외래 기반 전기경련치료의 임상적 근거와 실제

초록

Electroconvulsive therapy (ECT) is a highly effective neuromodulation treatment for various psychiatric and neurological conditions. Historically, its delivery has fluctuated between inpatient and outpatient settings, driven more by societal perceptions and policy shifts rather than by the procedure itself. Recently, advancements in anesthetic induction, including non-operating room anesthesia, and enhanced recovery management have facilitated a global shift toward outpatient-based ECT. While clinical indications for outpatientbased ECT largely mirror those for inpatient ECT, outpatient-based ECT is particularly advantageous for maintenance treatment, offering superior continuity and efficiency. Inpatient treatment remains the priority for patients who are medically or psychiatrically unstable or those lacking adequate home monitoring. However, when patients are appropriately selected, outpatient-based ECT provides safety and efficacy comparable to inpatient care while offering significant benefits in cost-effectiveness, convenience, and the preservation of daily social functioning. Successful outpatient delivery requires addressing non-medical factors such as transportation and caregiver availability through structured education. Drawing on clinical experiences from various psychiatric settings, ranging from university hospitals to private clinics, this comprehensive review examines the historical development and protocols of outpatient-based ECT. Ultimately, outpatient-based ECT represents a safe, accessible, and resource-efficient system that optimizes healthcare delivery and supports patient-centered care.

키워드