Electroconvulsive therapy (ECT) has retained an important but controversial position in contemporary psychiatric therapeutics. Out-dated standards of clinical practice regarding its technical administration, clinical indications, and dosage continue to influence the present use of ECT. Insofar as present knowledge permits, this paper describes optimum clinical standards for the use of ECT in contemporary practice. Where knowledge is insufficient to permit articulation of absolute standards, guidelines for its clinical use are presented. Particular emphasis is placed upon a narrow definition of the clinical indications for ECT, clearly linked to its demonstrated effectiveness and potential benefit in excess of its risks to any given patient. The technical administration of the procedure is described in detail with particular emphasis on the pre-treatment protocol, including consent, and the treatment dosage, including stimulus waveform, electrode placement, and number of treatments per course. The major deficiencies in knowledge are identified.
The rationale for and history of civil commitment legislation in Ontario are reviewed. The civil commitment rate in Ontario from 1926 to 1980 for provincial psychiatric hospitals, and from 1974 to 1980 for all psychiatric inpatient facilities was analyzed to detect variation in the rate over time and with relevant legislation. The findings indicate that mental health legislation has had little effect on commitment practices in Ontario. In addition, the variation in the commitment rate over the period reviewed cannot be ascribed to inconsistent application by physicians. The other variables affecting the rate are discussed in this context. The need for more descriptive studies of the major determinants of the commitment rate is emphasized.
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