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Previous Volume 360:1437-1444 April 2, 2009 Number 14 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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After a period of declining use, electroconvulsive therapy (ECT) is now used more widely as a treatment for major depression and other psychiatric disorders.¹ Many patients undergoing ECT are elderly and have multiple coexisting medical conditions. Consultants are often asked to provide a medical evaluation before ECT, although many may feel uncomfortable in this role. There is little summary guidance from the literature on the medical assessment of these patients. The technique and efficacy of ECT have been reviewed in the Journal.¹ In this article, we present an approach for medical consultants, with special attention to patients with coexisting . . . [Full Text of this Article]

Background

Procedure-Related Changes and Subsequent Morbidity

Evaluation before ECT

Routine Evaluation

Risk Stratification and Medical Optimization before ECT

            Unstable Cardiac Disease

            Space-Occupying Lesions or Intracranial Vascular Lesions

            Recent Stroke

            Uncontrolled Hypertension

Management of Preexisting Medical Conditions

Management of Complications after the Procedure

Prolonged Blood-Pressure Elevation

Asystole or Bradycardia

Myocardial Ischemia

Headache

Conclusions

Source Information

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, and Harvard Medical School — both in Boston.

Address reprint requests to Dr. Tess at the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02115, or at atess@bidmc.harvard.edu.

Related Letters:

Medical Evaluation before Electroconvulsive Therapy
Tavares A. R. Jr., Volpe F. M., Welch C. A., Tess A. V., Smetana G.
Extract | Full Text | PDF  
N Engl J Med 2009; 360:2791-2792, Jun 25, 2009. Correspondence

This article has been cited by other articles:

• Tavares, A. R. Jr., Volpe, F. M., Welch, C. A., Tess, A. V., Smetana, G. (2009). Medical evaluation before electroconvulsive therapy.. NEJM 360: 2791-2792 [Full Text]  
• (2009). Reviews of Note. JWatch Psychiatry 2009: 1-1 [Full Text]