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ECT for C-L Psychiatrists: An Effective Intervention That Might Save a Life

Electroconvulsive Therapy (ECT) is an effective, rapidly acting treatment for many psychiatric conditions including depression, mania, and catatonia. It is a key component of modern psychiatric care, providing relief of sometimes life-threatening symptoms for which no other therapies are effective. ACLP recognizes the need for ECT training: “The C-L psychiatrist must be knowledgeable about electroconvulsive therapy (ECT) and recognize when to introduce it in depressed, catatonic, or critically ill patients” (Bronheim, Fulop, Kunkel, et al; 1998). Because many patients seen by C-L psychiatrists have comorbid medical conditions that may be disabling and that can be made worse by one or more psychiatric conditions, rapid treatment and resolution of these conditions is essential to optimal patient care. This course will introduce C-L clinicians to ECT or serve as a refresher course for C-L clinicians familiar with its use and will show how it may be used in medical and surgical patients while addressing the legal, ethical, and physiological parameters that must be considered when providing a course of ECT for complex patients. We will also discuss the challenges faced by ECT recipients and providers during the COVID-19 pandemic. Several cases that illustrate the many ways ECT can be used successfully by C-L Psychiatrists will be presented. This Skills course will cover the following topics: Dr Rabinowitz -Background and history of ECT -ECT technique Dr Lewicki -Basic science of ECT -Hypothesized mechanisms of action Drs Eyler & Odefey -Work-up of the medical/surgical patient -Anesthesia technique & physiological response to electrically induced seizures -Role of the anesthesia provider in optimizing treatment success and preventing complications -Protecting patients and treatment team from viral exposure during the COVID-19 pandemic -Special considerations for evaluating candidates for ECT via telemedicine Drs Knight and Lewicki -Some diagnoses/conditions/cases in the general hospital that might benefit from ECT: *Expectant mother with life-threatening psychosis *Catatonia *Delirium *Medical conditions predictive of ECT use *ECT for our soldiers

Speakers
Terry Rabinowitz

 

Professor of Psychiatry and Family Medicine. Medical Director, Psychiatry Consultation Service | Larner College of Medicine at the University of Vermont

Dr. Rabinowitz is Professor in the Departments of Psychiatry and Family Medicine at the Larner College of Medicine at the University of Vermont and has been Medical Director of the Psychiatry Consultation Service at the University of Vermont Medical Center (UVMMC) since 1996. He has been an ECT provider at UVMMC since 2005 and has published several ECT-related papers. Along with Mallika Lavakumar and Lisa J Rosenthal, he is co-editor of two textbooks in C-L Psychiatry: Fundamentals of Consultation Liaison Psychiatry: Principles and Practice and Fundamentals of Consultation Liaison Psychiatry: Neuropsychiatry. He serves on the ACLP Board of Directors and on the Editorial Board of The Journal of the Academy of Consultation-Liaison Psychiatry and is Chair of the ACLP Membership Committee and Telepsychiatry SIG.
Amy Odefey

 

Assistant Professor of Anesthesiology | Larner College of Medicine at University of Vermont

Amy Odefey, MD completed anesthesiology residency at University of Vermont Medical Center and neuroanesthesiology fellowship at University of Michigan Health System. She is an Assistant Professor of Anesthesiology at the Larner College of Medicine at UVM in Burlington, VT. Dr. Odefey is a diplomate of the American Board of Anesthesiology. Interests include “greening” the OR, total intravenous anesthesia, anesthesia for stroke thrombectomy, and anesthetic techniques for awake craniotomies.
A. Evan Eyler

 

Professor of Psychiatry, Robert Larner, MD, College of Medicine at the University of Vermont | University of Vermont Medical Center

A. Evan Eyler, M.D., M.P.H., F.A.A.F.P., D.F.A.P.A. is a Professor of Psychiatry at the Robert Larner, M.D., College of Medicine at the University of Vermont, in Burlington, Vermont. Dr. Eyler is a diplomate of the American Board of Psychiatry and Neurology, with Certificate of Added Qualifications in Consultation Liaison Psychiatry, and the American Board of Family Medicine with Certificate of Added Qualifications in Adolescent Medicine. Dr. Eyler serves as Medical Director of the Clinical Neurostimulation Service at the University of Vermont Medical Center and is Deputy Representative to the Assembly Executive Committee of the American Psychiatric Association. In addition to neurostimulation, clinical practice focuses on consultation to primary care and transgender mental health. Dr Eyler is co-editor of the books, Principles of Transgender Medicine and Surgery (Routledge 2007) and Gay, Lesbian, Bisexual and Transgender Aging: Challenges in Research, Practice and Policy (Johns Hopkins University Press, 2012), and co-author of several APA practice guidelines.
Karen Lewicki

 

Medical Director, Acute Care and Inpatient Psychiatry | VAMC White River Junction

Karen Lewicki graduated with a BA in History from Harvard University and then returned to her native Los Angeles and completed a JD at the University of Southern California Law School where her law review article outlined a comparative history of legal treatment of infanticide. She then had a Hollywood career which included researching for The Guardian, and writing on both Dawson's Creek and Cold Case. Her 2005 original screenplay was recognized by Franklin Leonard's Black List. She attended medical school at Case Western Reserve University, where she created a class on Narrative Medicine as an Introduction to Trauma Informed Care which she continues to teach at the Larner College of Medicine in Burlington VT, and at the Geisel School of Medicine in Hanover NH. At the University of Vermont where she completed psychiatric residency, she was honored with the Gold Foundation Award for Humanism and Excellence in Teaching as an intern and served as Chief in her fourth year. She works at the VA Hospital in White River Junction as Medical Director of Acute Care and Inpatient Psychiatry, and she is interested in how combined pharmacologic and non-pharmacologic approaches can mitigate the effects of developmental stress along the lifespan.
Julia Knight

 

Director, Interventional Psychiatr | Dartmouth Hitchcock Medical Center

Dr. Knight completed her residency at University of Vermont Medical Center. During her training, she was a recipient of the APM Webb Fellowship Award (2015-16). Brain stimulation is a primary focus of her clinical practice and she is the Director of Interventional Psychiatry at Dartmouth-Hitchcock Medical Center. Clinical interests include: neuromodulation, collaborative consultation services in primary care, and treatment-refractory mood disorders. Research interests include: use of neuromodulation treatments in patients with medical co-morbidity

 

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Presentations:
ID Duration # Presentation Title Presentation Type Details

ECT for C-L Psychiatrists: An Effective Intervention That Might Save a Life

Description

⬅ Back to Session Schedule

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CE Hours
2
Track Name
Neurocognitive Disorders, Delirium and Neuropsychiatry
Primary Presenter / Moderator
 
Handouts

View Handout One

View Handout Two
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