truth is never "balanced dissenting voice". Truth can only be found through scientific research. Three hundred years ago, the balanced dissenting voice said the earth is the center of the universe. The man argued against the balanced dissenting voice was killed. However, the truth was, as it was 1 million years ago, as it is today, as it will be 1 million years later, that the globe is not the center of the universe. How do we know that? Through scientific research!