Electroconvulsive Therapy

Even with the rise of newer neuropsychiatric brain stimulation methods, electroconvulsive therapy (ECT) remains a widely used treatment for severe mental illness--and perhaps the most effective for serious mental illness. Optimal treatment requires that psychiatrists be skilled in diagnosis and familiar with the techniques of treatment. That's where Principles and Practice of Electroconvulsive Therapy comes in. With its up-to-date, comprehensive coverage of all aspects of ECT, this is an unrivaled resource for psychiatrists, whether in practice or still in training, striving for maximum treatment efficacy. The book begins with an overview of what ECT is and how it is carried out, followed by a brief history of the therapy, from its earliest applications to its use in modern times. The guide follows the typical course of treatment, discussing the following: - Understanding the indications for ECT and selecting patients who might benefit from this therapy--whether they suffer from depression, mania, schizophrenia, or catatonia- Educating patients and their families on ECT and obtaining patient consent- Conducting a pretreatment medical evaluation and understanding the role of anesthesia- Managing an individual ECT treatment, including choosing the electrical stimulus dose and parameter combination, delivering the electrical stimulus, assisting with recovery problems, etc.- Overseeing the course of treatments, particularly for practitioners not personally conducting the treatments- Managing patients after a course of treatments and preventing relapse- Assessing and managing the memory side effects of ECT The final chapter examines other neuropsychiatric stimulation therapies in relation to ECT and explains how to choose among them. All chapters conclude with easily referenced key points that summarize the most salient ideas. Readers seeking to further educate themselves on ECT will also benefit from the exhaustive reference list. Though particularly useful for psychiatrists and psychiatric residents, Principles and Practice of Electroconvulsive Therapy, with its straightforward style, is a ready resource for any mental health or medical professionals interested in ECT.

Enthusiastically defending the controversial use of electroconvulsive "therapy" (ECT), Abrams (psychiatry, Chicago Medical School), the director of a firm that manufactures ECT devices, reviews the practice and its literature. He briefly discusses the history of ECT and then outlines current practice and addresses the use of unilateral versus bitemporal ECT. He argues against the studies that find ECT to be a dangerous and unhelpful procedure. A final chapter considers ethical and legal issues, finding that doctors who refuse to subject patients to electroshock are behaving unethically and that malpractice suits are a relatively minor problem. Annotation copyrighted by Book News, Inc., Portland, OR.

Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. In this book, Edward Shorter and David Healy trace the controversial history of ECT and other "shock" therapies. Drawing on case studies, public debates, extensive interviews, and archival research, the authors expose the myths about ECT that have proliferated over the years. By showing ECT's often life-saving results, Shorter and Healy endorse a point of view that is hotly contested in professional circles and in public debates, but for the nearly half of all clinically depressed patients who do not respond to drugs, this book brings much needed hope.

Since the development of pharmacoconvulsive therapy in 1934 and of electroconvulsive therapy (ECT) in 1938, ECT has proven far more valuable than just the intervention of last resort. In comparison with psychotropic medications, we now know that ECT can act more effectively and more rapidly, with substantial clinical improvement that is often seen after only a few treatments. This is especially true for severely ill patients -- those with severe major depression with psychotic features, acute mania with psychotic features, or catatonia. For patients who are physically debilitated, elderly, or pregnant, ECT is also safer than psychotropic medications. The findings of the American Psychiatric Association (APA) Task Force on ECT were published by the APA in 1990 as the first edition of The Practice of Electroconvulsive Therapy, inaugurating the development of ECT guidelines by groups both within the United States and internationally. Since then, advances in the use of this technically demanding treatment prompted the APA to mandate a second edition. The updated format of this second edition presents background information followed by a summary of applicable recommendations for each chapter. This close integration of the recommendations with their justifications makes the material easy to read, understand, and use. To further enhance usability, recommendations critical to the safe, effective delivery of treatment are marked with the designation "should" to distinguish them from recommendations that are advisable but nonessential (with the designations "encouraged," "suggested," "considered"). The updated content of this second edition, which spans indication for use of ECT, patient evaluation, side effects, concurrent medications, consent procedures (with sample consent forms and patient information booklet), staffing, treatment administration, monitoring of outcome, management of patients following ECT, and documentation, as well as education, and clinical privileging. This volume reflects not only the wide expertise of its contributors, but also involved solicitation of input from a variety of other sources, including applicable medical professional organizations, individual experts in relevant fields, regulatory bodies, and major lay mental health organizations. In addition, the bibliography of this second edition is based upon an exhaustive search of the clinical ECT literature over the past decade and contains more than four times the original number of citations. Complemented by extensive annotations and useful appendixes, this remarkably comprehensive yet practical overview will prove an invaluable resource for practitioners and trainees in psychiatry and related disciplines.

This pioneering book is the first book of its kind and offers guidance about the use of ECT in youth with up-to-date and concise information. The editors, Neera Ghaziuddin MD, MRCPsych (University of Michigan, Ann Arbor, USA), and Garry Walter, MD, PhD (University of Sydney, Australia), have spearheaded the re-introduction of ECT as a safe and an effective treatment option for a subgroup of children and adolescents with severe psychiatric disorders. This book offers a review of the existing literature, firsthand experience of the authors who are regarded as experts in their respective field, and highly informative case descriptions. The book also offers a historical perspective, explaining the reasons why ECT fell out of favor, particularly among child and adolescent psychiatrists, and the resulting lost opportunity to train clinicians over many decades. Starting around the 1990's, there has been a revival of interest, probably due to the recognition of treatment resistance among some adolescents. The chapter about the mechanism of action ECT describes biological mechanisms that are known to underlie mental illness. Other chapters include a discussion about stigma associated with ECT, ethical and informed consent issues, a step-by-step guidance about using ECT, use of anesthesia during ECT and the interaction between ECT and medications. In addition, its use in youth with general medical and neurological disorders is described. The chapter detailing side effects of the treatment dispels misinformation and indicates that ECT is a safe, painless and a highly effective procedure which is not associated with any lasting side effects. The use of ECT in the treatment of specific disorders (mood and psychotic disorders, severe self-injury and catatonia) is described under respective chapters using case examples. Lay readers, families and patients considering this treatment will find the question and answer subsections at the end of each chapter useful. The experience of the editors gives a unique insight to ECT, dispelling myths and stigma and guides the reader about its proper use.

Few mental illness treatments are more reviled in the public mind than Electroconvulsive Shock Therapy. However, in reality, ECT is a safe and effective treatment for cases of clinical depression and catatonia that are unresponsive to drug therapy. Also, unlike drugs, ECT has relatively few side effects. The authors argue that it is time for this historically stigmatized procedure to be reevaluated. The authors make a strong case for greater professional and public attention to the procedure's benefits, offering historical coverage of ECT-related movements, legislation, public and practitioner sentiment and the introduction of competing treatments. This volume will not only garner the interest of mental health professionals, but will call on policy makers and ethicists to examine its arguments.

Electroconvulsive Therapy is widely demonized or idealized. Some detractors consider its very use to be a human rights violation, while some promoters depict it as a miracle, the "penicillin of psychiatry." This book traces the American history of one of the most controversial procedures in medicine, and seeks to provide an explanation of why ECT has been so controversial, juxtaposing evidence from clinical science, personal memoir, and popular culture. Contextualizing the controversies about ECT, instead of simply engaging in them, makes the history of ECT more richly revealing of wider changes in culture and medicine. It shows that the application of electricity to the brain to treat illness is not only a physiological event, but also one embedded in culturally patterned beliefs about the human body, the meaning of sickness, and medical authority.

Electroconvulsive Therapy (ECT) remains one of the most effective forms of neurostimulation for severe mental illness. Sound scientific research underpins contemporary practice challenging the complex history and stigma that surround this treatment. The Electroconvulsive Therapy Workbook integrates the history of ECT with major advances in practice, including ultrabrief ECT, in a hands-on workbook format. Novel forms of neurostimulation are reviewed, highlighting the future directions of practice in this exciting area. The book is also richly illustrated with historical and technical images and includes ‘clinical wisdom’ sections that provide the reader with clinical insights into ECT practice. Online eResources are also available, featuring a wide range of questions and answers related to each chapter to help test and consolidate readers’ understanding of ECT, as well as regionally specific legislation governing ECT practice in Australia and New Zealand. This comprehensive introduction to ECT is a must-read for doctors in training, psychiatrists who require credentialing in this procedure, anaesthetists, nursing staff who work in ECT and other professionals who have an interest in ECT as well as consumer and carer networks.