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Electroconvulsive Therapy (ECT)

The American Psychiatric Association released its second task force report in where specific details on the delivery, education, and training of ECT were documented.

Is ECT an Ethical Treatment?

Finally, in the American Psychiatric Association released its latest task force report. By , ECT was routinely covered by insurance companies for providing the "biggest bang for the buck" for otherwise intractable cases of severe mental illness, was receiving favorable media coverage, and was being provided in regional medical centers. Surveys of public opinion, the testimony of former patients, legal restrictions on the use of ECT and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial.

The World Health Organization advises that ECT should be used only with the informed consent of the patient or their guardian if their incapacity to consent has been established. In the US, this doctrine places a legal obligation on a doctor to make a patient aware of the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment.

The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that consent may be revoked and treatment discontinued at any time during a course of ECT. To demonstrate what he believes should be required to fully satisfy the legal obligation for informed consent, one psychiatrist, working for an anti-psychiatry organisation, has formulated his own consent form [] using the consent form developed and enacted by the Texas Legislature [] as a model.

According to the US Surgeon General, involuntary treatment is uncommon in the US and is typically used only in cases of great extremity, and only when all other treatment options have been exhausted. The use of ECT is believed to be a potentially life-saving treatment. In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects. A study published in the British Journal of Psychiatry described patients' perspectives on the adequacy of informed consent before ECT. Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form.

The proportion who feel they did not freely choose the treatment has actually increased over time. The same themes arise whether the patient had received treatment a year ago or 30 years ago. Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.

Procedures for involuntary ECT vary from country to country depending on local mental health laws. In the US, ECT devices came into existence prior to medical devices being regulated by the Food and Drug Administration ; when the law came into effect the FDA was obligated to retrospectively review already existing devices and classify them, and determine whether clinical trials were needed to prove efficacy and safety. While the FDA has classified the devices used to administer ECT as Class III medical devices , as of the FDA had not yet determined whether the devices should be withdrawn from the market until clinical trials prove their safety and efficacy.

Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective. Until in England and Wales, the Mental Health Act allowed the use of ECT on detained patients whether or not they had capacity to consent to it. However, following amendments which took effect in , ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act. Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues, on children, and on involuntary patients.

Public perceptions of ECT were found to be mainly negative. He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient He was diagnosed with paranoid schizophrenia and clinical depression as a result of an evaluation conducted by psychoanalysts, and was treated with electroconvulsive therapy on numerous occasions, a treatment he discusses in his novel, Zen and the Art of Motorcycle Maintenance.

American surgeon and award-winning author Sherwin B. Nuland is another notable person who has undergone ECT. After exhausting all treatment options, a young resident assigned to his case suggested ECT, which ended up being successful. She later wrote about this in her novel Faces in the Water.

More on this topic

Electroconvulsive therapy has been depicted in fiction, including fictional works partly based on true experiences. In the film Requiem for a Dream , Sarah Goldfarb receives "unmodified" electroconvulsive therapy after experiencing severe amphetamine psychosis following prolonged stimulant abuse. In the TV series Constantine , the protagonist John Constantine is institutionalized and specifically requests electroconvulsive therapy as an attempt to alleviate or resolve his mental problems.

The musical Next to Normal centers around the family of a woman who undergoes the procedure. The depiction is shown realistically, with an actual ECT machine. Throughout the history of ECT, women have received it two to three times as often as men. ECT treatment of severely autistic children with violent, sometimes self-harming behaviour first began in parts of the US during the early years of 21st century.

Each session reportedly alleviates symptoms for up to 10 days at a time, but it is not claimed as a cure. Though ECT use declined with the advent of modern antidepressants, there has been a resurgence of ECT with new modern technologies, techniques and lower side effect profile. In the last decade, physicians and patients have returned to using ECT to treat various mental illnesses including depression and bipolar disorder.

From Wikipedia, the free encyclopedia. For other uses, see Electroshock disambiguation. Further information: History of electroconvulsive therapy in the United Kingdom and History of electroconvulsive therapy in the United States. This section needs expansion. You can help by adding to it. June Main article: List of people who have undergone electroconvulsive therapy. Electroconvulsive therapy.

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Tasman, J. A Lieberman Eds. Curr Opin Anesthesiol. FDA Executive Summary. Quote, p "Three major practice guidelines have been published on ECT. There is significant agreement between the three sets of recommendations. Bipolar Disorders. Nov Weiner chairperson ; et al. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging 2nd ed. Dec Expert Rev Neurother. Barnes, Richard. Retrieved 3 November Epidemiologia e Psichiatria Sociale.

Archived from the original PDF on Retrieved Mar J Geriatr Psychiatry Neurol. Geneva, B The Medical Journal of Australia.

What Electroconvulsive Therapy (ECT) is like

National Institute for Clinical Excellence. Jan Canadian Medical Association Journal. The Journal of ECT. The Lancet. Depress Res Treat. Front Psychiatry. A systematic review and meta-analysis".

Illuminating the Art of Medicine

European Archives of Psychiatry and Clinical Neuroscience. Sep J Autism Dev Disord. Psychiatry Clin Neurosci. Curr Psychiatry Rep. Adams, C. Tharyan, Prathap ed. J ECT. Annals of General Psychiatry. Pharmaceutical Journal.

Electroconvulsive therapy in adolescents with the catatonia syndrome: Efficacy and ethics

Retrieved 10 July Am J Psychiatry. Br J Psychiatry. In AIF Scott ed. The ECT Handbook, second edition. London: The Royal College of Psychiatrists, pp.

Electroconvulsive Therapy in Adolescents With the Catatonia Syndrome: Efficacy and Ethics

Long-term follow-up". British Medical Journal. Primary Psychiatry.

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July The American Journal of Psychiatry. CNS Spectr Submitted manuscript.