The elderly now represent more than half of those treated with ECT which is often the preferred treatment in frail older patients with psychotic depression, catatonia, poor food and fluid intake, or marked psychomotor retardation, even in the absence of failure to have responded to a medication trial. As with any medical intervention, appropriate screening procedures should be performed to minimize the potential hazards and maximize the benefits of treatment. This presentation will briefly review (1) the administration of ECT focusing on the risks associated with general anesthesia and the hemodynamic changes that occur during ECT; (2) the management of patients with cardiovascular or other specific physical disease and the potential effects of concurrent medication use during ECT; (3) a systematic approach to the screening of ECT candidates with an emphasis on assessing physical illness that may require treatment modifications to minimize the risks of ECT.
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