특수한 환자의 전기경련요법

Electroconvulsive Thrapy in Special Patients

With the burgeonging of psychopharmacological treatment for depression over the past 30 years, it may have been believed that electroconvulsive therapy(ECT) was on the way to extinction. But we are now no longer optimistic about the efficacy of antidepressant medication for all psychiatric patients. Even with the most sophisticated psychopharmacholgical combinations, a substantial proportion o f patients remains severely ill. Because of the vulnerability and sensitivity to the side effect of antidepressant medication experienced by geriatric patients, ECT has become the important treatment for depression and required careful consideration as a therapeutic modality. In fact, ECT is especially safe and effective in the elderly patients. ECT can be compared favorably with any procedure in all of medicine for its low morbidity and mortality. W ith recent advances in ECT treatment technique, it has enjoyed a resurgence as a mainstream treatment in the psychiatry armamentarium. Furthermore, it has a rapid onset of effect and can be performed in both inpatient and outpatient settings. ECT also appears to be effective in patients with various medical illness and in some cases may even benefit in the underlying neurological disorder. So we should pay a careful attention to the patient s medical stage. We should be familiar with modem technique of administering ECT including delivery of the stimulus, anesthesia and muscular relaxation as well as ways of minimizing stress to the cardiovascular system. The authors reviewed the strength and lim itation of ECT in the elderly patients, patients with medical illness, children and adolescents patients and pregnant patients