The ECT Handbook (2nd Edition)

Electroconvulsive therapy (ECT) has been used to treat vari- This edition updates knowledge in ECT and recommends ous psychiatric conditions, including depressive illness, mania, schizophrenia and catatonia. The technique has become an important treatment in contemporary psychiatric practice. However, there are concerns about its efficacy, safety and mode of action. This handbook may not provide a clear solution or any definitive answer on the place in therapy of ECT, but it does provide timely materials and recommendations, and is written in the light of recent guidelines.

The main text is divided into 4 parts: clinical guidelines; psychotropic drug treatment and ECT; the administration of ECT; and the law and consent. Part 1 begins with "the place of ECT in contemporary psychiatric practice", where the existing recommendations on the role of ECT in the treatment of depressive disorder, mania, schizophrenia and catatonia can be found. These are considered and discussed in detail in the subsequent chapters. In the treatment of depression, the circumstances under which ECT should be used as a first- or second-line treatment are clearly delin- eated. In schizophrenia, the evidence to support the use of ECT as a maintenance treatment is examined critically.

The chapter on the law and consent to treatment reflects recent concern on legal aspects of informed consents and the rights of people incapacitated by mental disorder. The statutory provisions of the Mental Health Act 1983 are not directly applicable to Hong Kong. However, the common law position and reasoning, such as the 'Bournewood' judgement, the concept of 'necessity' and the assessment of mental capacity are relevant to our clinical practices. The discussion on the law and consent to treatment in the UK can be very useful material for trainee psychiatrists prepar- ing for professional examination in the UK. some important practical changes since its first edition, which was published in 1994. For example, it emphasises the need for the electrical dose to be tailored to the needs of individual patients. The fixed-dose policy, described as acceptable in the first edition, is criticised for its potential to cause acute and longer term cognitive effects without any commensurate efficacy benefit. Furthermore, this edition states that if the patient's clinical improvement is satisfactory, it is not necessary to increase the dose in the face of shortening of the length of convulsions over the course of ECT.

In addition to the main text for this book, the appendices must not be overlooked. A sample stimulus dosing protocol and a worked example can be found. These samples allow the reader an increased understanding of stimulus dose titration and adjustment throughout a course of ECT. In addition, there are examples of consent forms, suggested templates for authorization in the case of incapacitated com- pliant patients, and emergency treatment.

The information in this book is relatively easy to follow and comprehensive. It will prove a valuable resource not only to the practicing psychiatrist, but also to the trainee. I think that this book is unique in considering the theoretical and prac- tical aspects of ECT. Although the views expressed do not necessarily reflect those of the Royal College of Psychiatrists, the book can serve as an important reference concerning standards and guidelines for ECT in clinical practice.

Victor WC Lui
MBBS, MRCPsych, FHKCPsych, FHKAM (Psychiatry)
Tai Po Hospital, Tai Po
Hong Kong, China

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