Electroconvulsive Therapy

Abstract

Abstract In this fully-revised fourth edition of what has long been the standard textbook for the field, Dr. Richard Abrams once again demonstrates his unique ability to analyze and present a wealth of new(and often technical) material in a lucid, compelling, and highly readable fashion. Hundreds of new clinical studies called from the more than 1500 published since the third edition appeared have been analyzed in depth and incorporated throughout the book. An important new chapter has been added on Transcranial Magnetic Stimulation(TMS) therapy, a treatment for depression that is widely-used in Europe and expected to become available soon for clinical use in the United States. Dr. Abrams exposes the scientific flaws in several widely-cited reports, while focusing on the few carefully-controlled studies that provide solid support for the results claimed. The sections on the electrical stimulus, seizing introduction, seizure quality, and treatment electrode placement have been completely revised and updated with new information on those clinical and technical issues that are presently of greatest concern to practitioners and researchers. A comprehensive critical assessment of the nature of the seizure threshold and the validity of the stimulus titration method for ECT dosing is presented for the first time, with conclusions and recommendations that many will find surprising. The continued controversy over the relative efficacies of unilateral and bitemporal ECT is revisited in light of the latest dosing strategies and treatment outcomes reported, and of the latest results obtained with bifrontal ECT. The potential clinical and theoretical advantages of the recently-rediscovered technique of ultrabrief pulse therapy are explained in detail. The chapter on the memory and cognitive consequences of ECT has been expanded to focus on the subjective memory effects of treatment, with new analysis of the possible biological basis for the improvement in subjective memory so often reported. Recently-published claims of persistent or permanent memory effects of ECT are refuted in detail. In full accordance with the American Psychiatric Association’s new guidelines for the practice of ECT, Dr. Abrams’ book remains the essential practical guide and reference work for all those who prescribe, perform, or assist with ECT, or are interested in learning more about the subject.