About the ECT Service at University of Iowa Hospitals and Clinics
The ECT Service is a group of psychiatry faculty that consults to the rest of the Psychiatry Department and has specialized expertise in evaluating for and administering electroconvulsive therapy. The ECT service does not directly admit patients, but consults to all in-patient psychiatric units, including child psychiatry. The ECT Service also operates an ECT clinic for evaluation of new patients and medical management of present and former ECT patients. All ECT treatments at UI Hospitals and Clinics are done in an annex to the surgery area under the constant supervision of an ECT faculty member and of Anesthesia Department practitioners. UI Hospitals and Clinics also has a Medical/Psychiatry Unit. Thus, the ECT Service is able to evaluate and treat patients with complex medical and psychiatric comorbidity commensurate with a tertiary care hospital.
- How can a patient be referred for evaluation and treatment?
- In nearly all cases evaluation is arranged after referral from a patient’s primary psychiatrist, neurologist, or other physician. In some cases, evaluation and/or treatments may be on an outpatient basis. Outpatient ECT treatment is an increasingly popular choice, but is only possible when necessary conditions for safety and supervision can be met. In other cases, direct admission or hospital-to-hospital transfer must be arranged. See referral information for details.
- Electroconvulsive therapy, also known as ECT, is a type of physical procedure in which convulsive seizures are electrically induced under general anesthesia.
- This procedure was invented in the 1930s as a treatment for patients who had been so seriously psychiatrically ill that they required extended hospitalization at a time in history when there were few or no treatment alternatives.
- It was originally performed without any anesthesia (because appropriate anesthesia had not yet been invented) and was widely used for a variety of psychiatric problems. The popular image (and much of the stigma) of ECT developed during this era.
- When psychotropic medications (antipsychotics and antidepressants) were discovered in the 1950s and 1960s, ECT became a treatment largely reserved for patients who did not respond to or could not tolerate other forms of treatment. As this transition was taking place, other advances were taking place that made ECT substantially safer and easier to tolerate. It is now considered one of the safest procedures done under general anesthesia.
- Typically, a series of such treatments, one every few days, is used to treat certain psychiatric or medical conditions when several other kinds of treatments have failed or when the clinical situation is very urgent and unsafe.
Conditions commonly treated include, but are not limited to
- Neuroleptic malignant syndrome
- Schizoaffective disorder
- Certain kinds of schizophrenia
Additionally, ECT treatment has been shown in preliminary studies to occasionally be helpful for certain neurological conditions such as Parkinson's Disorder and status epilepticus, though such treatment at this time is "off-label."
For psychiatrists wishing to refer a patient:
- If the patient is not currently hospitalized, but is in need of direct psychiatric hospitalization because of acute symptoms, follow procedures for arranging general psychiatric hospitalization at UI Hospitals and Clinics and let the accepting physician know that you are recommending ECT.
- If the patient is already in a psychiatric hospital, and the referring psychiatrist wishes to transfer that patient to one of our psychiatric in-patient units, call 319-384-5000, the UI Hospitals and Clinics “supertriage” area where hospital-to-hospital transfers are arranged.
- If the patient is not currently hospitalized or acutely unstable and in need of immediate hospitalization, an outpatient ECT clinic evaluation can be requested. Call the ECT Clinic to make this request. We customarily ask that some records of previous treatment be faxed to the ECT Clinic fax.
- To make a referral, please fill out this form, then print and fax it to the ECT clinic.
For patients seeking ECT:
ECT is rarely the place to begin psychiatric treatment. We strongly urge patients to work with their local psychiatrist to treat their illness and, if necessary, arrive at the decision together to consider ECT treatment. However, patients may request an outpatient evaluation directly at the ECT clinic. ECT clinic evaluations are used to explore the history of symptoms and attempted treatments and to educate patients about the potential benefits and risk of ECT. Evaluation at the ECT clinic does not automatically lead to ECT treatment, but may be the starting point for either outpatient or inpatient ECT treatment, if it is deemed appropriate.