Electroconvulsive therapy (ECT) is a widely practiced intervention used to treat psychiatric disorders in specific groups of mental health patients.(1-3) A small electrical current is applied via electrodes attached to the patients head to induce a generalised cerebral seizure whilst the patient is sedated under a general anaesthetic.(4) The induction of seizures to treat psychiatric disorders originated from the historical observation that schizophrenic patients improved temporarily after a spontaneous seizure.(5-7) The most common contemporary use of ECT is found in the treatment of mood disorders. The indications, risks and adverse effects of ECT and the evidence justifying its clinical use shall be briefly discussed.
Indications
The primary indication for the use of ECT is for the treatment of Major Depressive Disorder arising as part of a unipolar/bipolar depression. Additionally, ECT is indicated in the treatment of mania, schizophrenia, schizoaffective disorder, Parkinson's disease, neuroleptic malignant syndrome and catatonia. (8) The presence of persistent suicidal ideation, psychotic features, malnutrition due to food refusal, history of good response to prior ECT, refractory depression and resistance to traditional anti-depressant medications are all features which should strongly influence the decision to use ECT as part of the patients treatment plan. (9) (10-12)
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Risks and Side Effects Associated with every medical intervention are adverse side effects and risks.
Patients and relatives must be made fully aware of the implications of proposed treatments and the benefits weighed against the risks of undergoing an intervention. The adverse effects of ECT occupy two distinct categories: general medical and cognitive
effects. General Medical Mortality - The mortality rate resulting from ECT has been documented as being between <2 and 2-4 deaths per 100,000 treatments and remains one of the safest procedures performed under general anaesthesia. (13-16) The evidence suggests that mortality in the period following ECT is associated with the use of general anaesthesia and medical complications thereof rather than as a direct result of the electrical stimulation associated with ECT itself.(17) This conclusion is further supported by a series of 10 systematic reviews, 7 meta-analyses and 3 practice guidelines reviewed in an FDA inquiry demonstrating the mortality associated with ECT being comparable to that associated with minor procedures involving general anaesthesia. (18) Aspiration Pneumonia (19, 20) - Laryngospasm, pneumopathy and cough are often associated with the inhalation of saliva during anaesthesia. (21) A fasting period prior to anaesthesia, endotracheal intubation with cricoid pressure and administration of antacid/antiemetic preparations are mentioned in the literature as recommended measures to avoid respiratory complications. (22, 23) Cardiovascular Effects - During the tonic phase of seizure activity, parasympathetic activity increases which can lead to arrhythmias, hypotension, premature atrial/ventricular contractions, AV block and systole.(24, 25) Approximately 66% of patients undergoing ECT experience a period of systole greater than 5 seconds with no lasting complications. (26) Clonic phase activity induces a catecholamine surge causing tachycardia and hypertension.(27) Transient ECG changes, depression of ejection fraction and a mild increase in creatinine kinase levels in otherwise healthy adults have been reported.(28) Resolution of these changes occurred quickly however and after the fourth ECT treatment (one week later) LV dysfunction was undetectable. (29, 30) Dental and Tongue Injuries - Jaw clenching and incorrect placement of oral bite blocks risk injury to teeth. (31) Headache - most common non-serious side effect of ECT. (32, 33) Nausea - commonly the result of anaesthesia and manipulation of the airway. (33) Somatic Symptoms: myalgia potentially resulting from muscular fasciculations due to succinylcholine use. (34) Cognitive Effects A majority of patients report adverse cognitive symptoms in the period immediately following ECT treatment. A series of observational studies involving 597 patients quantified this proportion to between 51-79% of patients.(35) Electrode placement influences the incidence and degree of impairment, however it should be noted that >15 days post ECT the effects were negligible to undetectable and appear to be short lived.(36) In summary there are three main categories of cognitive impairment associated with ECT: Acute confusion Anterograde amnesia Retrograde amnesia Justification and Evidence ECT has been demonstrated in the literature to be more effective than any other treatment in achieving remission of major depressive disorder.(18) With a reported remission rate of between 70-90%, ECT compares favourably with pharmacological treatments including paroxetine and citalopram with a reported 30% and 28% remission rate respectively. (37-39) Using the example of suicidal ideation to guage ECT efficacy, a study of patients completing a thrice weekly series of ECT treatments found that ideation resolved completely in 38% of patients after one week, 61% in two weeks and 81% by the completion of the month. (12) Further, a study using the Hamilton Rating Scale for Depression (HAMD) observed 34% of patients to show remission of symptoms after two weeks of bilateral thrice weekly ECT. Of the total 253 patients, 86% completed the trial and a sustained response occurred in 79% with remission of symptoms shown in 75% of the group. (10) The rapid response of symptoms to ECT contrasts strongly with a slower response derived from pharmacotherapy alone. A CORE report found 66% of patients showed response to medication in 4 weeks with remission of symptoms occurring months later in a smaller proportion of typically outpatient managed, less severely ill patients with major depression. (10) The placement and number of electrodes and the frequency of treatment further influences the efficacy and side effect profile of ECT. (40) Bilateral electrode placement as compared to unilateral and twice versus thrice weekly therapy has been observed in the literature to show superior and equivalent efficacy respectively. (40) Conclusion Electroconvulsive therapy (ECT) is a widely practiced, safe and effective intervention. (1-3) When applied to high risk patients or in treatment resistant groups, ECT has been shown to be superior to pharmacotherapy in inducing rapid remission of symptoms. The risks and averse medical/cognitive effects of ECT when appropriately managed are acceptable when compared to the significant and lasting benefits obtained in the majority of patients undergoing ECT.
...ects, which in my opinion shows that its introduction into society (decriminalization) could benefit the community in many aspects (such as volunteering for a good cause) due to the increased sensibility that one may develop in regards to the society/others. I find that society has been misinformed about this chemical, seeing it solemnly as dangerous substance and classifying it along with physically harmful and potentially deadly substances such as heroin and cocaine. Not only is psilocybin non-lethal, but its potential for abuse is lower than that of caffeine. To summarize and conclude, I find that used responsibly, psilocybin along with other entheogens can be beneficial for one’s mental health and that more light needs to be shed on its benefits to allow society to see it in a different angle rather than what is propagated through the media about it today.
According to the documentary, medicine is the most commonly used intervention mechanism to elevate and dull symptoms of bipolar disorder (2016). Of all the medicine used to combat bipolar disorder, lithium, is considered the “gold standard.” It has been shown to be the most effective and consistent and treating symptoms, however, only 30% of patients benefit from using lithium (2016). Other medications can be used, but have varying levels of effectiveness in patients. It often takes years for patients to find the right mixture of medication to help combat symptoms. For some patients with bipolar, medication is useless at fighting symptoms (2016). For example, the video followed Gary who was desperate for treatment and who was thought to be medication resistant. He elected to participate in Electro-convulsive therapy (ETC), which induces remission in 80% of patients and has been known to be rapidly effective for those with bi-polar disorder. For Gary, the treatment was used to apply electric current to the brain. This current changed the way neurons connect to one another in his brain and even stimulated the
... in assisting those who care about the bipolar individual, as well as providing socialization and a means to not feel alone. Generally, as a last resort, electroconvulsive therapy, or ECT is used. An electrical current is passed through the brain. This is thought to change the brain chemistry and increase the mood. This is used only for severe depression or when symptoms are unsuccessfully treated with medications. People with Bipolar Disorder are encouraged to avoid drinking alcohol, avoid the use of street drugs or misusing prescription medications, avoid unhealthy relationships, get plenty of sleep, and exercise on a regular basis. One thing is clear. The person themselves must be active in their own well-being in order to maintain a relatively healthy and productive lifestyle. In so doing, the prognosis for someone diagnosed with Bipolar Disorder is very good.
After attempting suicide for the eleventh time last November, she was sent to Sacramento, Calif. to a depression specialist. Everyday for two weeks, Figureoa underwent Electroconvulsive therapy (ECT), in which electric currents are briefly applied to the brain. This procedure is used to help ease only the most severe cases of de...
The strengths of the EMDR therapy are that it uses elements of cognitive behavior and psychodynamic to treat clients. (1).EMDR therapy has eight phases of the treatment approach, they are; in phase one is the development of the treatment plan and getting the history from the client. In the second phase of the treatment is to teach the client coping skills needed to deal with stress in a positive manner. In phases three, four, and five the focus is on the therapist assisting the client into finding positive belief to replace negative ones. In the seventh phase the clients keeps a journal for the week. In that journal the client writes down anything that may trigger any negative ima...
When ECT was first introduced, it was a terrifying and hazardous procedure: patients suffered serious side effects, even breaking a bone from convulsions (Nairne, Smith & Lindsay, 2001). It has been criticized since its beginnings, and only recently it has begun to be seen more positively. The major reason for this is the fact that the treatment went through significant changes over the years – it is now much safer than before. Nowadays, patients are given a general anaesthetic and medications that relax the muscles to prevent injuries from occur. However, most professionals still consider it to be a treatment of last resort. It is used when people have shown...
Currently, there is a lack of studies in regards to whether or not this therapy causes significant damage to the brain. Correspondingly, there is little research done in regards to how great relapse rates are and how long the treatment can truly last. Consequently, many people have abstained from receiving treatment to avoid any possibility of impairment or reversion. However, it has not been denied nor confirmed that ECT directly causes the aforementioned results. Moreover, many theories created to downplay electroconvulsive therapy’s effectiveness are being brought back into the spotlight, including one that attributes ECT’s success to brain damage. Breggin states, “More recently [Harold] Sackeim and Sackeim with a team of colleagues have covertly revived the principle that a therapeutic response depends upon the degree of brain damage and dysfunction” (par. 17). Although this theory was made to discredit ECT, there has been no research done to disprove its accuracy. Furthermore, because of a lack of research, when a new study such as this comes out, many people believe it right away no matter how erroneous it may actually be. More research on ECT is desperately needed to see if these theories are factual or not. As a result of these truths or fallacies, the therapy can be improved upon
Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of Bipolar Disorder: How Far Have We Come? Psychopharmacology Bulletin. 30 (1): 27-38.
CBT has been known to cure a variety of disorders both in clinical environments and non-clinical environments. This type of therapy technique has been tested for efficacy and has proven to be highly effective. Furthermore, the future for CBT looks very positive as well. Researchers and theorist are now working on making this type of therapy available for suicide prevention, schizophrenia, and other psychopathologies.
Many treatments within the medical field have been considered controversial, but even after seventy-eight years of use electroconvulsive therapy, also referred to as ECT, is still one of the most questionable treatments. Just like any other treatment ECT has its risk and advantages, but it seems to have an even more negative connotation than other controversial treatments due to its violent history. Throughout the seventy-eight years that ECT has been around, research has been done to learn more about the treatment, which disorders it can be useful for, and what side effects can occur. The research has led to adjustments being made to the procedure and has significantly improved patient safety. The success of electroconvulsive therapy can be shown by numbers and case opinions; it may work for one person, but not another.
Epilepsy, also known as “seizure disorder,” or “seizure attack,” is the fourth most common neurological disorder known to mankind, affecting an estimated 2.3 million adults and 467,711 children in the United States. Unfortunately this disorder is becoming far more common and widespread worldwide. This staggering number of cases of people suffering from Epilepsy also involves an average growth rate of 150,000 new cases each year in the United States alone. Generally, many of the people who develop who are a part of the new are mainly either young children or older adults. Your brain communicates through chemical and electrical signals that are all specialized for specific tasks. However, through the process of communication, chemical messengers, also known as neurotransmitters can suddenly fail, resulting in what is known as a seizure attack. Epilepsy occurs when a few too many brain cells become excited, or activated simultaneously, so that the brain cannot function properly and to it’s highest potential. Epilepsy is characterized when there is an abnormal imbalance in the chemical activity of the brain, leading to a disruption in the electrical activity of the brain. This disruption specifically occurs in the central nervous system (CNS), which is the part of the nervous system that contains the brain and spinal cord. This causes an interruption in communication between presynaptic neurons and postsynaptic neurons; between the axon of one neuron, the message sender and the dendrite of another neuron, the message recipient. Consequently, the effects that epileptic seizures may induce may range anywhere from mild to severe, life-threatening ramifications and complications. There are many different types of seizures associa...
?What is the role of ECT in the treatment of mania?? Harvard Mental Health Letter. June 1997.
It was a cold, rainy day. I could see most of the kids at the bus stop had winter coats and hats. The clouds were particularly low in the sky. After evading the numerous puddles in the road, I reached the bus stop and walked up to a group of friends. A girl in my class spotted me and asked, "Are you going to the dance tomorrow?"
The diagnosis of epilepsy is usually made after the patient experiences a second unprovoked seizure (Leppik, 2002). Diagnosis is often difficult, however, since it is unlikely that the physician will actually see the patient experience and epileptic seizure, and therefore must rely heavily on patient’s history. An electroencephalography (EEG) is often used to examine the patient’s brain waves, and some forms of epilepsy can be revealed by a characteristic disturbance in electrical frequency (Bassick, 1993). The variations in frequency can take form as spikes or sharp waves (Fisher, 1995). The variations are divided into two groups, ictal electrograph abnormalities, which are disturbances resulting from seizure activity, and interictal electrograph abnormalities, or disturbances between seizures. The EEG can also give clues as to which region of the brain the disturbances arise from. Interictal temporal spikes will predict the side of seizure origin in 95% of patients if three times as ...
The rationale for ECT is to provide relief from the signs and symptoms of mental illnesses such as severe depression, mania, and catatonic schizophrenia. ECT is indicated when patients need rapid improvement because they are suicidal, at risk of self-harm, refuse to eat or drink or are non compliant with prescribed medication. ECT will only be prescribed after adequate trials of other treatment options have proved to be ineffective or the condition is considered potentially life threatening (NICE 2010). A programme of ECT refers to no more than 12 treatments, prescribed by a consultant psychiatrist, following a psychiatric examination of the patient with a mental disorder for which use of ECT is indicated (Mental Health Commission 2009).