Elektrokonvulzivna terapija: osamdeset godina iskustva u Hrvatskoj i u svijetu
2020
Electroconvulsive therapy (ECT), even more than 80 years since its introduction, continues to be the
most effective treatment for severe mental disorders. Croatian psychiatrists have used ECT since 1940s. Today it is
performed only at the University Hospital Centre Zagreb, predominantly in patients with schizophrenia. Extensive
research reported numerous biological effects of ECT, which contribute to its antidepressant, antimanic, antipsychotic,
anticonvulsive and antiparkinsonian effects. Convulsions trigger changes in the cerebral blood flow and
metabolism, increase the permeability of the blood-brain barrier, modulate glutamatergic, GABAergic, serotonergic,
noradrenergic and dopaminergic neurotransmission, affect hormone secretion, gene expression, stimulate
neuroplasticity, and eventually induce brain structural changes. Some of these effects are short-lasting and
others,
such a neuroplasticity, last for at least several months. While ECT is generally considered a low-risk medical
treatment, patients with severe somatic comorbidity require careful risk-benefit assessment. The most commonly
observed adverse events are transient forgetfulness and headache. Prior to initiation, candidates undergo comprehensive
diagnostic evaluation according to international standards. The procedure is performed by an interdisciplinary
team, consisting of psychiatrist, anesthesiologist, and psychiatric and anesthesiological nurses. The application
of general anesthesia enables rapid loss of consciousness, short-time muscular relaxation, suppression of
hyperdynamic response to electrical current and fast recovery of breathing and awareness. Recently, the Croatian
expert group has proposed national guidelines for the ECT treatment. Due to its efficacy in both treatment-refractory
and very severe symptomatology, ECT might be of a great benefit in carefully selected patients.
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