Abstract

Electroconvulsive therapy (ECT), an efficient psychiatric treatment method, is one of the most controversial and the most stigmatized therapeutic approaches in medicine. ECT uses transcranial electrical impulses to induce artificial epileptiform paroxysm. For the first time it was used in 1938 by Italian neuro-psychiatrists Ugo Cerletti and Lucio Bini in treatment of schizophrenia. Efficacy of the method was proven in clinical practice, clinical studies and meta-analyses. ECT is the most efficient in the treatment of mood disorders and in lesser extent in some other disorders. Important advance in ECT was the introduction of anaesthesia and muscle relaxation. It reduced adverse effect incidence and severity. Currently, ECT is associated mostly with anaesthesia adverse effects. Other adverse reactions include muscle pain, headache, prolonged paroxysm, cardiopulmonary complications. The most discussed and the most disturbing adverse effect is memory impairment which is usually transient. Incidence and severity of adverse effects is comparable to other therapeutic modalities. Examining the available information it appears, that modern practice of ECT in Europe (European Union member states) and USA is, apart from a few exceptions, in accordance with principles of beneficence and to some extent with autonomy and nonmaleficence. In many countries, the principle of justice is not respected – either because of limited availability or restrictive laws. In the Czech Republic the problem is non-existence of codified treatment guidelines and insufficient training of medical specialists. Aside from this, position of ECT in the Czech Republic is similar to that in the rest of Europe and in USA.