Which of the following is not a recommended preparation for electroconvulsive therapy (ECT)?

  1. premedication with an anticholinergic agent
  2. morning bath, NPO after midnight
  3. informed consent in writing
  4. administration of an anticonvulsant 30 minutes before ECT
Number 4 is correct.
Rationale: The purpose of ECT is to trigger a short-term seizure of 30 – 90 seconds. As such, administration of an anticonvulsant prior to the procedure is contraindicated. An anticholinergic agent is administered prior to ECT to lessen secretions that could be aspirated. Cleansing the body prior to an ECT promotes effective transmission of the electrical current. Fasting after midnight prevents aspiration of stomach contents during the procedure. As an intrusive medical procedure, an informed consent in writing is required.