Psych · Psychopharmacology — ECT and neurostimulation
ECT and neurostimulation
Also known as Electroconvulsive therapy · ECT · rTMS · iTBS · theta burst stimulation · tDCS · vagus nerve stimulation · VNS · deep brain stimulation depression · neurostimulation psychiatry · continuation ECT · maintenance ECT
Exam-exhaustive fellowship reference on ECT and neurostimulation — indications (depression, mania, catatonia, clozapine-resistant schizophrenia), consent and capacity, electrode placement and stimulus dosing, anaesthesia essentials for psychiatrists, cognitive adverse effects, continuation and maintenance, plus evidence-tiered rTMS/iTBS, tDCS, VNS and DBS. FRANZCP-primary, globally tagged.
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12 MCQs with explanations
Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
Malignant catatonia, food–fluid refusal, or high-intent suicidality with severe depression — do not delay ECT for endless medication trialsProlonged seizure or status epilepticus peri-ECT — abort stimulation, manage airway, follow anaesthetic emergency protocolsNew focal neurology or unexpected prolonged post-ictal coma — investigate medical/neurological complication, not 'just ECT recovery'Capacity lost for treatment decisions — use jurisdiction-specific mental health law; never invent section numbersLeaving successful index ECT without a relapse-prevention plan (pharmacotherapy and/or continuation ECT) — high early relapse riskSuspected NMS vs catatonia vs serotonin toxicity — wrong pathway kills; examine and treat the syndrome you have
Meet the patient
A 71-year-old man with psychotic depression has not eaten for six days. He believes his bowel has rotted away and that food would be wasted on him. Three adequate antidepressant trials behind him, an augmenting antipsychotic on board, urea and creatinine climbing.[1][4][6]
The team is discussing a fourth drug. The examiner will ask a different question: how many more weeks does this man have? That is the question ECT answers, and speed of response is exactly why it exists.[3][5][6]
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- [23]Aaronson ST, Sears P, Ruvuna F, et al. A 5-Year Observational Study of Patients With Treatment-Resistant Depression Treated With Vagus Nerve Stimulation or Treatment as Usual: Comparison of Response, Remission, and Suicidality Am J Psychiatry, 2017.PMID 28359201
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- [25]Holtzheimer PE, Husain MM, Lisanby SH, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial Lancet Psychiatry, 2017.PMID 28988904
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- [30]McCall WV, Lisanby SH, Rosenquist PB, et al. Effects of continuation electroconvulsive therapy on quality of life in elderly depressed patients: A randomized clinical trial J Psychiatr Res, 2018.PMID 29195125