Electroconvulsive therapy ( ECT ), formerly known as electric shock therapy , and often referred to as shock therapy, is a treatment psychiatry in which electrical spasms are induced in the patient to provide relief from mental disorders. The ECT procedure was first performed in 1938 and is the only form of shock therapy currently used in psychiatry. ECT is often used with informed consent as the last line of intervention for major depressive disorders, mania, and catatonia. The ECT machine has been placed in the Class II (special control) category by the US Food and Drug Administration (FDA) since 1976.
One round of ECT is effective for about 50% of people with severe depression who are resistant to treatment, whether unipolar or bipolar. Advanced treatment is still poorly studied, but about half of the people who responded to relapse within 12 months. In addition to effects in the brain, the general physical risk of ECT is similar to the general short anesthesia. Immediately after treatment, the most common side effects are confusion and memory loss. ECT is considered one of the most innocuous treatment options available for pregnant women with severe depression.
Usually ECT involves a lot of administration, usually given two or three times per week until the patient no longer suffers symptoms. ECT is administered under anesthesia with muscle relaxants. Electroconvulsive therapy may differ in its application in three ways: electrode placement, maintenance frequency, and the electrical waveform of the stimulus. These three forms of application have significant differences in both side effects and remission of symptoms. Placement can be bilateral, in which an electric current is passed through the brain, or unilaterally, where the current is passed through one hemisphere. Bilateral placement seems to have greater efficacy than unilateral, but it also carries a greater risk of memory loss. After treatment, drug therapy is usually continued, and some patients receive ECT treatment.
ECT seems to work in the short term through most anticonvulsant effects in the frontal lobe, and long-term through neurotropic effects especially in the medial temporal lobes.
Video Electroconvulsive therapy
Medical use
ECT is used with informed consent in the treatment-induced major depression disorder, medication resistant cataatonia, or prolonged or severe mania, and under conditions where "there is a need for a prompt and definitive response due to the severity of psychiatric or medical conditions (eg, when disease is characterized by stupor, psycho-motor backwardness, delusions of depression or hallucinations, or life-threatening physical fatigue associated with mania). "
Major depressive disorder
For major depressive disorders, ECT is commonly used only when other treatments fail, or in an emergency, such as an imminent suicide. ECT has also been used in some cases of depression that occurs in multiple sclerosis settings, Parkinson's disease, Huntington's chorea, developmental delays, brain arteriovenous malformations and hydrocephalus.
Benefits
A meta-analysis on the effectiveness of ECT on unipolar and bipolar depression was performed in 2012. The results showed that although patients with unipolar depression and bipolar depression responded differently to other medical treatments, both groups responded equally well to ECT. The overall remission rate for patients given ECT treatment rounds was 51.5% for those with unipolar depression and 50.9% for those with bipolar depression. The severity of each patient's depression is assessed at the same baseline in each group.
There is little agreement about the most appropriate follow-up for ECT for people with major depressive disorder. When ECT was followed by treatment with antidepressants, about 50% of people recurred 12 months after successful initial treatment with ECT, with about 37% recurring in the first 6 months. About twice as many relapses without antidepressants. Most evidence for advanced therapy is with tricyclics; evidence for the prevention of relapse with new antidepressants is lacking.
In 2004, a meta-analytic review paper was found in terms of efficacy, "a significant ECT advantage in all comparisons: ECT versus ECT simulation, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCA and ECT versus MAOI."
In 2003, the UK ECT Review group published a systematic review and meta-analysis that compared ECT with placebo and antidepressant drugs. This meta-analysis shows a large effect size (high efficacy relative to mean in terms of standard deviation) for ECT compared with placebo, and against antidepressant drugs.
Compared with transcranial magnetic stimulation for people with drug-induced major depression disorder, ECT reduces depression by about twice as well, reducing the score on the Hamilton Scale for Depression scores by 15 points, while TMS reduces it by 9 points.
Catatonia
ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but it is a first-line treatment for severe or life-threatening catatonia. There is a lack of clinical evidence for its efficacy but "the efficacy of excellent ECT in catatonia is generally recognized". For people with autism spectrum disorders who have catatonia, there is little published evidence of ECT efficacy; by 2014 there are twelve case reports, and while ECT has "saving lives" efficacy in some, mixed and temporary results, and maintenance of ECT is necessary to maintain any benefit.
Mania
ECT is used to treat people who have severe or prolonged mania; NICE recommends it only in life-threatening situations or when other treatments fail and as second-line treatment for bipolar mania.
Schizophrenia
ECT is rarely used in drug-resistant schizophrenia, but is sometimes recommended for schizophrenia when short-term global improvement is desirable, or the subject shows little response to antipsychotics alone. This is useful in cases of severe catatonic schizophrenic exacerbations, whether excited or stuporous.
Maps Electroconvulsive therapy
Effects
In addition to effects in the brain, the general physical risk of ECT is similar to a brief general anesthesia; The US Surgeon General's report says that "there is no absolute health contraindication" to its use. Immediately after treatment, the most common side effects are confusion and memory loss. It should be used with extreme caution in people with epilepsy or other neurological disorders because it provokes a minor tonic-clonic seizure, so it is unlikely to be given to people with uncontrolled epilepsy. Some patients experience muscle pain after ECT. This is due to the muscle relaxants provided during the procedure and rarely due to muscle activity. ECT, especially when combined with a deep sleep therapy, can cause brain damage if given in such a way as to cause hypoxia or anoxia in patients. The mortality rate due to ECT is about 4 per 100,000 procedures. There is evidence and reason to support low doses of benzodiazepines or low-dose general anesthetics that cause sedation but not anesthesia for patients to reduce the adverse effects of ECT.
Although there is no absolute contraindication to ECT, there is an increased risk for patients with an unstable or severe cardiovascular condition or aneurysm; who recently had a stroke; who experience increased intracranial pressure (eg, due to dense brain tumors), or who have severe pulmonary conditions, or who are generally at high risk of receiving anesthesia.
In adolescents, ECT is highly efficient for some psychiatric disorders, with few and relatively harmless side effects.
In a study published in 2017 involving 30 patients from the National Health Service (NHS) of Worcestershire, 80% said they would get treatment soon after 37% said it was frightening.
Cognitive impairment
Cognitive disorders are sometimes noted after ECT.
Effects on memory
Retrograde amnesia occurs to some extent in almost all ECT recipients. The report of the American Psychiatric Association (2001) acknowledges: "In some patients, recovery from retrograde amnesia will be incomplete, and evidence has shown that ECT can result in permanent or permanent memory loss". This is a recognized effect of ECT on long-term memory that raises many concerns around its use.
However, the methods used to measure memory loss are generally poor, and its application to people with depression, who have cognitive deficits including problems with memory, has been problematic.
The acute effects of ECT may include amnesia, both retrograde (for events occurring before treatment) and anterograde (for events occurring after treatment). Memory loss and confusion are more apparent with placement of bilateral rather than unilateral electrodes, and with obsolete sine waves rather than short pulse currents. The use of constant electrical impulse or pulsation also varies the result of memory loss in the patient. Patients who receive pulsed electrical impulses compared with stable flow seem to lose memory. Most modern treatments use a short pulse.
Retrograde amnesia is most marked for events occurring in the weeks or months before treatment, with one study showing that although some people lose memory from several years before treatment, such memory recoveries are "nearing completion" by seven months post-treatment, with only lasting loss which become memories in the weeks and months before the treatment. The loss of anterograde memory is usually limited at the time of treatment itself or shortly thereafter. In the weeks and months following ECT memory problems are gradually improving, but some people have persistent losses, especially with bilateral ECT. One published review summarizes the results of the questionnaire about subjective memory loss found that between 29% and 55% of respondents believe they are experiencing long-term or permanent memory changes. In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with impaired public event memory disorder compared with RUL ECT.
Effects on brain structure
There is considerable controversy over the effects of ECT on brain tissue, although a number of mental health associations - including the American Psychiatric Association - have concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the US Surgeon General states: "The fear that ECT causes poor structural brain pathology has not been supported by years of research methodology in both humans and animals."
Many ECT supporters argue that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a leading ECT researcher and former editor in chief of the Journal of ECT, said in a 2007 interview that "There are a number of well-designed studies that show ECT does not cause brain damage and many patient reports have received many treatments during their lifetime and have not experienced significant problems due to ECT. " Kellner cites a study that showed no cognitive impairment in eight subjects after more than 100 lifelong ECT treatments. Dr. Kellner stated "Rather than causing brain damage, there is evidence that ECT can reverse some of the damaging effects of serious psychiatric illness."
Effects on pregnancy
If steps are taken to reduce potential risks, ECT is generally accepted to be relatively safe during all trimesters of pregnancy, especially when compared with pharmacological treatments. Recommended preparations for ECT during pregnancy include pelvic examination, non-essential anticholinergic drug withdrawal, uterine tocodynamometry, intravenous hydration, and nonparticulate antacid administration. During ECT, improvements in the right hip of pregnant women, external fetal heart monitoring, intubation, and avoidance of excessive hyperventilation are recommended. In many cases of active mood disorders during pregnancy, the risk of untreated symptoms may be greater than the risk of ECT. Potential ECT complications during pregnancy can be minimized by modification techniques. The use of ECT during pregnancy requires a thorough evaluation of the patient's capacity for informed consent.
Technique
ECT requires consent of the patient.
Whether psychiatric drugs are stopped before treatment or maintained, varies. However, drugs known to cause toxicity in combination with ECT, such as lithium, discontinuation, and benzodiazepines, which increase the seizure threshold, are discontinued, benzodiazepine antagonists are administered at each ECT session, or adjusted ECT treatment appropriately..
The placement of electrodes, as well as the dose and duration of stimulation are determined on a per patient basis.
In unilateral ECT, both electrodes are placed on the same side of the patient's head. Unilateral ECT can be used first to minimize side effects such as memory loss.
In bilateral ECT, both electrodes are placed on both sides of the head. Always, the bitemporal placement is used, where the electrodes are placed on the temple. Not common, bifrontal placement is used; this involves the position of the electrode on the forehead of the patient, approximately above each eye.
Unilateral ECT is thought to cause fewer cognitive effects than bilateral treatment, but is less effective unless administered at higher doses. Most patients in the US and almost all in the UK receive bilateral ECT.
Electrodes provide an electric stimulus. The recommended stimulus rate for ECT is more than a person's seizure threshold: about one and a half times the seizure threshold for bilateral ECT and up to 12 times for unilateral ECT. Below this level of treatment may not be effective despite seizures, while doses are massively above the threshold, especially with bilateral ECT, exposing patients to the risk of more severe cognitive impairment without additional therapeutic benefit. The seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still using "fixed dose" (ie, all patients are given the same dose) and others compromise by estimating the patient's threshold by age and sex. Older men tend to have higher thresholds than younger women, but they are not hard and fast rules, and other factors, such as drugs, affect the threshold of seizures.
Immediately prior to treatment, patients are given short-acting anesthetics such as methohexital, etomidate, or thiopental, muscle relaxants such as suxamethonium (succinylcholine), and sometimes atropine to inhibit saliva. In some countries like Japan, India, and Nigeria, ECT can be used without anesthesia. The Union of Health Ministry of India recommends banning ECT without anesthesia in the 2010 Indian Mental Health Treaty and the 2013 Mental Health Draft Act. Some psychiatrists in India are opposed to the unmodified ECT ban due to the lack of trained anesthesiologists available to manage ECT with anesthesia. This practice was removed in the largest mental hospital in Turkey in 2008.
EEG, ECG, and blood oxygen levels of patients are monitored during treatment.
ECT is usually given three times a week, on alternate days, for two to four weeks.
Device
Most modern ECT devices provide short pulse currents, which are thought to cause fewer cognitive effects than the sine wave currents originally used in ECT. A small proportion of psychiatrists in the US still use sinus sine stimulation. Sinus waves are no longer used in England or Ireland. Typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and currents flow from one to six seconds.
In the US, ECT devices are produced by two companies, Somatics, owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta. In the UK, the market for ECT devices has long been monopolized by Ectron Ltd., founded by psychiatrist Robert Russell.
Action mechanism
Despite decades of research, the exact mechanism of ECT action is still elusive. Neuroimaging studies in people who had experienced ECT, investigated the differences between respondents and non-responders, and relapsers, found that respondents had most anticonvulsant effects in the frontal lobe, which corresponded to direct responses, and neurotropic effects particularly in the medial temporal lobes. Anticonvulsant effects are decreased blood flow and decreased metabolism, while opposite neurotropic effects - increased perfusion and metabolism, as well as increased hippocampal volume.
Usage
In 2001, it was estimated that about one million people received ECT every year.
There is wide variation in the use of ECT between different countries, different hospitals, and different psychiatrists. International practice varies widely from the widespread use of therapy in many Western countries to a small number of countries that do not use ECT at all, such as Slovenia.
About 70 percent of ECT patients are women. This may be due to the fact that women are more likely to be diagnosed with depression. Older and more affluent patients are also more likely to receive ECT. The use of ECT is not common in ethnic minorities.
Sarah Hall reported, "ECT has been plagued by conflicts between psychiatrists who swear by it, and some patients and families of patients who say that their lives have been devastated by it.This is controversial in some European countries like the Netherlands and Italy, where its use is severely restricted".
United States
ECT became popular in the US in the 1940s. At that time, psychiatric hospitals were flooded with patients whose doctors were desperate to treat and heal. While lobotomy will reduce the patient to a more manageable submissive state, ECT helps improve mood in those with severe depression. A psychiatric practice survey in the late 1980s found that about 100,000 people receive ECT every year, with wide variations between metropolitan statistical areas. Accurate statistics on the frequency, context, and circumstances of ECT in the US are difficult to obtain because only a few states are reporting legislation requiring processing facilities to supply state authorities with this information. In 13 of the 50 states, ECT practices are governed by law. One country that reported such data was Texas, where in the mid-1990s, ECT was used in about a third of psychiatric facilities and given to about 1,650 people each year. The use of ECT has since declined slightly; in 2000-01 ECT was given to about 1500 people aged 16 to 97 (in Texas it was illegal to give ECT to anyone under sixteen). ECT is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in ECT statistics. In the United States, ECT is usually given three times a week; in the UK, usually given twice a week. Sometimes given every day. The courses usually consist of 6-12 treatments, but may be more or less. After ECT, some patients may be given follow-up care or ECT maintenance with further treatment at weekly, two-week or monthly intervals. Some psychiatrists in the US use multi-monitored ECT (MMECT), in which patients receive more than one treatment per anesthesia. Electroconvulsive therapy is not a necessary course in US medical school and is not a required skill in psychiatric residency training. Privileges for ECT practice in institutions are a local choice: no established national certification standards, and no ECT ongoing training experience is required of ECT practitioners.
United Kingdom
In the United Kingdom in 1980, an estimated 50,000 people received ECT every year, with use steadily declining ever since to about 12,000 per year in 2002. It is still used in almost all mental hospitals, with an ECT usage survey of findings in 2002 that 71 percent patients were women and 46 percent were over 65 years old. Eighty-one percent had a diagnosis of mood disorder; schizophrenia is the next most common diagnosis. Sixteen percent are treated without their consent. In 2003, the National Institute for Health and Nursing Excellence, a government body set up to standardize care across National Health Services in England and Wales, issued guidance on the use of ECT. Its use is recommended "only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has been shown to be ineffective and/or when the condition is considered potentially life-threatening in individuals with severe depression, catatonia or prolonged episodes of mania".
Guidance receives mixed acceptance. It was greeted by an editorial at the British Medical Journal but the Royal College of Psychiatrists launched a failed appeal. The NICE guidelines, as shown by the British Medical Journal editorial, are just policy statements and psychiatrists may deviate from them if they wish. Adherence to standards has not been universal in the past. A survey of the use of ECT in 1980 found that more than half of ECT clinics failed to meet the minimum standards set by the Royal College of Psychiatrists, with later surveys in 1998 finding that minimum standards were largely adhered, but two-thirds of the clinics were still less than current guidance this, especially in the training and supervision of junior doctors involved in this procedure. The voluntary accreditation scheme, ECTAS, was founded in 2004 by Royal College, but in 2006 only a few ECT clinics in England, Wales, Northern Ireland and the Republic of Ireland have registered.
The Mental Health Act 2007 allows people to be treated against their will. This law has extra protection regarding ECT. A patient capable of making a decision may refuse treatment, and in this case care can not be given unless it will save the patient's life or be immediately needed to prevent the deteriorating condition of the patient. A patient may be unable to make decisions (they are "lacking capacity"), and in that situation ECT can be provided if it is appropriate and also if no face directives prevent the use of ECT.
China
ECT was introduced in China in the early 1950s and while it was initially done without anesthesia, by 2012 virtually all procedures were performed with it. In 2012, there are about 400 ECT machines in China, and 150,000 ECT treatments are performed annually. China's national practice guidelines recommend ECT for the treatment of schizophrenia, depressive disorder, and bipolar disorder and in Chinese literature, ECT is an effective treatment for schizophrenia and mood disorders. Although the Chinese government stopped classifying homosexuality as a disease in 2001, electroconvulsive therapy is still used by some companies as a form of "conversion therapy".
History
At the beginning of the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, therapeutic use of seizure induction was documented in the London Medical Journal. For the earliest antecedents one doctor claimed 1744 as the dawn of the use of electrical therapy, as documented in the first issue of Electrical and Medical . The treatment and cure of hysterical blindness is documented eleven years later. Benjamin Franklin writes that the electrostatic machine heals "a hysterical woman." In 1801, Giovanni Aldini used galvanism to treat patients suffering from various mental disorders. G.B.C. Duchenne, "Father of Electrotherapy" of the 19th century, says that its use is an integral part of neurological practice.
In the second half of the nineteenth century, such attempts were quite common in British psychiatric hospitals to make them famous.
Convulsive therapy was introduced in 1934 by Hungarian neurologist Ladislas J. Meduna who, erroneously believes that schizophrenia and epilepsy are antagonistic abnormalities, causing first seizures with camphor and then metrazol (cardiazol). Meduna is considered the father of seizure therapy. In 1937, the first international meeting on seizure therapy was held in Switzerland by the Swiss psychiatrist Muller. The proceedings are published in the American Journal of Psychiatry and, within three years, cardiazol seizure therapy is being used worldwide. The Italian professor of neuropsychiatry Ugo Cerletti, who has used electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of ​​using electricity instead of metrazol in convulsive therapy and, in 1938, experimented for the first time in a person. It is believed from the outset that pushing seizures helps in helping those with severe schizophrenia but later found most beneficial with affective disorders such as depression. Cerletti has recorded a shock on the head that causes the seizures in dogs. The idea of ​​using electric shock in humans came to Cerletti when he saw how pigs were given electric shocks before being slaughtered to put them in anesthetic state. Cerletti and Bini practice until they feel they have the exact parameters needed to have a successful human experiment. As soon as they start testing on patients, they find that after 10-20 treatments the results are significant. Patients have improved considerably. A positive side effect on treatment is retrograde amnesia. Because of these side effects patients can not remember the treatment and have no pain. ECT immediately replaces metrazol therapy worldwide because it is cheaper, less scary and more comfortable. Cerletti and Bini were nominated for the Nobel Prize but did not receive one. In 1940, the procedure was introduced to Britain and the United States. In Germany and Austria, promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread.
In the early 1940s, in an attempt to reduce memory impairment and treatment-related confusion, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal currents with short pulses. It took years for short pulse equipment to be widely adopted. In the 1940s and early 1950s ECT, usually given in the form of "unmodified", without muscle relaxants, and seizures resulted in full-scale convulsions. A rare but serious complication of unmodified ECT is a long bone fracture or dislocation. In the 1940s, psychiatrists began experimenting with curare, a crippling South American poison, to modify seizures. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to wider use of "modified" ECT. Short-acting anesthesia is usually given in addition to muscle relaxants to save patients from the fear of suffocation that can be experienced with muscle relaxants.
The steady growth in use of antidepressants along with the negative depiction of ECT in the mass media led to a noticeable reduction in the use of ECT during the 1950s to the 1970s. The Surgeon General stated there was a problem with electric shock therapy in the early years before anesthesia was routinely given, and that "these present-old practices contribute to the negative portrayal of ECT in popular media." The New York Times describes the public negative perception of ECT as being primarily caused by a single film: "For the Great Nurse at One Fly Above the Cuckoo's Nest, it is a tool of terror, and, in the public mind, shock therapy has retained the tarnished image given by Ken Kesey's novel: dangerous, inhuman and overused ".
In 1976, Dr. Blatchley demonstrates the effectiveness of his constant and concise ECT tools today. This device ultimately largely replaces the previous device due to the reduction of cognitive side effects, although in 2012 some ECT clinics still use a sine wave device. The 1970s saw the publication of the first American Psychiatric Action Report (APA) on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). This report supports the use of ECT in the treatment of depression. The decade also sees criticism of ECT. In particular, critics point out shortcomings such as recorded side effects, procedures used as a form of abuse, and uneven ECT applications. The use of ECT declined until the 1980s, "when use began to rise amid rising awareness of the benefits and cost-effectiveness of treating severe depression". In 1985, the National Institute of Mental Health and the National Institutes of Health held a consensus development conference on ECT and concluded that, while ECT is the most controversial treatment in psychiatry and has significant side effects, it has proven effective for a narrow range of severe psychiatric disorders.
Because of the reactions noted earlier, national institutions review past practices and set new standards. In 1978, the American Psychiatric Association released the first task force report in which new standards for approval were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference underscores the therapeutic role of ECT under certain circumstances. The American Psychiatric Association released its second taskforce report in 1990 in which specific details of ECT shipments, education, and training were documented. Finally, in 2001, the American Psychiatric Association released the latest task force report. The report emphasizes the importance of informed consent, and the expanded role of that procedure in modern medicine. By 2017, ECT is routinely covered by insurance companies to provide the "biggest blow to money" for severe cases of severe mental illness, receiving good media coverage, and provided in regional medical centers.
Society and culture
Public opinion surveys, former patient testimony, legal restrictions on the use of ECT and disagreements about the efficacy, ethics and harmful effects of ECT in the psychiatric medical community and more broadly suggest that the use of ECT is still controversial. This was reflected in the January 2011 vote by the FDA's Advisory Neurological Advisory Board to recommend that the FDA maintain ECT devices in the Class III device category for high-risk devices except for patients suffering from catatonia. This may result in the manufacturer of the device having to conduct a controlled trial on its safety and efficacy for the first time. In justifying their position, panelists refer to ECT-related memory loss and lack of long-term data.
Legal status
Informed consent
The World Health Organization (2005) suggests that ECT should be used only with the informed consent of the patient (or their guardian if their inability to agree has been established).
In the US, this doctrine places a legal obligation on doctors to make patients aware of the reasons for the treatment, the risks and benefits of the proposed treatment, the risks and benefits of alternative medicine, and the risks and benefits of not receiving treatment. The patient is then given the opportunity to accept or refuse treatment. The form states how much treatment is recommended and also makes the patient aware that consent can be revoked and treatment is stopped at any time during ECT. The US Surgeon General's Report on Mental Health states that patients should be warned that the benefits of ECT are short-lived without continued active treatment in the form of drugs or ECT further, and that there may be some risk of permanent memory loss after ECT. The report advises psychiatrists to engage patients in discussions, perhaps with the help of flyers or videos, both before and during the course of ECT.
To demonstrate what he believes should be required to fully fulfill his legal obligations for informed consent, a psychiatrist, working for an anti-psychiatric organization, has formulated his own agreement form using an approval form developed and endorsed by the Texas Legislature as a model.
According to the US Surgeon General, unintentional treatment is rare in the US and is usually used only in cases of high extremities, and only when all other treatment options are depleted. Use of ECT is believed to be a potentially life-saving treatment.
In one of several jurisdictions where the latest statistics on the use of ECT are available, the ECT national audit by the Scottish ECT Accreditation Network shows that 77% of patients receiving treatment in 2008 were able to provide informed consent.
In the UK, for approval to take effect, an explanation of the "broad terms" of the nature of the procedure and its possible effects may be required. One review from 2005 found that only about half of the patients felt they were given enough information about ECT and its adverse effects and other surveys found that about fifty percent of psychiatrists and nurses agreed with them.
A 2005 study published in the British Journal of Psychiatry describes the patient's perspective on the adequacy of informed consent before ECT. The study found that "About half (45-55%) of patients reported they were given adequate ECT explanations, implying the same percentage they perceived did not." The authors also state:
About one-third did not feel they freely approve the ECT even when they have signed the consent form. The proportions who feel they are not free to choose treatment have improved over time. The same theme emerges whether the patient has received treatment a year ago or 30 years ago. Both current and proposed protection for patients is insufficient to ensure informed consent with respect to ECT, at least in England and Wales.
ECT Forced
Procedures for unexpected ECT vary from country to country depending on local mental health legislation.
United States
In the US, ECT devices appear before medical devices are regulated by the Food and Drug Administration; when the law comes into force, the FDA is obliged to retrospectively review existing devices and classify them, and determine whether clinical trials are needed to prove efficacy and safety. While the FDA has classified devices used to manage ECT as a Class III medical device, in 2011 the FDA has not yet determined whether the device should be withdrawn from the market until clinical trials prove their safety and efficacy. The FDA considers the ECT machine as an experimental tool. In most states in the US, a court order after a formal examination is required before the patient can be forced to undergo unintentional ECT. However, ECT can also be inadvertently given in situations with less immediate dangers. Suicide intent is a common justification for accidental use, especially when other treatments are ineffective.
United Kingdom
Until 2007 in England and Wales, the Mental Health Act of 1983 enabled the use of ECT in patients who were detained whether they had the capacity to approve it or not. However, following amendments to force in 2007, ECT may not be generally given to patients who have the capacity and reject it, irrespective of its detention under the Act. In fact, even if a patient is considered lack of capacity, if they make a valid initial decision to reject ECT then they should not be granted; and even if they do not have a decision first, the psychiatrist should get an independent second opinion (which is also the case if the patient is under the age of consent). However, there are exceptions without approval and capacity; under Section 62 of the Act, if a caring psychiatrist says the need for care is urgent they can start an ECT program without authorization. From 2003 to 2005, about 2,000 people per year in England and Wales were treated without their consent under the Mental Health Act. Concern has been raised by the official regulators that psychiatrists are too prepared to assume that patients have the capacity to approve their care, and that there is an alarming lack of independent advocacy. In Scotland, Mental Health (Nursing and Care) (Scotland) Act 2003 also provides patients with the right capacity to reject ECT.
Public perception
A questionnaire survey of 379 members of the general public in Australia shows that over 60% of respondents are knowledgeable about the main aspects of ECT. Participants are generally opposed to the use of ECT in depressed individuals with psychosocial problems, in children, and in non-voluntary patients. Public perceptions of ECT were found to be mainly negative.
Resurgence
Although ECT has been a treatment that is not recommended, many people have recently encouraged to restore this controversial procedure. The 1975 One Flew Over the Cuckoo's Nest film has convinced viewers that ECT is a terrible procedure that only causes complete loss of patient memory. Scientists have since denied the idea that patients suffer from acute memory loss after treatment, but the horror of ECT presence in the film remains a setback. In the past decade, patients have again used ECT to treat various mental illnesses including depression and bipolar disorder. Addressing the looming controversy has proven difficult for doctors and scientists, and various campaigns to challenge negative stereotypes have gained popularity in recent years. In 2014, the American Psychiatric Association launched a petition to reclassify ECT as a low-risk treatment. Although many people still believe in ECT as an inhumane procedure, many pro-ECT patients have been openly exposed with their positive response to treatment. One patient by the name of Shelley Miller claims that "drugs have a 50-60% success rate of patients getting better, while ECT is successful at 70-90%." With the combined support of patients and doctors, ECT is slowly challenging stereotypes and making its way back to the medical community. However, the negative stigma of ECT still maintains excellence in today's society.
Famous case
Ernest Hemingway, an American author, died of suicide shortly after ECT at the Mayo Clinic in 1961. He reportedly said to his biographer, "Well, what is the meaning of destroying my head and erasing my memory, which is my capital, and got me out of business? It's a brilliant remedy but we're losing patients.... "American surgeon and award-winning writer Sherwin B. Nuland is another famous person who has undergone ECT. At the age of 40, this successful surgeon's depression became so severe that he had to be institutionalized. After spending all the treatment options, a young citizen assigned to his case suggested ECT, which ultimately succeeded. Writer David Foster Wallace has also received ECT for many years, starting as a teenager, before committing suicide at the age of 46.
The award-winning New Zealand Writer Janet Frame has ECT. He then writes about this in his novel Faces in the Water.
Fictional examples
Electroconvulsive therapy has been described in fiction, including partial fiction based on true experience. These include the autobiographical novel Sylvia Plath, The Bell Jar , and Ken Kesey's novel One Flew Over the Cuckoo's Nest ; Novel Kesey is a direct product of his time working in graveyard removal as an orderly at mental health facility in Menlo Park, California.
In the 2000 movie Requiem for a Dream, Sarah Goldfarb received "unmodified" electroconvulsive therapy after severe amphetamine psychosis after prolonged stimulant torture. In the 2014 Constantine TV series, the protagonist John Constantine was instituted and specifically requested electroconvulsive therapy in an attempt to alleviate or resolve his mental problems.
The music center Next to Normal centers around a woman's family undergoing the procedure.
Robert Pirsig suffered a nervous breakdown and spent time in and out of the asylum between 1961 and 1963. He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation performed by a psychoanalyst, and was treated with electroconvulsive therapy on many occasions, the treatment he discussed in his novel, Zen and the Art of Motorcycles Maintenance .
In the Six Feet Under HBO series (TV series) season 5, George is undergoing ECT treatment to deal with increasing paranoia. The depiction is displayed realistically, with the actual ECT machine.
Gender
Throughout the history of ECT, women have received it two to three times more often than men. Currently, about 70 percent of ECT patients are women. This may be due to the fact that women are more likely to be diagnosed with depression. An ECT study in Massachusetts in 1974 reported that women comprised 69 percent of those given ECT. The Canadian Department of Health reported that from 1999 to 2000 in the province of Ontario, women were 71 percent of those given ECT in provincial psychiatric institutions, and 75 percent of the total ECT was given to women.
Young
ECT treatment in children with severe autism with violent behavior, sometimes self-injury was first started in some parts of the US during the early years of the 21st century. Each session was reported to relieve symptoms up to 10 days at a time, but not claimed to be a cure. A practitioner, Charles Kellner, director of ECT at Mount Sinai Hospital in New York, firmly believes that ECT is effective and safe so that he allows parents to watch procedures and the BBC to record interventions.
See also
References
External links
- Position Statement on Electroconvulsive Therapy (ECT) 2015 Ã, - from the American Psychiatric Association.
- ECT - information from the mental health charity Royal College of Psychiatrists
Source of the article : Wikipedia
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