ECT Contraindications — MRCPsych Paper B MCQ

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HardMood DisordersECT ContraindicationsMRCPsych Paper B

A 55-year-old man with severe psychotic depression is being assessed for an urgent course of electroconvulsive therapy. Pre-anaesthetic assessment identifies the following comorbidities. Which finding is the clearest reason to defer ECT until the underlying condition has been treated?

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Correct answer: C — Biochemically active phaeochromocytoma that has not yet been treated with alpha-blockade

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

B is correct. Untreated, biochemically active phaeochromocytoma can produce unpredictable catecholamine release and severe haemodynamic instability; a UK NHS ECT anaesthesia protocol explicitly lists untreated phaeochromocytoma as a contraindication. The qualification “untreated” is important. A myocardial infarction more than 3 months previously is outside that protocol’s specified high-risk interval, although individual cardiology and anaesthetic review remains necessary. Stable angina, controlled hypertension and rate-controlled atrial fibrillation on anticoagulation are not automatic reasons to withhold ECT; each requires an individualised risk assessment and peri-procedural plan. The original wording was repaired because phaeochromocytoma is an endocrine rather than cardiac condition, and describing contraindications as universally “absolute” understates the contemporary emphasis on individual risk-benefit assessment.

Reference: Cambridgeshire and Peterborough NHS Foundation Trust. Administration of Electro-Convulsive Therapy Policy, Appendix 26: Anaesthesia for ECT Protocol, version 3.1, 2019. https://www.cpft.nhs.uk/download.cfm?doc=docm93jijm4n2582.pdf&ver=3398