Classics in ECT: ECT in a Psychiatric Intensive Care Unit, in the Australian and New Zealand Journal of Psychiatry, 1994

 "Classics in ECT" brings you this paper from Aust NZ Psychiatry in 1994:

Electroconvulsive therapy in a psychiatric intensive care unit.

Hafner RJ, Holme G.Aust N Z J Psychiatry. 1994 Jun;28(2):269-73. doi: 10.1080/00048679409075638.PMID: 7993281

The abstract is copied below:

This study reviewed all patients (N = 37) treated with ECT in a psychiatric intensive care unit during 1989-91. Diagnoses were: psychotic depression (8); bipolar disorder, manic phase (13); schizoaffective disorder (14); and schizophrenia (2). All patients were very severely disturbed and had failed to respond to medication given at highest levels judged to be safe, usually over 3-4 weeks. Response to ECT was generally rapid and marked, allowing substantial reductions in medication. To achieve the same clinical outcome for each course of ECT, 50% more unilateral than bilateral treatments were required, suggesting that bilateral ECT has a more rapid effect in this highly disturbed population.

The pdf is here.

And from the text:

This is a really excellent short paper describing the use of ECT for VERY severe psychiatric illness. It is nicely written, and the case vignettes are poignant and instructive. Here are some early anecdotal data for the benefits of ECT in bipolar disorder; the observation about the greater speed of response with bilateral electrode placement is also worth noting.

I strongly recommend a full read to all healthcare personnel involved with ECT, ~ 10 minutes; in fact, I wish the lay public could read this paper, to better understand how ill some of our ECT patients are. The authors' comments about prejudice against ECT and psychiatrists' reluctance to prescribe it, of course, still resonate today...