Explaining ECT and cognitive risk to a patient and partner (CASC)

Station instructions (candidate)

You have 7 minutes. Explain why ECT is being recommended for severe treatment-resistant melancholic depression with high risk, what modern ECT involves (anaesthesia, not a horror scene), cognitive risks honestly, and how rTMS/iTBS differs in urgency and evidence role. Invite questions. Do not guarantee cure. Do not dismiss fears. Do not invent legal section numbers. Offer written information and a follow-up for consent formalities.[1][2][3][5][7]

Marking domains

Empathy and agenda setting; accurate plain-language explanation of indication and modern technique; honest memory risk counselling with mitigation (placement/pulse width); clear comparison with rTMS (outpatient, no anaesthetic, different evidence niche, not equivalent for this severity/urgency); discussion of common side effects and rare serious risks; continuation/relapse-prevention mention; collaborative plan and check-back.[1][2][3][4][5][6]

Model communication map

1. Open: thank them; ask what they have heard about ECT; acknowledge fear without ridicule.[2]
2. Why now: severe depression has not responded to two proper medicine trials; symptoms include high suicide risk features; ECT is among the most effective short-term treatments for this severity.[1][2]
3. What happens: short general anaesthetic, muscle relaxant, brief controlled electrical stimulation that produces a short seizure in the brain while the body is protected; oxygen and monitoring; usually two or three times a week for a course individualised to response.[2][7]
4. Memory — honest: temporary confusion after sessions; learning can be fuzzy during the course and usually improves; some people notice gaps in personal memories around the treatment period — we take that seriously, choose techniques that reduce that risk where safe (for example right-sided and ultrabrief approaches), and monitor.[3][4]
5. "Magnet treatment" (rTMS): real option for many people with treatment-resistant depression who are medically stable outpatients; no anaesthetic; good trial evidence including shorter theta-burst sessions. For this current severity and risk profile, ECT is more appropriate acutely; rTMS can be discussed later if the clinical picture fits.[5]
6. Aftercare: medicines and/or spaced continuation ECT to reduce relapse — finishing the acute course is not the end of the plan.[6]
7. Close: questions, written info, consent process next steps, partner support, crisis contacts.[7]

Common fails

• Saying "ECT never affects memory" or "ECT always permanently destroys memory".[3]
• Describing unmodified historical ECT imagery as current practice.[2]
• Dismissing rTMS as fake or promising rTMS as identical to ECT for malignant-risk depression.[5]
• Omitting relapse-prevention after successful treatment.[6]
• Coercive language without exploring values, or abandoning recommendation when risk is high and capacity is intact but fear is based on myth alone (explore, correct, re-recommend).[7]