PS13.1 | Therapeutics in Psychiatry — Glossary

A legal document under the MHCA 2017 in which a person with mental illness specifies their preferences for treatment (including ECT) in the event of future incapacity; legally binding on treating clinicians.

Difficulty forming new memories during and immediately after an ECT course; typically transient and resolves after the treatment course ends.

ECT electrode configuration with one electrode on each temple, producing greater efficacy and faster response than unilateral placement but with more pronounced cognitive side effects.

A stimulus waveform used in modern ECT machines that delivers shorter electrical pulses than the older sine-wave form, achieving the seizure threshold with less total charge and fewer cognitive side effects.

A neuropsychiatric syndrome characterised by marked psychomotor disturbance (immobility, mutism, posturing, or agitated excitement); responsive to benzodiazepines and ECT.

A biological psychiatric treatment involving the application of a controlled electrical stimulus to the scalp to induce a therapeutic generalised cerebral seizure, administered under anaesthesia.

Periodic ECT sessions given after an acute course (typically monthly or less) to prevent relapse in patients with recurrent or treatment-resistant conditions.

Indian legislation governing the rights of persons with mental illness, replaced the Mental Health Act 1987; prohibits unmodified ECT for adults and requires High Court approval for ECT in minors.

ECT performed under general anaesthesia with succinylcholine (muscle relaxant) and oxygenation/ventilation, which abolishes the peripheral motor component of the seizure and prevents musculoskeletal complications.

A life-threatening reaction to antidopaminergic agents characterised by fever, lead-pipe rigidity, autonomic instability, and raised CK; ECT is an option when pharmacological management fails.

Temporary cognitive disorientation following a seizure (including those induced by ECT), lasting minutes to tens of minutes; a normal and expected occurrence after each ECT session.

A rare genetic condition that impairs the metabolism of succinylcholine, potentially leading to prolonged neuromuscular blockade; identified through pre-anaesthetic assessment.

Difficulty recalling events that occurred before the ECT course; a recognised side effect that is usually transient and resolves within weeks to months after treatment.

The minimum electrical stimulus energy required to induce a generalised seizure in a given patient; varies with age, electrode placement, and concomitant medications.

A depolarising neuromuscular blocking agent used in modified ECT to produce brief, complete peripheral muscular paralysis, preventing the motor convulsion while leaving the cerebral seizure intact.

A short-acting barbiturate induction agent commonly used in modified ECT in Indian practice to render the patient unconscious before succinylcholine administration.

Depression that has failed to respond adequately to ≥2 trials of antidepressants at adequate doses and duration; a major indication for ECT.

ECT electrode configuration with both electrodes on the non-dominant (usually right) hemisphere, producing fewer cognitive effects at the cost of potentially reduced efficacy per session.

The historical form of ECT administered without anaesthesia or muscle relaxation, associated with serious musculoskeletal complications including vertebral fractures; prohibited for adults under the MHCA 2017.