Electroconvulsive therapy - general considerations and experience in Croatia.

Despite controversy, ECT has been recognized as significantly effective for the treatment of mental disorders since 1938, when Cerletti and Bini introduced ECT in clinical psychiatric practice for treatment of schizophrenia. In the next period, indication for ECT switched more toward depression and catatonia. ECT was even banned from psychiatric training in 1960's, due to the anti-psychiatric movement, which were fortified by Oscar winning movie "One Flew over the Cuckoo's Nest". Due to its robust effectiveness, ECT revived in the early 1980's and today holds its position in clinical psychiatric practices around the world. Mechanism of ECT on brain and psychopathology is still not fully understood. Main theories have been neurotransmitter, post-receptor, neurophysiological and neuroendocrine theory. Regarding best clinical practices and evidence reported in the literature, ECT today is considered a treatment option for, traditionally, depression, suicidality and catatonia, and also schizophrenia, schizoaffective disorder, bipolar disorder, malignant neuroleptic syndrome, postpartal depression and psychosis, obsessive compulsive disorder, post-traumatic stress disorder, dementia, etc. Recent evidence of ECT efficacy is growing stronger also in the treatment resistant cases, for depression and psychosis. Great advantage of ECT is lack of absolute contraindications. ECT in Croatia was introduced in clinical psychiatric practice in 1960's in four institutions. Mainly due to stigma, but also a tendency for shifting toward hypothesized action mechanism, ECT in Croatia has been re-named to electrostimulative therapy or electroneuromodulatory treatment. In recent decades, the Department of psychiatry in the University Hospital Centre Zagreb (KBC Zagreb), has continuously been practicing ECT. Our department is considered a regional leader, regarding number of patient cases and overall experience in homeland and neighbouring countries. In the 2016, Croatian expert group, selected by the Croatian Psychiatric Association, proposed national guidelines for the ECT. Research in ECT at our department has shown predominance of the treatment for therapy resistance in depression and psychosis. The other research at our department also showed improvement in several cognitive functions of patients after ECT application.