Right unilateral ECT at 6x seizure threshold: is it effective in the psychoses?

Abstract

OBJECTIVE: To date, right unilateral electroconvulsive therapy administered at 6x seizure threshold (6x RUL-ECT) has been described in relation to unipolar depression alone. For clinicians who have developed an experience and confidence in bilateral ECT, the effectiveness of 6x RUL-ECT in other psychiatric disorders, particularly those who are severely ill, has remained untested and therefore unknown. This article describes the results of 6x RUL-ECT in a select series of patients with a nondepressive psychotic illness.

METHOD: Six patients with psychotic disorders of nondepressive origin were selected from a recent 2-year retrospective review of 6x RUL-ECT practice. The clinical presentation, ECT parameters, and responses were recorded.

RESULTS: Four patients with severe psychotic disorders, two of whom met broad criteria for catatonia, responded to an index course of 6x RUL-ECT. One psychogeriatric patient who had protracted inpatient mania continues to benefit from outpatient maintenance 6x RUL-ECT over 18 months. Two elderly males, in whom seizures were difficult to elicit and maintain, responded poorly.

CONCLUSION: 6x RUL-ECT was effective in 4 patients with nondepressive, psychotic disorders. While clinically viable and although memory was not assessed, it is uncertain what advantage 6x RUL-ECT confers over a bilateral electrode placement. The real focus should remain on clinical responsivity.