Motohashi Nobutaka
Tokyo Medical and Dental University, Graduate School of Medical and Dental Research, Section of Psychiatry and Behavioral Science.
Seishin Shinkeigaku Zasshi. 2004;106(5):537-45.
Although electroconvulsive therapy (ECT) was first introduced to treat schizophrenia in 1938, it is widely used for the treatment of various major psychiatric disorders, including depression. In western countries, its safety has been improved with the introduction of techniques such as succinylcholine muscle relaxation, barbiturate anesthesia, oxygenation and brief-pulse stimulation. Although the first use of ECT in Japan was reported in 1939, few modifications of the ECT technique have been made since then. From the 1980s, in collaboration with anesthesiologists, ECT with anesthesia and muscle relaxation (modified ECT) has been administered in numerous general hospitals. Moreover, brief-pulse ECT devices were approved in 2002. Rapid progress in ECT practices is expected in Japan. Before administering ECT, informed consent should be obtained from the patient, except when the patient lacks capacity to consent. The major problems in ECT are cognitive side effects and high relapse rates. Furthermore, its mechanisms of action are still unknown. These problems must be solved in the near future.
尽管电休克疗法（ECT）于1938年首次被用于治疗精神分裂症，但它如今被广泛应用于包括抑郁症在内的各种严重精神疾病的治疗。在西方国家，随着琥珀酰胆碱肌肉松弛、巴比妥类麻醉、给氧和短脉冲刺激等技术的引入，其安全性得到了提高。尽管日本于1939年首次报道了ECT的使用，但自那时起ECT技术几乎没有改进。从20世纪80年代起，在与麻醉医生的合作下，许多综合医院开始实施麻醉和肌肉松弛的ECT（改良ECT）。此外，短脉冲ECT设备于2002年获得批准。预计日本的ECT实践将取得快速进展。在实施ECT之前，应获得患者的知情同意，除非患者缺乏同意能力。ECT的主要问题是认知副作用和高复发率。此外，其作用机制仍然未知。这些问题必须在不久的将来得到解决。
