Psych CASC / OSCE · Psychopharmacology — ECT and neurostimulation
Explaining ECT and cognitive risk to a patient and partner (CASC)
CASC-style communication station: shared decision on acute ECT vs rTMS, honest cognitive risk counselling, consent elements, and relapse-prevention framing without stigma or false reassurance.
On this page
Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 45-year-old with severe melancholic depression and previous near-lethal overdose sits with her partner. She has failed two adequate antidepressant trials. She says 'ECT fries your brain and steals your memories'. The partner asks why not 'just do that magnet treatment instead'.
Station instructions (candidate)
You have 7 minutes. Explain why ECT is being recommended for severe treatment-resistant melancholic depression with high risk, what modern ECT involves (anaesthesia, not a horror scene), cognitive risks honestly, and how rTMS/iTBS differs in urgency and evidence role. Invite questions. Do not guarantee cure. Do not dismiss fears. Do not invent legal section numbers. Offer written information and a follow-up for consent formalities.[1][2][3][5][7]
References7ShowHide
- [1]UK ECT Review Group Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis Lancet, 2003.PMID 12642045
- [2]Espinoza RT, Kellner CH Electroconvulsive Therapy N Engl J Med, 2022.PMID 35172057
- [3]Sackeim HA, Prudic J, Fuller R, et al. The cognitive effects of electroconvulsive therapy in community settings Neuropsychopharmacology, 2007.PMID 16936712
- [4]Sackeim HA, Prudic J, Nobler MS, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy Brain Stimul, 2008.PMID 19756236
- [5]Blumberger DM, Vila-Rodriguez F, Thorpe KE, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D) Lancet, 2018.PMID 29726344
- [6]Kellner CH, Knapp RG, Petrides G, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: CORE Arch Gen Psychiatry, 2006.PMID 17146008
- [7]Weiss A, Hussain S, Ng B, et al. RANZCP professional practice guidelines for the administration of electroconvulsive therapy Aust N Z J Psychiatry, 2019.PMID 30966782