Book Review: Electroconvulsive Therapy: The ECT Handbook. Third Edition

Electroconvulsive Therapy The ECT Handbook. Third Edition. Jonathan Waite, Andrew Easton, editors. London (GB): RCPsych Publications; 2013. 288 p. £45.00Reviewer rating: GoodSince the seminal editorial in the Lancet by Dr Chris Freeman, who admonished his colleagues by stating if ECT is ever legislated against or falls into disuse it will not be because it is an ineffective or dangerous treatment, it will be because psychiatrists have failed to supervise and monitor its use adequately,1, p 1208 leading electroconvulsive therapy (ECT) practitioners in the United Kingdom have paved the way in conducting systematic surveys of practice, developing clinical practice guidelines (CPGs), and creating ECT interdisciplinary accreditation services to monitor ECT clinics. The latest iteration of the Royal College of Psychiatrists' The ECT Handbook, which updates the previous edition published in 2005, reflects guidance and recommendations encompassing the scope of ECT practice in 23 user-friendly chapters. The ECT Handbook discusses the decade-old controversy surrounding some of the Royal College Special Committee on ECT's recommendations as being divergent to those of the National Institute of Clinical Excellence (NICE), with some reconciliation in 2009 after revised NICE guidelines,2 which illustrates the tension that can occur when governmental agencies attempt to impose restrictions on clinical practice without sufficient input from treatment providers. This tension has also been manifest in the United States in the ongoing review by the Food and Drug Administration Advisory Panel on the safety of ECT devices.3The ECT Handbook covers areas of practice not contained in previous British or American ECT CPGs, including ultrabrief pulse width and bifrontal ECT, biological mechanisms, comparison with other neurostimulation therapies, and a very helpful section on dental assessment and management. The chapters on the risks of cognitive impairment and training or competency to administer ECT are particularly illuminating, respectively reflecting contemporary reviews and UK residency training standards. Recommendations are clearly laid out at the end of most chapters, though the reader will sometimes need to refer to the text to gather other recommendations.More tables would have highlighted certain points more succinctly. There are appendices that provide sample ECT information for patients and families, and a sample consent form. These pieces of information can help educate and supplement the Canadian video information that is now widely available.4For Canadian practitioners, many recommendations are pertinent, although there are some distinct differences that may render certain ones not as applicable to practice here. UK ECT devices can deliver almost double the maximum stimulus energy (1000 mC), compared with those in North America. North American practice tends toward ECT 3 times weekly and 2 times above seizure threshold bilateral ECT, as opposed to the twice weekly ECT and 1.5 times above seizure threshold bilateral ECT, as more conservatively recommended by The ECT Handbook. There was some discrepancy on the definition of prolonged ECT-elicited seizure in The ECT Handbook, as one chapter stated 90 seconds while another indicated 120 seconds, but they are still less than the 180 seconds, as defined in the American Psychiatric Association (APA)5 and British Columbia ECT guidelines.6 As well, The ECT Handbook's concept of an escort nurse, who knows the patient, knows the ECT process, and must accompany him or her to and from the session, may be ideal, yet can be practically difficult owing to limited nursing availability in some places. …

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