| Preface |
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xvii | |
| Acknowledgements |
|
xix | |
| 1 Introduction |
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1 | (20) |
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3 | (8) |
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3 | (2) |
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5 | (1) |
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5 | (1) |
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A competency-based ECT programme |
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5 | (6) |
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11 | (3) |
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14 | (7) |
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14 | (5) |
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ECT device characteristics |
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19 | (2) |
| 2 Knowledge |
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21 | (118) |
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2.1 History: treatment of mental illness |
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23 | (10) |
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Trepanning: early psychosurgery? |
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23 | (1) |
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24 | (1) |
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25 | (1) |
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26 | (1) |
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27 | (2) |
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29 | (4) |
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33 | (9) |
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Mental illness and convulsions |
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34 | (2) |
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36 | (1) |
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The media fans negativity |
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36 | (1) |
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37 | (1) |
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The changing face of the media |
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38 | (1) |
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39 | (3) |
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2.3 Major advances in ECT practice |
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42 | (11) |
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Introduction of anaesthesia |
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43 | (1) |
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43 | (1) |
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43 | (1) |
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Hyperoxygenation and hyperventilation |
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43 | (1) |
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44 | (1) |
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45 | (1) |
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45 | (1) |
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Seizure threshold and stimulus dose titration |
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46 | (1) |
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Electroencephalogram ( EEG) |
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47 | (1) |
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ECT: minimum standards and audit |
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48 | (1) |
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48 | (5) |
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53 | (6) |
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54 | (1) |
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Electrophysiological hypothesis |
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54 | (1) |
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Neuroendocrine hypothesis |
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54 | (1) |
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55 | (1) |
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Anticonvulsive hypothesis |
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56 | (1) |
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56 | (1) |
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Gene expression hypothesis |
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56 | (1) |
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57 | (2) |
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2.5 Clinical indications for ECT: adults |
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59 | (21) |
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Major depressive disorder/unipolar depression |
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59 | (6) |
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Clinical practice guidelines (CPGs) |
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61 | (4) |
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61 | (1) |
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62 | (1) |
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62 | (1) |
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World Federation of Societies of Biological Psychiatry (WFSBP) |
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62 | (1) |
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63 | (1) |
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63 | (1) |
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64 | (1) |
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Bipolar disorder: mania, depression and mixed state |
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65 | (3) |
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Clinical practice guidelines (CPGs) |
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66 | (2) |
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66 | (1) |
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66 | (1) |
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World Federation of Societies of Biological Psychiatry (WFSBP) |
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66 | (1) |
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67 | (1) |
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67 | (1) |
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67 | (1) |
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68 | (2) |
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Clinical practice guidelines (CPGs) |
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69 | (1) |
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70 | (1) |
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70 | (1) |
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Neuroleptic malignant syndrome |
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71 | (1) |
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71 | (1) |
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72 | (1) |
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73 | (7) |
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2.6 Clinical indications: children and adolescents |
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80 | (12) |
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80 | (1) |
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81 | (2) |
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83 | (1) |
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Major depressive disorder with melancholia and psychosis |
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83 | (1) |
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Major depressive disorder with lethal suicide attempts/severe self-injurious behaviour (SIB) |
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84 | (1) |
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Treatment-resistant depression and bipolar disorder in adolescents |
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84 | (1) |
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Bipolar disorder unresponsive to mood stabilisers |
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85 | (1) |
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Schizophrenia spectrum disorders (SSD) |
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85 | (2) |
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Catatonia in children and adolescents |
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87 | (1) |
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Tolerability of ECT in adolescents |
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87 | (1) |
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88 | (4) |
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2.7 Clinical indications: older people |
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92 | (5) |
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92 | (1) |
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93 | (1) |
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Tolerability of ECT in old age |
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93 | (2) |
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Management special considerations |
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95 | (2) |
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97 | (3) |
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2.9 Contraindications for ECT |
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100 | (4) |
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100 | (1) |
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101 | (1) |
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101 | (1) |
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Risk of untreated psychiatric illness |
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101 | (1) |
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102 | (1) |
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102 | (2) |
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2.10 Brain stimulation: new directions |
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104 | (35) |
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105 | (1) |
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Advantages of brain stimulation techniques |
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105 | (1) |
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Convulsive stimulation techniques |
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106 | (2) |
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Magnetic seizure therapy (MST) |
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106 | (1) |
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Focal electrically assisted seizure therapy (FEAST) |
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107 | (1) |
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Non-convulsive stimulation techniques |
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108 | (14) |
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Repetitive transcranial magnetic stimulation (rTMS) |
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108 | (6) |
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109 | (1) |
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110 | (1) |
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111 | (1) |
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111 | (1) |
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112 | (1) |
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Factors that affect efficacy of rTMS |
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112 | (1) |
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112 | (1) |
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113 | (1) |
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rTMS as a clinical treatment option |
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113 | (1) |
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RANZCP Position Statement 79: rTMS (RANZCP, 2013) |
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114 | (1) |
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Deep repetitive transcranial magnetic stimulation (dTMS) |
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114 | (2) |
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115 | (1) |
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dTMS in psychiatric conditions |
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115 | (1) |
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116 | (1) |
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Transcranial direct current stimulation (tDCS) |
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116 | (4) |
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117 | (1) |
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Other forms of transcranial electrical stimulation |
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118 | (1) |
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118 | (2) |
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120 | (1) |
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Caloric vestibular stimulation (CVS) |
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120 | (1) |
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Galvanic vestibular stimulation (GVS) |
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121 | (1) |
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121 | (1) |
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Sensory evoked potentials |
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121 | (1) |
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Visual evoked potentials (VEPs) |
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121 | (1) |
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Short-latency brainstem auditory evoked potentials (BAEPs) |
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122 | (1) |
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Somatosensory evoked potentials (SEPs) |
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122 | (1) |
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122 | (1) |
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Transcranial electrical motor evoked potential monitoring (TCeMEP) |
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122 | (1) |
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Surgically invasive techniques |
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122 | (7) |
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Deep brain stimulation (DBS) |
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122 | (3) |
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DBS and Parkinson's disease |
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123 | (1) |
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124 | (1) |
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DBS and obsessive compulsive disorder (OCD) |
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125 | (1) |
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Vagus nerve stimulation (VNS) |
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125 | (2) |
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VNS and intractable epilepsy |
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126 | (1) |
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VNS and treatment-resistant depression |
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126 | (1) |
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Transcutaneous vagus nerve stimulation (t-VNS) |
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127 | (1) |
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Direct cortical stimulation (DCS) |
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128 | (1) |
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Navigated repetitive TMS (nTMS) |
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128 | (1) |
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Pre-surgical functional magnetic resonance imaging (fMRI) for language assessment |
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128 | (1) |
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Magnetoencephalography (MEG) |
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129 | (1) |
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129 | (10) |
| 3 Organisational/administrative skills |
|
139 | (16) |
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3.1 Setting up an ECT service/clinical governance |
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141 | (14) |
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Approach to service delivery |
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142 | (1) |
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143 | (14) |
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143 | (1) |
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143 | (1) |
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143 | (1) |
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144 | (1) |
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144 | (1) |
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144 | (1) |
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Clinical director of ECT services |
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144 | (1) |
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Psychiatry registrars/trainees |
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144 | (1) |
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ECT coordinator/nurse specialist |
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145 | (1) |
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145 | (1) |
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145 | (1) |
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145 | (2) |
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147 | (1) |
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148 | (1) |
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148 | (1) |
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148 | (1) |
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148 | (1) |
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149 | (1) |
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150 | (1) |
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150 | (1) |
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Continuation and maintenance ECT |
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151 | (1) |
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151 | (1) |
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151 | (4) |
| 4 Clinical skills |
|
155 | (96) |
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157 | (7) |
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157 | (1) |
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158 | (1) |
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158 | (1) |
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159 | (1) |
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159 | (1) |
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160 | (1) |
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161 | (1) |
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162 | (2) |
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4.2 Adverse events of ECT |
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164 | (23) |
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Adverse events during ECT |
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164 | (6) |
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164 | (1) |
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Asystole/electrocardiac pause |
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165 | (2) |
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167 | (1) |
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168 | (1) |
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Complications secondary to medication |
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168 | (1) |
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168 | (2) |
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Adverse events immediately post-ECT treatment |
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170 | (2) |
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Transient postictal delirium |
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170 | (1) |
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170 | (1) |
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171 | (1) |
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171 | (1) |
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Adverse effects after the course of ECT treatment |
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172 | (15) |
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172 | (6) |
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173 | (1) |
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173 | (1) |
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Current debate: evaluating autobiographical memory |
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174 | (1) |
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175 | (1) |
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176 | (1) |
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Subjective memory deficits |
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176 | (1) |
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177 | (1) |
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178 | (1) |
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Detection of cognitive deficits |
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178 | (2) |
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Audio Recorded Cognitive Screen (ARCS) |
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180 | (1) |
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Strategies to improve efficacy and minimise cognitive impairment |
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180 | (7) |
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4.3 Medical risks and management |
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187 | (31) |
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Cardiovascular complications |
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188 | (3) |
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188 | (1) |
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189 | (1) |
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High-risk cardiovascular conditions |
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189 | (1) |
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Management of the haemodynamic risk |
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189 | (1) |
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Myocardial infarction (MI) and unstable angina |
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190 | (1) |
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191 | (1) |
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191 | (1) |
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191 | (3) |
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Cerebral infarction and haemorrhage |
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191 | (1) |
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192 | (1) |
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192 | (1) |
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192 | (1) |
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192 | (1) |
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Skull defects and intracranial metal objects |
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193 | (1) |
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Neuropsychiatric disorders |
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194 | (3) |
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194 | (1) |
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Pseudodementia/depressive dementia |
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195 | (1) |
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Neuroleptic malignant syndrome (NMS) |
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195 | (1) |
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196 | (1) |
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Muscular skeletal disorders |
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197 | (1) |
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197 | (2) |
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197 | (1) |
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197 | (1) |
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Hypothalamic-pituitary-thyroid axis |
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198 | (1) |
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198 | (1) |
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198 | (1) |
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Chronic adrenal insufficiency (Addison's disease) |
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199 | (1) |
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Other endocrine conditions |
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199 | (1) |
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199 | (1) |
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199 | (1) |
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199 | (1) |
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200 | (1) |
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200 | (1) |
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200 | (1) |
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200 | (3) |
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200 | (1) |
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201 | (1) |
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201 | (1) |
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Chronic obstructive pulmonary disease and asthma |
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201 | (1) |
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Gastro-oesophageal reflux disease (GORD) |
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202 | (1) |
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202 | (1) |
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202 | (1) |
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Pseudocholinestase deficiency |
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203 | (1) |
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203 | (15) |
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Anaesthetic considerations |
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205 | (1) |
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206 | (1) |
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206 | (1) |
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207 | (11) |
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218 | (16) |
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219 | (3) |
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Tricyclic antidepressants (TCA) |
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220 | (1) |
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Selective serotonin/noradrenaline reuptake inhibitors (SSRI and SNRI) |
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221 | (1) |
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Noradrenaline reuptake inhibitors |
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221 | (1) |
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221 | (1) |
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221 | (1) |
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Monoamine oxidase inhibitors (MAOI) |
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221 | (1) |
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222 | (1) |
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222 | (1) |
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223 | (2) |
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224 | (1) |
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225 | (2) |
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Anticonvulsant medication |
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225 | (1) |
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225 | (1) |
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Anticonvulsants and epilepsy |
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226 | (1) |
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226 | (1) |
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227 | (2) |
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227 | (1) |
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228 | (1) |
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228 | (1) |
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228 | (1) |
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228 | (1) |
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Acetylcholinesterase inhibitors |
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228 | (1) |
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Australian psychotropic therapeutic guidelines |
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229 | (5) |
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4.5 Tips for clinical practice |
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234 | (17) |
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234 | (2) |
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236 | (1) |
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236 | (1) |
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Operating theatre or stand-alone suite? |
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236 | (2) |
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To titrate or not to titrate? |
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238 | (1) |
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To clean or not to clean? |
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238 | (1) |
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Disposable or handheld electrodes? |
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239 | (1) |
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To monitor or not to monitor? |
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240 | (2) |
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241 | (1) |
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241 | (1) |
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241 | (1) |
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241 | (1) |
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241 | (1) |
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242 | (1) |
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To measure or not to measure? |
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242 | (1) |
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Ultrabrief or not ultrabrief? |
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|
242 | (1) |
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What next after ultrabrief? |
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|
243 | (1) |
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Twice a week or three times a week? |
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|
244 | (1) |
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To restrain or not to restrain? |
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244 | (1) |
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244 | (1) |
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245 | (1) |
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245 | (1) |
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To treat or not to treat? |
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|
245 | (2) |
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To continue or not to continue? |
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|
247 | (1) |
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Which device: MECTA or Thymatron? |
|
|
247 | (1) |
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|
248 | (3) |
| 5 Technical skills |
|
251 | (98) |
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253 | (14) |
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253 | (1) |
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Isolated limb technique (ILT) |
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254 | (2) |
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256 | (1) |
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Monitoring electrodes anatomical placement |
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|
257 | (1) |
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257 | (1) |
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258 | (1) |
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Electrode site skin preparation |
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|
258 | (2) |
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Apply treatment electrodes |
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260 | (1) |
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260 | (1) |
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260 | (1) |
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261 | (1) |
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Oxygenation/hyperventilation |
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|
261 | (1) |
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Protection of the oral cavity |
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|
262 | (1) |
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263 | (1) |
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264 | (1) |
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Administration of anaesthetic agents |
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|
264 | (1) |
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264 | (1) |
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264 | (1) |
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264 | (1) |
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265 | (1) |
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265 | (1) |
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Missed or abortive seizures |
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265 | (1) |
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265 | (2) |
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266 | (1) |
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267 | (19) |
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268 | (1) |
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268 | (1) |
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268 | (2) |
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270 | (1) |
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Right unilateral ECT non-dominant (RUL) |
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|
270 | (2) |
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"Handedness" or laterality |
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|
272 | (1) |
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Left unilateral electrode placement (LUL) |
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|
273 | (1) |
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274 | (1) |
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|
275 | (3) |
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Left anterior right temporal (LART)/left frontal right temporal (LFRT) ECT |
|
|
278 | (2) |
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Other electrode placements |
|
|
280 | (1) |
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Recommendations for clinical practice |
|
|
280 | (1) |
|
Unipolar and bipolar depression |
|
|
280 | (1) |
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|
281 | (5) |
|
5.3 Stimulus dosing strategies |
|
|
286 | (7) |
|
Current debate concerning dosing strategies |
|
|
287 | (1) |
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|
287 | (1) |
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287 | (1) |
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288 | (1) |
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288 | (1) |
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288 | (1) |
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Changing the stimulus dose |
|
|
288 | (3) |
|
Dose based upon multiple factors |
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|
291 | (2) |
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291 | (1) |
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|
292 | (1) |
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|
293 | (18) |
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|
293 | (2) |
|
The ECT electrical circuit |
|
|
295 | (1) |
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295 | (1) |
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296 | (1) |
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296 | (1) |
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297 | (1) |
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297 | (1) |
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298 | (1) |
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298 | (1) |
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299 | (1) |
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300 | (1) |
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300 | (1) |
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301 | (1) |
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301 | (1) |
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301 | (1) |
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302 | (1) |
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302 | (1) |
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303 | (1) |
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303 | (1) |
|
|
|
304 | (1) |
|
|
|
305 | (1) |
|
Combined titration and treatment |
|
|
306 | (1) |
|
Subconvulsive stimulation |
|
|
306 | (5) |
|
|
|
306 | (1) |
|
|
|
307 | (4) |
|
5.5 The electroencephalogram (EEG) |
|
|
311 | (18) |
|
|
|
311 | (1) |
|
|
|
312 | (1) |
|
|
|
313 | (1) |
|
Categorisation of bandwidths |
|
|
313 | (1) |
|
|
|
314 | (1) |
|
|
|
314 | (1) |
|
|
|
315 | (1) |
|
|
|
315 | (5) |
|
|
|
320 | (1) |
|
|
|
320 | (1) |
|
Measurement of the motor fit |
|
|
321 | (1) |
|
|
|
321 | (2) |
|
Markers of seizure adequacy |
|
|
323 | (1) |
|
|
|
323 | (1) |
|
|
|
324 | (1) |
|
|
|
324 | (2) |
|
|
|
326 | (1) |
|
|
|
327 | (2) |
|
|
|
329 | (11) |
|
|
|
329 | (2) |
|
|
|
331 | (2) |
|
|
|
331 | (1) |
|
|
|
331 | (2) |
|
|
|
331 | (1) |
|
|
|
332 | (1) |
|
|
|
332 | (1) |
|
|
|
332 | (1) |
|
|
|
333 | (1) |
|
|
|
333 | (1) |
|
|
|
333 | (1) |
|
Suxamethonium or succinylcholine |
|
|
334 | (1) |
|
Non-depolarising muscle relaxants |
|
|
334 | (1) |
|
|
|
334 | (1) |
|
|
|
335 | (1) |
|
|
|
336 | (1) |
|
|
|
336 | (1) |
|
|
|
337 | (3) |
|
|
|
337 | (3) |
|
Disposable/single-use bite blocks |
|
|
337 | (1) |
|
Re-useable/rubber bite blocks |
|
|
337 | (3) |
|
5.7 EGT devices: set-up procedure |
|
|
340 | (9) |
|
|
|
340 | (4) |
|
For power settings above 100% without ultrabrief pulse width (0.3 ms) modification |
|
|
344 | (1) |
|
Safety monitor activated alarm |
|
|
344 | (1) |
|
For power settings above 100% with ultrabrief pulse width (0.3 ms) modification |
|
|
344 | (1) |
|
MECTA spECTrum 5000M and Q |
|
|
344 | (3) |
|
|
|
347 | (2) |
| 6 Ambulatory ECT, continuation ECT and maintenance ECT |
|
349 | (12) |
|
6.1 ECT after completion of the index course |
|
|
351 | (10) |
|
|
|
351 | (2) |
|
|
|
352 | (1) |
|
Tapering or step-down ECT |
|
|
353 | (1) |
|
|
|
353 | (1) |
|
|
|
353 | (1) |
|
Indications for continuation and maintenance ECT |
|
|
353 | (1) |
|
Current state of the evidence |
|
|
354 | (1) |
|
|
|
354 | (2) |
|
|
|
356 | (1) |
|
The end point for maintenance ECT |
|
|
357 | (6) |
|
|
|
357 | (1) |
|
|
|
357 | (1) |
|
|
|
357 | (1) |
|
|
|
358 | (3) |
| 7 The ECT nurse and the ECT coordinator |
|
361 | (8) |
|
7.1 Nurses: key members of the ECT team |
|
|
363 | (6) |
|
Nursing involvement in the ECT journey |
|
|
363 | (1) |
|
|
|
364 | (1) |
|
|
|
365 | (1) |
|
|
|
365 | (2) |
|
|
|
367 | (1) |
|
|
|
367 | (2) |
| 8 ECT: the lived experience |
|
369 | (10) |
|
8.1 Consumer perspectives |
|
|
371 | (8) |
|
Wow I have my life back! By Alirra |
|
|
373 | (6) |
| 9 Scenario-based problems |
|
379 | (42) |
|
9.1 Postictal delirium and ECT |
|
|
381 | (5) |
|
9.2 ECT, the elderly and a high seizure threshold |
|
|
386 | (7) |
|
9.3 ECT, epilepsy and obsessional personality style |
|
|
393 | (6) |
|
|
|
399 | (8) |
|
9.5 Complex ECT treatment: identify errors and make recommendations for improvement |
|
|
407 | (4) |
|
9.6 EEG challenges: what should you do next? |
|
|
411 | (10) |
|
Case 1: 19-year-old female, suprathreshold seizure |
|
|
411 | (2) |
|
Case 2: 42-year-old male, threshold seizure |
|
|
413 | (3) |
|
Case 3: 84-year-old female, poor-quality EEG |
|
|
416 | (2) |
|
Case 4: 36-year-old female, fifth treatment with short EEG |
|
|
418 | (3) |
| Index |
|
421 | |
