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Matthews G, Ho M. Mental health treatments and the influence of culture: portrayals of hypnotherapy and electroconvulsive therapy in Singaporean television dramas. MEDICAL HUMANITIES 2025; 51:13-25. [PMID: 38991757 DOI: 10.1136/medhum-2023-012854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/13/2024]
Abstract
Stigma is one of the chief reasons for treatment-avoidant behaviour among people with mental health conditions. Stigmatising attitudes are spread through multiple determinants, including but not limited to: (i) individual beliefs; (ii) interpersonal influences; (iii) local cultural values and (iv) shared culture such as depictions in television shows. Our research indicates that popular television shows are currently understudied vectors for narratives that alternately reify or debunk assumptions and stereotypes about people with mental health conditions. Although such shows are fictional, they influence perception by normalising 'common sense' assumptions over extended periods of time. Consequently, representations of patients, psychiatrists and treatments influence knowledge and understanding of mental health and treatment-seeking behaviour. While storytelling about sickness can inspire possibilities and bestow meaning on traumatic experiences, fictional narratives written without sufficient care can have the inverse effect of curtailing horizons and limiting expectations. Problematic portrayals of patients, mental health professionals and psychological interventions are often reductive and may increase stigma and prevent treatment-seeking behaviour. This article analyses the representation of hypnotherapy and electroconvulsive therapy (ECT) in Singaporean television dramas that attract a wide, mainstream audience. Our diverse team investigated dramas in all four of the official languages of Singapore: English, Mandarin Chinese, Bahasa Melayu and Tamil. We found that depictions of hypnotherapy tend to produce problematic images of mental health professionals as manipulative, able to read minds, engaging in criminal behaviour, lacking in compassion and self-interested. Meanwhile, representations of ECT typically focus on the fear and distress of the patient, and it is primarily depicted as a disciplinary tool rather than a safe and effective medical procedure for patients whose condition is severe and refractory to pharmacotherapy and behavioural interventions. These depictions have the potential to discourage treatment-seeking behaviour-when early intervention has found to be crucial-among vulnerable populations.
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Affiliation(s)
| | - Melissa Ho
- Nanyang Technological University, Singapore
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Chen J, Yuan D, Dong R, Cai J, Ai Z, Zhou S. Artificial intelligence significantly facilitates development in the mental health of college students: a bibliometric analysis. Front Psychol 2024; 15:1375294. [PMID: 38515973 PMCID: PMC10955080 DOI: 10.3389/fpsyg.2024.1375294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Objective College students are currently grappling with severe mental health challenges, and research on artificial intelligence (AI) related to college students mental health, as a crucial catalyst for promoting psychological well-being, is rapidly advancing. Employing bibliometric methods, this study aim to analyze and discuss the research on AI in college student mental health. Methods Publications pertaining to AI and college student mental health were retrieved from the Web of Science core database. The distribution of publications were analyzed to gage the predominant productivity. Data on countries, authors, journal, and keywords were analyzed using VOSViewer, exploring collaboration patterns, disciplinary composition, research hotspots and trends. Results Spanning 2003 to 2023, the study encompassed 1722 publications, revealing notable insights: (1) a gradual rise in annual publications, reaching its zenith in 2022; (2) Journal of Affective Disorders and Psychiatry Research emerged were the most productive and influential sources in this field, with significant contributions from China, the United States, and their affiliated higher education institutions; (3) the primary mental health issues were depression and anxiety, with machine learning and AI having the widest range of applications; (4) an imperative for enhanced international and interdisciplinary collaboration; (5) research hotspots exploring factors influencing college student mental health and AI applications. Conclusion This study provides a succinct yet comprehensive overview of this field, facilitating a nuanced understanding of prospective applications of AI in college student mental health. Professionals can leverage this research to discern the advantages, risks, and potential impacts of AI in this critical field.
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Affiliation(s)
- Jing Chen
- Wuhan University China Institute of Boundary and Ocean Studies, Wuhan, China
| | - Dongfeng Yuan
- Faculty of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Ruotong Dong
- Faculty of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Jingyi Cai
- Faculty of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Zhongzhu Ai
- Faculty of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
| | - Shanshan Zhou
- Hubei Shizhen Laboratory, Wuhan, China
- The First Clinical Medical School, Hubei University of Chinese Medicine, Wuhan, China
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Read J, Morrison L, Harrop C. An independent audit of electroconvulsive therapy patient information leaflets in Northern Ireland, Scotland and Wales. Psychol Psychother 2023; 96:885-901. [PMID: 37466121 DOI: 10.1111/papt.12481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent. DESIGN AND METHODS To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40-item accuracy measure used in the England audit. RESULTS The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long-term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the 'most effective treatment' and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives. CONCLUSIONS Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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Han KY, Wang CM, Du CB, Qiao J, Wang YL, Lv LZ. Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression. World J Psychiatry 2023; 13:949-957. [DOI: 10.5498/wjp.v13.i11.949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/07/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Traditional treatments for major depressive disorder (MDD), including medication and therapy, often fail and have undesirable side effects. Electroconvulsive therapy (ECT) uses electrical currents to induce brief seizures in the brain, resulting in rapid and potent antidepressant effects. However, owing to misconceptions and controversies, ECT is not as widely used as it could and often faces stigmatization.
AIM To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.
METHODS This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups. The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions. The non-ECT group received medication and/or therapy according to clinical guidelines for MDD. The primary outcome was the variation in the hamilton depression rating scale (HDRS) score from treatment/ECT initiation to week 12. In addition, patients’ quality of life, cognitive abilities, and biomarkers were measured throughout the study.
RESULTS Although both groups showed significant improvements in their HDRS scores over time, the improvement was more pronounced in the ECT group than in the non-ECT group. Additionally, the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group. Compared with the non-ECT group, the ECT group exhibited evi-dently lower variations in the brain-derived neurotrophic factor (BDNF) and cytokine interleukin-6 (IL-6) levels. The side effects were generally mild and comparable between the two groups. ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms, enhancing well-being, and bolstering cognitive capabilities in individuals with severe MDD. ECT may also affect the levels of BDNF and IL-6, which are indicators of neuroplasticity and inflammation, respectively.
CONCLUSION ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.
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Affiliation(s)
- Ke-Yan Han
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
| | - Chao-Min Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
| | - Chong-Bo Du
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
| | - Jun Qiao
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
| | - Yong-Liang Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
| | - Li-Zhao Lv
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, Hebei Province, China
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Su Y, Ye C, Xin Q, Si T. Major depressive disorder with suicidal ideation or behavior in Chinese population: A scoping review of current evidence on disease assessment, burden, treatment and risk factors. J Affect Disord 2023; 340:732-742. [PMID: 37619652 DOI: 10.1016/j.jad.2023.08.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Identifying and managing major depressive disorder (MDD) patients with suicidal ideation or behavior (MDSI) is critical for reducing the disease burden. This scoping review aims to map the existing evidence related to MDSI in the Chinese population. METHOD A scoping review was conducted to summarize the published evidence regarding epidemiology or disease burden, evaluation, diagnosis, management, and prognosis of MDSI. The search strategy imposed restriction on English or Chinese publications between 1 January 2011 and 28 February 2022. RESULTS Of the 14,005 identified records, 133 met the eligibility criteria and were included for analysis. The included studies were characterized as high heterogeneity in evaluation of suicidal ideation or behavior. Compared with MDD patients without suicidal ideation or behavior, MDSI patients were more likely to suffer from psychological and somatic symptoms, social function impairment, and lower quality of life. Younger age, female gender, longer disease course, and comorbid psychological or physical symptoms were consistently found to be risk factors of suicidal ideation or behavior. Relevant research gaps remain regarding comprehensive evaluation of standard clinical diagnosis, disease burden, social-cultural risk factors, and effectiveness of interventions targeting MDSI. Studies with large sample size, representative population are warranted to provide high-quality evidence. CONCLUSIONS MDD patients with suicidal ideation or behavior should be prioritized in treatment and resource allocation. Heterogeneity exists in the definition and evaluation of MDSI in different studies. To better inform clinical practice, it is imperative to establish a unified standard for evaluation and diagnosis of suicidal ideation or behavior among MDD population.
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Affiliation(s)
- Yun'Ai Su
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Qin Xin
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Kyuragi Y, Oishi N, Yamasaki S, Hazama M, Miyata J, Shibata M, Fujiwara H, Fushimi Y, Murai T, Suwa T. Information flow and dynamic functional connectivity during electroconvulsive therapy in patients with depression. J Affect Disord 2023; 328:141-152. [PMID: 36801417 DOI: 10.1016/j.jad.2023.02.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Electroconvulsive therapy is effectively used for treatment-resistant depression; however, its neural mechanism is largely unknown. Resting-state functional magnetic resonance imaging is promising for monitoring outcomes of electroconvulsive therapy for depression. This study aimed to explore the imaging correlates of the electroconvulsive therapy effects on depression using Granger causality analysis and dynamic functional connectivity analyses. METHODS We performed advanced analyses of resting-state functional magnetic resonance imaging data at the beginning and intermediate stages and end of the therapeutic course to identify neural markers that reflect or predict the therapeutic effects of electroconvulsive therapy on depression. RESULTS We demonstrated that information flow between the functional networks analyzed by Granger causality changes during electroconvulsive therapy, and this change was correlated with the therapeutic outcome. Information flow and the dwell time (an index reflecting the temporal stability of functional connectivity) before electroconvulsive therapy are correlated with depressive symptoms during and after treatment. LIMITATIONS First, the sample size was small. A larger group is needed to confirm our findings. Second, the influence of concomitant pharmacotherapy on our results was not fully addressed, although we expected it to be minimal because only minor changes in pharmacotherapy occurred during electroconvulsive therapy. Third, different scanners were used the groups, although the acquisition parameters were the same; a direct comparison between patient and healthy participant data was not possible. Thus, we presented the data of the healthy participants separately from that of the patients as a reference. CONCLUSIONS These results show the specific properties of functional brain connectivity.
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Affiliation(s)
- Yusuke Kyuragi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Naoya Oishi
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto 606-8397, Japan.
| | - Shimpei Yamasaki
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Masaaki Hazama
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Mami Shibata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hironobu Fujiwara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; Artificial Intelligence Ethics and Society Team, RIKEN Center for Advanced Intelligence Project, Saitama 351-0198, Japan; The General Research Division, Research Center on Ethical, Legal and Social Issues, Osaka University, Osaka 565-0871, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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7
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Read J. Commentary on 'Information flow and dynamic functional connectivity during electroconvulsive therapy in patients with depression'. J Affect Disord 2023; 332:341. [PMID: 37086793 DOI: 10.1016/j.jad.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Affiliation(s)
- John Read
- University of East London, London E15 4LZ, United Kingdom of Great Britain and Northern Ireland.
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Read J, Ross C, Timimi S. A study of ECT on 278 children and adolescents; methodological, conceptual, and ethical concerns. Brain Behav 2023; 13:e2866. [PMID: 36571516 PMCID: PMC9847600 DOI: 10.1002/brb3.2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
| | - Colin Ross
- Colin A. Ross Institute for Psychological Trauma, Dallas, Texas, USA
| | - Sami Timimi
- Lincolnshire Partnership NHS Foundation Trust, Lincolnshire, UK
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Shin S, Ho J, Francis-Taylor R, Wells K, Halliday G, Jacek S, Lah S. Effect of an Educational Video and Information Pamphlet on Knowledge and Attitudes About Electroconvulsive Therapy: A Randomized, Blind, Controlled Study. J ECT 2022; 38:211-217. [PMID: 35462384 DOI: 10.1097/yct.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is considered an effective, yet underused and stigmatized form of psychiatric treatment. Public misconception can impact informed decision making, and therefore, it is important to educate the community with accurate and realistic representations of modern ECT. The aim of this study was to determine whether exposure to brief information packages developed in Australia leads to changes in attitudes and knowledge about ECT. METHODS A sample of 100 undergraduate psychology students and 88 volunteers from the general public were randomly allocated to view 1 of 3 resource packages (each containing an information pamphlet and videos totaling ~15 minutes): Concord Centre for Mental Health-Revised, Concord Centre for Mental Health-Original, and a generic information package on depression. Participants' attitudes and knowledge of ECT were assessed before and after psychoeducation using the Questionnaire on Attitudes and Knowledge of ECT (QuAKE). RESULTS Participants in the student and general population exposed to either ECT resource package showed significantly improved attitudes and knowledge of ECT compared with participants exposed to generic information about depression and its treatment. A fine-grained analysis of the QuAKE revealed that, although many aspects of knowledge and attitudes improved after exposure to ECT information packages, some remained unchanged. CONCLUSIONS Brief education through information resources in video and written format can markedly improve attitudes and knowledge toward ECT. Further research is recommended to determine whether the resources contribute to informed decision making of consumers with mental illness, especially those who are candidates for ECT.
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Affiliation(s)
- Selina Shin
- From the School of Psychology, University of Sydney, Camperdown
| | - Joanna Ho
- Concord Centre for Mental Health, Concord
| | | | | | | | | | - Suncica Lah
- From the School of Psychology, University of Sydney, Camperdown
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McManus KR, Lapid MI, Forester BP, Mueller M, Hermida AP, Nykamp L, Harper DG, Seiner SJ, Sanghani S, Patrick R, Gentry MT, Kung S, Leal JC, Johnson EK, Petrides G. Simulated Electroconvulsive Therapy: A Novel Approach to a Control Group in Clinical Trials. J ECT 2022; 38:165-170. [PMID: 35220356 PMCID: PMC9420159 DOI: 10.1097/yct.0000000000000832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Agitation is the most common behavioral symptom of Alzheimer disease (AD) affecting approximately 40% to 60% of the AD population, yet there are no Food and Drug Administration-approved therapies for the myriad of behavioral or psychological symptoms of dementia. There is growing evidence from naturalistic studies that electroconvulsive therapy (ECT) is a safe and effective treatment for agitation in AD patients who are refractory to pharmacotherapy and behavioral interventions. Despite the existing evidence, ECT remains underused because of stigma, lack of education, and concerns regarding adverse cognitive effects. Randomized controlled clinical trials of ECT are an opportunity to provide high-quality evidence of ECT as a safe and efficacious treatment for agitation in the AD population. We describe the methods for the Electroconvulsive Therapy in Alzheimer's Dementia study, which uses a novel, simulated ECT (S-ECT) control group to conduct a single-blind efficacy study of ECT for the treatment of agitation and aggression in individuals with moderate to severe AD. METHODS We discuss the rationale, study design, methodology, ethical and practical challenges, and management strategies in using an S-ECT group as the comparator arm in this randomized controlled trial of ECT in AD-related treatment refractory agitation and aggression. CONCLUSIONS Validation of the safety and efficacy of ECT in patients with advanced AD with refractory agitation and aggression is necessary. This can be accomplished through creative formulation of S-ECT groups that effectively maintain the blind while providing scientific integrity.
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Affiliation(s)
| | | | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
| | | | | | - Louis Nykamp
- Pine Rest Christian Mental Health Services, Grand Rapids, MI
| | - David G. Harper
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
| | - Stephen J. Seiner
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
| | - Sohag Sanghani
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Regan Patrick
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
| | | | | | | | | | - Georgios Petrides
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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Wells K, Hancock N, Honey A. How Do People Perceive and Adapt to Any Consequences of Electro Convulsive Therapy on Their Daily Lives? Community Ment Health J 2022; 58:1049-1059. [PMID: 34812963 DOI: 10.1007/s10597-021-00913-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
Great controversy surrounds the use of electroconvulsive therapy or ECT. However, it continues to be used internationally. While research on short term effects of ECT abound, there is limited knowledge about long term impacts of ECT on individuals, especially from the lived experience perspective. The aim of this qualitative study was to gain an in-depth understanding of longer-term lived experiences of ECT and how people navigate any impacts on their daily lives. Twenty-three people participated in semi-structured interviews. Data collection and analysis involved an iterative process. Data were coded into four categories: (1) My ECT experience included physical mechanics, decision making, clinic experiences, post ECT support and attitudes and support of others); (2) Direct impacts of ECT on me encompassed both cognitive and emotional impacts; (3) Impacts on my life comprised daily activities, relationships, ongoing health care; and My strategies incorporated fixing or working around the problem, reframing, using support networks, protecting myself and taking control. Insights gleaned through lived experiences have important implications for other service users, direct service providers and those striving for system reforms that embrace more recovery orientated and trauma informed practices.
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Affiliation(s)
- Karen Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia.
| | - Nicola Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia
| | - Anne Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia
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Singh MF, Cole MW, Braver TS, Ching S. Developing control-theoretic objectives for large-scale brain dynamics and cognitive enhancement. ANNUAL REVIEWS IN CONTROL 2022; 54:363-376. [PMID: 38250171 PMCID: PMC10798814 DOI: 10.1016/j.arcontrol.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The development of technologies for brain stimulation provides a means for scientists and clinicians to directly actuate the brain and nervous system. Brain stimulation has shown intriguing potential in terms of modifying particular symptom clusters in patients and behavioral characteristics of subjects. The stage is thus set for optimization of these techniques and the pursuit of more nuanced stimulation objectives, including the modification of complex cognitive functions such as memory and attention. Control theory and engineering will play a key role in the development of these methods, guiding computational and algorithmic strategies for stimulation. In particular, realizing this goal will require new development of frameworks that allow for controlling not only brain activity, but also latent dynamics that underlie neural computation and information processing. In the current opinion, we review recent progress in brain stimulation and outline challenges and potential research pathways associated with exogenous control of cognitive function.
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Affiliation(s)
- Matthew F Singh
- Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, 63130, MO, USA
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, 07102, NJ, USA
- Psychological and Brain Science, Washington University in St. Louis, St. Louis, 63130, MO, USA
| | - Michael W Cole
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, 07102, NJ, USA
| | - Todd S Braver
- Psychological and Brain Science, Washington University in St. Louis, St. Louis, 63130, MO, USA
| | - ShiNung Ching
- Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, 63130, MO, USA
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Abstract
The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for one another when we are suffering in this way. This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization and service users who have suffered negative consequences of physical treatments that modify brain functions in ways that are not well-understood.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London E15 4LZ, UK
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14
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Moncrieff J, Read J. Messing about with the brain: a response to commentaries on 'Depression: why electricity and drugs are not the answer'. Psychol Med 2022; 52:1426-1427. [PMID: 35514110 DOI: 10.1017/s0033291722001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - John Read
- University College London, London, UK
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Gergel T. 'Shock tactics', ethics and fear: an academic and personal perspective on the case against electroconvulsive therapy. Br J Psychiatry 2022; 220:109-112. [PMID: 35049476 PMCID: PMC7612414 DOI: 10.1192/bjp.2021.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite extensive evidence for its effectiveness, electroconvulsive therapy remains the subject of fierce opposition from those contesting its benefits and claiming extreme harms. Alongside some reflections on my experiences of this treatment, I examine the case against electroconvulsive therapy and find that it appears to rest primarily on unsubstantiated claims about major ethical violations, rather than clinical factors such as effectiveness and risk.
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Read J. A response to yet another defence of ECT in the absence of robust efficacy and safety evidence. Epidemiol Psychiatr Sci 2022; 31:e13. [PMID: 35164891 PMCID: PMC8967695 DOI: 10.1017/s2045796021000846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
It is estimated that electroconvulsive therapy is still administered to approximately a million people a year. It involves passing enough electric current through the human brain, eight to twelve times, to cause convulsions, in the hope of somehow alleviating emotional suffering, primarily depression. There have only ever been 11 placebo-controlled studies (where general anaesthesia is administered but the electric shock is withheld), all of which were pre-1986, had very small sample sizes and were seriously methodologically flawed. Five of these studies found no difference between the two groups at the end of treatment, four found ECT produced better outcomes for some patients, and two produced mixed results, including one where psychiatrists' ratings produced a difference, but the ratings of nurses and patients did not. In the 80 years since the first ECT no studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have somehow concluded that ECT is more effective than placebo despite the studies' multiple failings. Meanwhile, evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated. Attempts to highlight this failure of ECT proponents to provide robust evidence that their treatment is effective and safe are routinely dismissed, diminished, denied and denounced. This paper responds to one such attempt, by Drs Meechan, Laws, Young, McLoughlin and Jauhar, to discredit two systematic reviews of the eleven pre-1986 studies, in 2010 and 2019, the latter of which also reviewed five meta-analyses that had ignored the studies' failings. The criticisms and claims of the recent crtiique of the two systematic reviews are examined in detail, by the first author of both reviews, for accuracy, relevance and logic. The critique is found to include multiple errors, misrepresentations, omissions, inconsistencies and logical flaws. It is concluded that Meechan et al. fail to make a fact-based, coherent argument against suspending ECT pending a series of large, carefully designed placebo-controlled studies to establish whether ECT does have any beneficial effects against which to weigh the significant established adverse effects.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, Water Lane, Stratford, LondonE15 4LZ, UK
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Abstract
There has been recent debate regarding the efficacy of electroconvulsive therapy in the treatment of depression. This has been based on narrative reviews that contradict existing systematic reviews and meta-analyses. In this special article, we highlight the mistakes that occur when interpreting evidence using narrative reviews, as opposed to conventional systematic reviews and meta-analyses.
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Probert J. Moving Toward a Human Rights Approach to Mental Health. Community Ment Health J 2021; 57:1414-1426. [PMID: 33934236 PMCID: PMC8088315 DOI: 10.1007/s10597-021-00830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/24/2021] [Indexed: 11/29/2022]
Abstract
The University of Florida Counseling and Wellness Center (UFCWC) has implemented peer support and professional training programs to address human rights identified within advocacy groups comprised of individuals who have, themselves, been diagnosed with mental illness. These programs are moving the UFCWC toward fulfilling a 2017 United Nations report emphasizing rights-based professional training, provision of genuine informed consent, and availability of non-compromised peer support alternatives. Collaborating with student peers, four UFCWC faculty members have facilitated forms of peer support developed within service-user movements, while openly identifying experiences of reclaiming their own lives from the impacts of adversity, intense mental distress, and traumatizing responses of others to their distress. In the wake of the current pervasive health, economic, and social justice crises, professionals have a collective opportunity to recognize the human experience and rights of those suffering mental distress. These UFCWC programs offer one example of steps taken toward that goal.
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Affiliation(s)
- Jim Probert
- Division of Student Affairs/Department of Psychology, University of Florida Counseling and Wellness Center, 3190 Radio Road, P.O. Box 112662, Gainesville, FL, 32611-2662, USA.
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Duriez P, Bou Khalil R, Chamoun Y, Maatoug R, Strumila R, Seneque M, Gorwood P, Courtet P, Guillaume S. Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives. J Clin Med 2020; 9:2358. [PMID: 32717984 PMCID: PMC7465000 DOI: 10.3390/jcm9082358] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Rami Bou Khalil
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
| | - Yara Chamoun
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
| | - Redwan Maatoug
- Sorbonne Université, AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, 75013 Paris, France;
| | - Robertas Strumila
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, 03101 Vilnius, Lithuania;
| | - Maude Seneque
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Philip Gorwood
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Philippe Courtet
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Sébastien Guillaume
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
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Read J, Harper DJ. The Power Threat Meaning Framework: Addressing Adversity, Challenging Prejudice and Stigma, and Transforming Services. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1773356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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Read J, Kirsch I, McGrath L. Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses. ACTA ACUST UNITED AC 2020. [DOI: 10.1891/ehpp-d-19-00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundElectroconvulsive therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT versus simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT versus SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based.MethodsThe meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigor of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review.ResultsThe five meta-analyses include between 1 and 7 of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT.ConclusionsThe quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a controversial treatment. Research has predominantly focused on clinician assessment of short-term efficacy and, occasionally, on participant experiences of the treatment itself. While service user accounts of the long-term impacts of ECT are reported, they are dispersed throughout the literature and typically tangential to studie's main foci. AIM The aim of this study was to synthesise service-user accounts, within peer-reviewed literature, of long-term impacts of ECT in their daily lives. METHODS A qualitative meta-synthesis was conducted. A systematic literature search identified qualitative articles meeting the inclusion criteria. Results sections of eligible papers were analysed thematically. RESULTS From 16 eligible papers, the review identified 11 long-term impacts, four social influences and five strategies that people employed to navigate these long-term impacts. CONCLUSION Limited research has examined long-term experiences of ECT from service-user perspectives. These lived experience perspectives are required to facilitate peer-to-peer learning and assist future service delivery to align with needs of people living with long-term ECT impacts.
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Affiliation(s)
- K Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - N Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - A Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Grover S, Kumar A, Chakrabarti S, Avasthi A. The incidence of prolonged post-electroconvulsive therapy delirium: A retrospective study. Indian J Psychiatry 2020; 62:193-197. [PMID: 32382180 PMCID: PMC7197832 DOI: 10.4103/psychiatry.indianjpsychiatry_553_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/27/2019] [Accepted: 01/19/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objective of the study was to assess the incidence and determinants of electroconvulsive therapy (ECT)-induced delirium. MATERIALS AND METHODS Using a retrospective study design, data of 488 patients undergoing modified ECT were evaluated for the development of new-onset prolonged delirium. Demographic and clinical parameters of patients who developed delirium and those who did not develop delirium were compared. RESULTS 5.7% of the patients developed prolonged post-ECT delirium. The use of quetiapine in higher doses and the lack of use of antidepressants while receiving ECT were associated with the development of prolonged post-ECT delirium. None of the other clinical and ECT-related parameters emerged as a significant factor associated with the development of prolonged post-ECT delirium. CONCLUSIONS A small proportion of patients undergoing ECT develop post-ECT prolonged delirium.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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24
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Chiesa M. Electroconvulsive therapy effectiveness and harm. Br J Psychiatry 2020; 216:120. [PMID: 32345399 DOI: 10.1192/bjp.2019.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marco Chiesa
- Consultant Psychiatrist and Visiting Professor, University College London, UK.
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25
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Factors Influencing Staff's Attitude Toward Electroconvulsive Therapy: A Comparison of New Versus Experienced Electroconvulsive Therapy Clinics. J ECT 2019; 35:106-109. [PMID: 30308568 DOI: 10.1097/yct.0000000000000544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Despite being a highly effective treatment, electroconvulsive therapy (ECT) is still stigmatized even among professionals. The aim of this study was to identify factors associated with a positive attitude toward ECT among health care workers. METHODS We investigated staff's attitude and their self-assessment of knowledge while introducing ECT in 3 German psychiatric clinics. Furthermore, we compared this data to that of a clinic where ECT has been applied with a long tradition. An anonymous questionnaire was answered by n = 182 employees in the ECT-introducing clinics (novices) and n = 68 employees in the clinic with a long history of ECT (experts). RESULTS Irrespective of the clinical history, the majority of participants approved the application of ECT in their clinic. Factors associated with a positive attitude were (a) profession (physicians presented a more positive mindset about ECT than nursing staff), (b) subjective feeling of being adequately informed, and (c) having had contact to patients undergoing ECT. Interestingly, the general attitude toward ECT did not differ between subjects who reported to have seen an ECT and those who had not. CONCLUSIONS When introducing ECT as a new treatment into a clinic, formal information should be adapted to the needs of each profession with a special emphasis on nurses. To further increase acceptance, contact to ECT-experienced patients (professionals taught by patients) might result in a more positive attitude toward ECT than participation in an ECT treatment itself.
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26
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Davarinejad O, Hendesi K, Shahi H, Brand S, Khazaie H. A Pilot Study on Daily Intensive ECT over 8 Days Improved Positive and Negative Symptoms and General Psychopathology of Patients with Treatment-Resistant Schizophrenia up to 4 Weeks after Treatment. Neuropsychobiology 2019; 77:83-91. [PMID: 30463074 DOI: 10.1159/000494698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/17/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE For patients with treatment-resistant schizophrenia (TRS) who do not respond to drug therapy, electroconvulsive therapy (ECT) is often employed as an additional treatment. The aims of the present study were to investigate to what extent an 8-day daily ECT treatment might reduce symptoms of schizophrenia among patients with TRS both in the short term (end of the treatment) and medium term, that is 4 and 12 weeks after the treatment. METHODS Fourteen patients with TRS based on DSM-5 criteria took part in the present study. ECT consisted of daily sessions for 8 consecutive days. At baseline, at the end of the intervention, and 4 and 12 weeks after study completion, trained psychiatrists assessed the patients' disease severity (positive and negative symptoms; psychopathology) and cognitive functions. RESULTS Disease symptoms (positive and negative symptoms; psychopathology) became reduced from baseline to the end of the intervention and to 4 weeks after treatment. Twelve weeks after the intervention symptoms again increased. Cognitive functions decreased from baseline to the end of the study and 4 weeks after treatment. However, by 12 weeks after the intervention, cognitive functions had returned to baseline levels. CONCLUSION The pattern of results suggests that an intensive 8-day daily course of ECT reduced psychiatric symptoms (positive and negative symptoms, psychopathology) in both the short and medium term among patients with TRS. The increase in symptoms between 4 and 12 weeks following intervention suggests that booster sessions of ECT could be beneficial.
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Affiliation(s)
- Omran Davarinejad
- Department of Psychiatry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Koorosh Hendesi
- Department of Psychiatry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hassan Shahi
- Department of Psychiatry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Serge Brand
- Department of Psychiatry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran, .,Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran, .,Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland, .,Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland,
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Affiliation(s)
- John Read
- University of East London, London, UK
| | | | - Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
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Kirkby LA, Luongo FJ, Lee MB, Nahum M, Van Vleet TM, Rao VR, Dawes HE, Chang EF, Sohal VS. An Amygdala-Hippocampus Subnetwork that Encodes Variation in Human Mood. Cell 2018; 175:1688-1700.e14. [DOI: 10.1016/j.cell.2018.10.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/26/2018] [Accepted: 09/28/2018] [Indexed: 10/27/2022]
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Read J, Harrop C, Geekie J, Renton J. An audit of ECT in England 2011-2015: Usage, demographics, and adherence to guidelines and legislation. Psychol Psychother 2018; 91:263-277. [PMID: 29052308 DOI: 10.1111/papt.12160] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) continues to be used in England, but without comprehensive national auditing. Therefore, information was gathered on usage, demographics, consent, and adherence to the guidelines of the National Institute of Clinical Excellence (N.I.C.E.) and to the Mental Health Act. DESIGN AND METHODS Freedom of Information Act requests were sent to 56 National Health Service Trusts. RESULTS Thirty-two trusts provided some usable data. Only 10 were able to report how many people received psychological therapy prior to ECT in accordance with N.I.C.E. recommendations, with figures ranging from 0% to 100%. The number of people currently receiving ECT in England annually is between 2,100 and 2,700, and falling. There was a 12-fold difference between the Trusts with the highest and lowest usage rates per capita. Most recipients are still women (66%) and over 60 (56%). More than a third (39%) is given without consent, with 30% of Trusts not adhering to mental health legislation concerning second opinions. At least 44% were not using validated measures of efficacy, and at least 33% failed to do so for adverse effects. Only four provided any actual data for positive outcomes or adverse effects. None provided any data on efficacy beyond the end of treatment. CONCLUSIONS National audits should be reinstated. Independent, objective monitoring of adverse effects is urgently required. An investigation into why ECT is still administered excessively to older people and women seems long overdue. PRACTITIONER POINTS Mental health staff should seek to ensure that all depressed people in their service are offered evidence-based psychological treatments before being offered E.C.T. Staff should lobby managers to ensure proper auditing of E.C.T. within their service Individuals receiving ECT should be closely monitored for adverse cognitive effects Overuse of ECT with women and older people should be avoided.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, UK
| | | | - Jim Geekie
- NHS Education for Scotland, Edinburgh, UK
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Khan AR, Mahmood H, Wasiq S, Saeed H. Prolonged Post-electroconvulsive Therapy Delirium: An Unusual Presentation. Cureus 2018; 10:e3221. [PMID: 30405996 PMCID: PMC6205900 DOI: 10.7759/cureus.3221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective but underutilized modality for the treatment of depression unresponsive to antidepressants. Mild to moderate cognitive impairment is a commonly encountered adverse effect but it normally resolves within hours. We report a case of post-ECT delirium lasting over a course of 14 days with succeeding sessions. Modification of ECT protocol by spacing the intervals of subsequent sessions and switching from bilateral brief pulse to unilateral ultra-brief pulse was found to be effective in reducing the confusion.
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Affiliation(s)
- Ahmad R Khan
- Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Hafsa Mahmood
- Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Saad Wasiq
- Psychiatry, University of Health Sciences, Islamabad, PAK
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31
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Duxbury A, Smith I, Mair-Edwards B, Bennison G, Irving K, Hodge S, Anderson I, Weatherhead S. What is the process by which a decision to administer electroconvulsive therapy (ECT) or not is made? A grounded theory informed study of the multi-disciplinary professionals involved. Soc Psychiatry Psychiatr Epidemiol 2018; 53:785-793. [PMID: 29947858 PMCID: PMC6061435 DOI: 10.1007/s00127-018-1541-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To develop a grounded theory-informed model explaining the decision-making process professionals in multi-disciplinary teams go through in deciding whether to administer electroconvulsive therapy (ECT) or not. METHODS A grounded theory informed methodology was used to analyse the data offered by ten participants who had all been involved in the process of deciding if someone has ECT or not. RESULTS The core categories, described as 'layers' in this research, 'personal and professional identity'; 'subjective vs objective'; 'Guidelines or Clinical Instinct?'; 'Someone has to take Responsibility' and 'the decision in action', were constructed from the data. CONCLUSIONS The study describes a useful insight into the layers of the decision-making process that could be further considered in clinical settings. The model highlights the decision to give ECT that has many different layers including professional identity, how a person understands the evidence base, past experiences, and the amount of power they have in the process. The consultant psychiatrist and the patient were seen as holding most power in the process depending on whether the Mental Capacity Act (2005) or Mental Health Act (2007) was being followed. Patients were seen to experience a very different decision-making process dependant on the personal views of the professionals in relation to ECT.
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Affiliation(s)
- Anna Duxbury
- Department of Clinical Psychology, Lancaster University, Lancaster, UK
| | - Ian Smith
- Department of Clinical Psychology, Lancaster University, Lancaster, UK
| | | | | | - Kerry Irving
- Department of Clinical Psychology, Lancaster University, Lancaster, UK
| | - Suzanne Hodge
- Department of Clinical Psychology, Lancaster University, Lancaster, UK
| | - Ian Anderson
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen Weatherhead
- Department of Clinical Psychology, Lancaster University, Lancaster, UK.
- Department of Clinical Psychology, University of Liverpool, Room 2.12, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
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Wells K, Scanlan JN, Gomez L, Rutter S, Hancock N, Tuite A, Ho J, Jacek S, Jones A, Mehdi H, Still M, Halliday G. Decision making and support available to individuals considering and undertaking electroconvulsive therapy (ECT): a qualitative, consumer-led study. BMC Psychiatry 2018; 18:236. [PMID: 30041602 PMCID: PMC6056939 DOI: 10.1186/s12888-018-1813-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most controversial treatments in psychiatry. This controversy and diverse and often strongly held opinions can make decision making processes around ECT more complex. METHOD This consumer-led project explored the experiences of individuals who had received ECT in terms of the information they received, their experience of ECT and suggestions for ways that decision making processes and experiences of ECT can be improved. Interviews were conducted by consumer researchers who had also received ECT and transcripts were analysed using constant comparative techniques. RESULTS Seventeen individuals participated. Four overarching categories were identified from participant interviews: Information matters; Preparation and decisions before ECT; Experience of ECT; and Suggestions for improvement. Most participants suggested that more information was required and that this information should be made available more regularly to support decision making. Additional suggestions included greater involvement of family and friends (including having a family member or friend present during the ECT procedure), opportunities to gain information from individuals who had received ECT and more support for managing memory and cognitive side effects. CONCLUSION This study provides valuable consumer-provided insights and recommendations for psychiatrists and mental health clinicians working within ECT clinics and with consumers considering or preparing for ECT.
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Affiliation(s)
- Karen Wells
- New Horizons Inc, Ashfield, Australia. .,The University of Sydney, Faculty of Health Sciences, PO Box 170, Lidcombe, NSW, 1825, Australia.
| | - Justin Newton Scanlan
- 0000 0004 1936 834Xgrid.1013.3The University of Sydney, Faculty of Health Sciences, PO Box 170, Lidcombe, NSW 1825 Australia ,Sydney Local Health District, Mental Health Services, Concord, Australia
| | | | | | - Nicola Hancock
- 0000 0004 1936 834Xgrid.1013.3The University of Sydney, Faculty of Health Sciences, PO Box 170, Lidcombe, NSW 1825 Australia
| | | | - Joanna Ho
- Sydney Local Health District, Mental Health Services, Concord, Australia
| | - Sarah Jacek
- Sydney Local Health District, Mental Health Services, Concord, Australia
| | - Andrew Jones
- Sydney Local Health District, Mental Health Services, Concord, Australia
| | - Hassan Mehdi
- Sydney Local Health District, Mental Health Services, Concord, Australia
| | - Megan Still
- Sydney Local Health District, Mental Health Services, Concord, Australia
| | - Graeme Halliday
- Sydney Local Health District, Mental Health Services, Concord, Australia
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Anderson IM. Does electroconvulsive therapy damage the brain? Lancet Psychiatry 2018. [PMID: 29523430 DOI: 10.1016/s2215-0366(18)30084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ian M Anderson
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, M13 9PT, UK.
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Seniuk P. I'm shocked: informed consent in ECT and the phenomenological-self. LIFE SCIENCES, SOCIETY AND POLICY 2018; 14:5. [PMID: 29442207 PMCID: PMC5811419 DOI: 10.1186/s40504-018-0068-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Abstract
This paper argues that phenomenological insights regarding selfhood are relevant to the informed consent process in the treatment of depression using electro-convulsive therapy (ECT). One of the most significant side-effects associated with ECT is retrograde amnesia. Unfortunately, the current informed consent model does not adequately appreciate the full extent in which memory loss disturbs lived-experience. Through the philosophy of Merleau-Ponty, it is possible to appreciate the way in which memory loss affects a person's self-experience, with emphasis given to one's pre-reflective and embodied, relationship with things in the world. This paper aims to demonstrate that proper informed consent should acknowledge the extent to which repeated ECT treatments affect a patient's sense self.
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Affiliation(s)
- Patrick Seniuk
- Södertörn University, Stockholm, Sweden.
- Centre for Studies in Practical Knowledge, School of Culture and Education, Alfred Nobels allé 7, 141 81, Huddinge, Sweden.
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Maran S, Raghavan V, Gopal S, Karpagavalli, Tharoor H. A 5-year descriptive study of electroconvulsive therapy at SCARF. Asian J Psychiatr 2017; 30:107-108. [PMID: 28869921 DOI: 10.1016/j.ajp.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sindhu Maran
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - Vijaya Raghavan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India.
| | - Subhashini Gopal
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - Karpagavalli
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
| | - Hema Tharoor
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu 600101, India
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Read J, Arnold C. Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009. ETHICAL HUMAN PSYCHOLOGY AND PSYCHIATRY 2017; 19:5-23. [DOI: 10.1891/1559-4343.19.1.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Background:A 2010 review of studies, previous reviews and meta-analyses found minimal evidence that electroconvulsive therapy (ECT) for depression was more effective than placebo during the treatment period and no evidence at all of efficacy beyond the end of treatment. The current review explored whether any contradictory evidence has since been generated.Method:MEDLINE and PsycINFO were searched to identify all post-2009 studies that had compared ECT and simulated ECT for depression, or had in any other way generated valid depression data for ECT recipients at two or more points in time.Results:Ninety-one studies met inclusion criteria. There were no new placebo-controlled trials. There have now been no such studies since 1985. Only 4 placebo-controlled studies have ever produced data beyond the end of treatment, none of which have found any advantage for ECT over placebo. Of the 91 studies, only 2 aimed to evaluate the efficacy of ECT. Both were severely flawed. None of the other 89 produced robust evidence that ECT is effective for depression, primarily because at least 60% maintained ECT participants on medication and 89% produced no meaningful follow-up data beyond the end of treatment. No studies investigated whether ECT prevents suicide.Conclusions:There is still no evidence that ECT is more effective than placebo for depression reduction or suicide prevention. Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.
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37
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In search of an evidence-based role for psychiatry. Future Sci OA 2016; 2:FSO101. [PMID: 28031948 PMCID: PMC5137842 DOI: 10.4155/fsoa-2015-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 12/27/2022] Open
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Rosenquist PB, McCall WV, Youssef N. Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed? J Psychosoc Nurs Ment Health Serv 2016; 54:39-43. [DOI: 10.3928/02793695-20161208-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bracken P, Giller J, Summerfield D. Primum non nocere. The case for a critical approach to global mental health. Epidemiol Psychiatr Sci 2016; 25:506-510. [PMID: 27522868 PMCID: PMC7137661 DOI: 10.1017/s2045796016000494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The Movement for Global Mental Health (MGMH) argues that there is a moral imperative that psychiatric treatments should be made available to all communities across the world. But psychiatric theories, categories and interventions emerged in the Western world are based on a set of assumptions about the nature of the self and society, nature and the supernatural, health and healing that are not universally accepted. In this paper we argue that there is a stronger moral case for caution with regard to the export of psychiatric thinking. Without a critical interrogation of such thinking the MGMH is at risk of doing a great deal of harm to the diverse, and sometimes fragile, systems of care that already exist across the world.
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Affiliation(s)
- P. Bracken
- Centre for Mental Health Care and Recovery, Bantry General Hospital, Bantry, Co Cork, Ireland
| | - J. Giller
- Centre for Mental Health Care and Recovery, Bantry General Hospital, Bantry, Co Cork, Ireland
| | - D. Summerfield
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
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Rosenquist PB, McCall WV, Youssef N. Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed? Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160927-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND The use of electroconvulsive therapy (ECT) is still very limited in Italy for ideological rather than scientific reasons. OBJECTIVES To describe the public controversies surrounding ECT in Italy and to propose a plan of action to resolve the dispute. METHODS We describe the historical background and the current public controversies about ECT by reviewing the official documents issued by the entities involved in the debate and by reporting our personal experiences of ECT practice. RESULTS According to the highest legal and health authorities, there are no ethical reasons for doubting the licit nature of ECT. However, because of politically and ideologically based conflicts, public ECT centers are still lacking. The situation could further deteriorate because local initiatives are endeavoring to criminalize and ban the treatment. CONCLUSIONS The enactment of specific regulations and guidelines concerning the use of ECT by the Italian government is highly warranted to increase the availability of the treatment. Education and information campaigns must strive to increase the knowledge of health professionals and the lay public regarding the safe and beneficial use of ECT.
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42
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Burstow B. Recruitment for Psychiatric Treatment Trials. JOURNAL OF HUMANISTIC PSYCHOLOGY 2016. [DOI: 10.1177/0022167815594546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article is about ethics, specifically, the myriad of unethical practices characterizing recruitment for psychiatric trials. Using a case study approach, honing on recruitment material, and examining the typical, the author explores recruitment in two studies—one involving electroconvulsive therapy, the other, a psychiatric drug. The bulk of the article is on these trials. The ethical problems which surface include minimization of risk; euphemism; lack of transparency; false and misleading claims, unfair inducement; failure to mention most of the common and serious negative effects; and a predatory quality. The author also identifies some worrisome new trends. Of special interest to the humanistic counselor is the attempt to implicate people’s own counselors and therapists in recruitment. The article ends with reflections on the onus that such practices place on all practitioners striving to be ethical. The author concludes that it is critical that counselors and therapists not be complicit and beyond that they take it on themselves to confront and expose. Concrete practice suggestions include adopting an explicit policy against such referrals, alerting any clients who may be considering such trials of the danger, and countering false claims.
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Telegdy G, Kovács AK, Rákosi K, Zarándi M, Tóth GK. Antiamnesic properties of analogs and mimetics of the tripeptide human urocortin 3. Amino Acids 2016; 48:2261-6. [PMID: 27262310 DOI: 10.1007/s00726-016-2268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/27/2016] [Indexed: 11/29/2022]
Abstract
Amnesia is a deficit in memory caused by brain damage, disease, or trauma. Until now, there are no successful medications on the drug market available to treat amnesia. Short analogs and mimetics of human urocortin 3 (Ucn 3) tripeptide were synthetized and tested for their action against amnesia induced by eletroconvulsion in mice. Among the 16 investigated derivatives of Ucn 3 tripeptide, eight compounds displayed antiamnesic effect. Our results proved that the configuration of chiral center of glutamine does not affect the antiamnesic properties. Alkyl amide or isoleucyl amide at the C-terminus may lead to antiamnesic compounds. As concerned the N-terminus, acetyl, Boc, and alkyl ureido moieties were found among the active analogs, but the free amino function at the N-terminus usually led to an inactive derivatives. These observations may lead to the design and synthesis of small peptidomimetics and amino acid derivatives as antiamnesic drug candidates, although the elucidation of the mechanism of the action requires further investigations.
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Affiliation(s)
- Gyula Telegdy
- Department of Pathophysiology, University of Szeged, Semmelweis u. 1, Szeged, 6725, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, University of Szeged, Semmelweis u. 1, Szeged, 6725, Hungary
| | - Anita Kármen Kovács
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary
| | - Kinga Rákosi
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary
| | - Márta Zarándi
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary
| | - Gábor K Tóth
- Department of Medical Chemistry, University of Szeged, Dóm tér 8, Szeged, 6720, Hungary.
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Pourafkari N, Pourafkari L, Nader ND. Electroconvulsive therapy for depression following acute coronary syndromes: a concern for the anesthesiologist. J Clin Anesth 2016; 31:223-8. [DOI: 10.1016/j.jclinane.2016.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/28/2016] [Indexed: 01/28/2023]
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Abstract
Electroconvulsive therapy (ECT) has demonstrated to be highly effective and safe, even life saving for many psychiatric disorders such as major depression, bipolar disorder and schizophrenia. Most patients who require ECT are also on concurrent pharmacotherapy. As such, the objective of this article is to provide a review of the most recent literature focusing on the medications used during an ECT procedure and on the effects of concurrent psychiatric and non-psychiatric medications on the effectiveness and safety of ECT. The review also attempts to summarize the recommendations derived from existing documents to guide pharmacotherapy decisions for patients undergoing ECT. For this purpose, using electronic databases, an extensive search of the current literature was made using ECT and medications or drug classes as keywords.
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Affiliation(s)
- Monica Zolezzi
- Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar
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Wand T. Recovery is about a focus on resilience and wellness, not a fixation with risk and illness. Aust N Z J Psychiatry 2015; 49:1083-4. [PMID: 26494848 DOI: 10.1177/0004867415614107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Timothy Wand
- University of Sydney and Sydney Local Health District, Royal Prince Alfred Hospital, NSW, Australia
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47
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Essali A, Al-baroudi B, Jaber B, Al Mukhallalati A, Gillies D. Unilateral electroconvulsive therapy versus bilateral electroconvulsive therapy for schizophrenia. Hippokratia 2015. [DOI: 10.1002/14651858.cd011933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Adib Essali
- Waikato District Health Board; Manaaki Centre; crn Rolleston and Mary Streets Thames New Zealand 3575
| | - Bilal Al-baroudi
- Damascus University; Faculty of Medicine; Mezzah Autostrade Damascus Syrian Arab Republic PO Box 7583
| | - Basem Jaber
- Faculty of Medicine, Damascus University; Mezzah Autostrade Damascus Syrian Arab Republic PO Box 7583
| | - Amr Al Mukhallalati
- Faculty of Medicine, Damascus University; Mezzah Autostrade Damascus Syrian Arab Republic PO Box 7583
| | - Donna Gillies
- Western Sydney Local Health District - Mental Health; Cumberland Hospital Locked Bag 7118 Parramatta NSW Australia 2124
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Cox N, Webb L. Poles apart: does the export of mental health expertise from the Global North to the Global South represent a neutral relocation of knowledge and practice? SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:683-697. [PMID: 25683600 DOI: 10.1111/1467-9566.12230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The World Health Organization's Mental Health Action Plan 2013-2020 identifies actions for all member states to alleviate the global burden of mental ill health, including an obligation for mental healthcare to be delivered in a 'culturally appropriate' manner. In this article we argue that such a requirement is problematic, not least because such pronouncements remain framed by the normative prepositions of Western medical and psychological practice and their associated ethical, legal and institutional standpoints. As such, when striving to export Western mental health expertise, different paradigms for evidence will be necessary to deliver locally meaningful interventions to low and middle income countries. Our discussion highlights a number of philosophical concerns regarding methodologies for future research practice, including those relating to representation and exclusion in the guise of epistemic injury, presumptive methodologies arising from Western notions of selfhood, and related ethical issues.
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Affiliation(s)
- Nigel Cox
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, UK
| | - Lucy Webb
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, UK
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Abstract
A strong placebo response in psychiatric disorders has been noted for the past 50 years and various attempts have been made to identify predictors of it, by use of meta-analyses of randomised controlled trials and laboratory studies. We reviewed 31 meta-analyses and systematic reviews of more than 500 randomised placebo-controlled trials across psychiatry (depression, schizophrenia, mania, attention-deficit hyperactivity disorder, autism, psychosis, binge-eating disorder, and addiction) for factors identified to be associated with increased placebo response. Of 20 factors discussed, only three were often linked to high placebo responses: low baseline severity of symptoms, more recent trials, and unbalanced randomisation (more patients randomly assigned to drug than placebo). Randomised controlled trials in non-drug therapy have not added further predictors, and laboratory studies with psychological, brain, and genetic approaches have not been successful in identifying predictors of placebo responses. This comprehensive Review suggests that predictors of the placebo response are still to be discovered, the response probably has more than one mediator, and that different and distinct moderators are probably what cause the placebo response within psychiatry and beyond.
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50
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DeJong H, Bunton P, Hare DJ. A systematic review of interventions used to treat catatonic symptoms in people with autistic spectrum disorders. J Autism Dev Disord 2014; 44:2127-36. [PMID: 24643578 DOI: 10.1007/s10803-014-2085-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A systematic review was conducted to examine the efficacy of a range of treatments for autistic catatonia. The review identified 22 relevant papers, reporting a total of 28 cases including both adult and paediatric patients. Treatment methods included electroconvulsive therapy (ECT), medication, behavioural and sensory interventions. Quality assessment found the standard of the existing literature to be generally poor, with particular limitations in treatment description and outcome measurement. There is some limited evidence to support the use of ECT, high dose lorazepam and behavioural interventions for people with autistic catatonia. However, there is a need for controlled, high-quality trials. Reporting of side effects and adverse events should also be improved, in order to better evaluate the safety of these treatments.
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Affiliation(s)
- Hannah DeJong
- Division of Clinical Psychology, University of Manchester, 2nd Floor, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK,
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