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  1. More effective and less side effects on non-dominant side
  2. Premeditation with Atropine is required.
  3. Dose 110 volts, for 0.6 sec., 1600 M.A. current.
  4. Ad/E:     

a. Amnesia both anterograde and retrograde (due to neuronal hypoxia)But more of retrograde.

b. # of thoracic spine, femur, humerus (common) (Side effects of direct ECT).

c. Headache, body ache, vomiting, confusion (Side effect of modified ECT)

d. Increase ICT, Decrease IOT (with direct ECT)

  • Absolute C/I : None
  • Relative C/l are--- raised ICT,  recent MI, severe HTN & severe pulmonary disease, pheochromocytoma

a. Amnesia is common Ad/e after modified ECT

b. Bodyache / headache is common after Direct / unmodified ECT.

c. ECT is not or least effective in chronic schizophrenia.


Indications of ECT are

+ Major severe depression with suicidal risk is the most important indication for ECT.

+ In mania & schizophrenia used of ECT is reserved only for stuporous mania.


Delirium is m/c organic disorders.

“Sun downing” phenomena is found in delirium.



Eugen Bleuler's fundamental symptoms (4A'S)

  1. Ambivalence
  2. Autism
  3. Affect disorders
  4. Association disturbance
  5. Schneider’s first rank symptoms – total II



Thought alienation

Passivity phenomena


1. Thought echo

2. 3rd person hallucination

3. Running commentary

4. Thought withdrawal

5. Thought insertion

6. Thought diffusion

    or Broadcasting


7. Made feeling

8. Made impulse

9. Made volition or acts

10. Somatic passivity

11. Delusional perception



- is defined as inability to experience pleasure .Seen in PTSD, schizophrenia


- lack of initiative.


- lack of feeling or emotions.


- Lethargy, apathy, loss of interest, anergia, reduced drive and lack of ambition

  1. Anhedonia, Apathy, Avolition occurs in schizophrenia
  2. Amotivation occurs in chronic cannabis use.
  3. Morbid jealousy is seen in --- Mood disorder, Alcoholism, Drug abuse, Epilepsy, Schizophrenia (MADES)
Simple Schiz. Least common, early onset
Paranoid Schiz Most common, late onset
Hebephrenic Schiz Worst prognosis, early onset
Catatonic Schiz Best prognosis (best response to ECT)

Good prognostic factors for schizophrenia

  1. Acute or abrupt onset
  2. Onset after 35 yrs.      
  3. Presence of precipitants stressor
  4. Catatonic subtype
  5. Presence of depression
  6. Predominance of positive symptoms
  7. First episode
  8. Female sex
  9. Normal cranial CT scan

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