Ethics In Electroconvulsive Therapy

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.

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.

In this book, recognized anesthesiology experts present the latest findings on anesthesia for electro-convulsive therapy (ECT). With the development of modified electroconvulsive therapy (m-ECT) and devices to provide brief-pulse stimulation, ECT is currently being re-evaluated as an important procedure in psychiatric disorder therapy and is increasingly being used worldwide to treat several psychiatric conditions. This trend is due to the social phenomenon of the growing number of patients for whom ECT is applicable. Since the new approach is more safe and effective than the original method without anesthesia, m-ECT is currently applied under general anesthesia in most advanced countries. This book provides an overview and practice of total anesthesia management in the perioperative period of ECT. It offers an indispensable resource not only for professional anesthesiologists but also healthcare professionals who use this therapy.

This book is an attempt to address the ethical issues raised by mental illness and its treatment by focusing on the question of autonomy. The mentally ill may be regarded as non-autonomous by virtue of irrationality, which may result in treatment models which deny them a voice. As a counter to this, some have moved to the other extreme and argued that the mentally ill must be regarded as fully autonomous in all circumstances, and consequently that all their wishes regarding treatment must be respected. This book examines the ethical consequences of such simplistic approaches towards autonomy and mental illness, and considers the ethical issues raised by specific forms of treatment. It is suggested in conclusion that improvement in the care and treatment of the mentally ill requires not only a fundamental change in social attitudes but also a less impoverished conception of autonomy than some of those currently employed.

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.

Ethics in Psychiatry: (1) presents a comprehensive review of ethical issues arising in psychiatric care and research; (2) relates ethical issues to changes and challenges of society; (3) examines the application of general ethics to specific psychiatric problems and relates these to moral implications of psychiatry practice; (4) deals with recently arising ethical problems; (5) contains contributions of leading European ethicists, philosophers, lawyers, historians and psychiatrists; (6) provides a basis for the exploration of culture-bound influences on morals, manners and customs in the light of ethical principles of global validity.

Struck by Living, originally published in 2010, is a story about me, Julie Kosnik Hersh, my experience with electroconvulsive therapy (ECT), and management of depression. This new version includes a prologue detailing the strange series of events this book spurred, as well as a wellness list in the back. On the original book tour, I decided it was too depressing to just talk about my depression, so I talked about how I stayed well too. People scribbled down these ideas like gospel, which they aren’t. They are common-sense ideas I’ve learned from years of psychotherapy, my own reading, and talking to people about this topic. I’ve included these ideas in this new edition so people don’t have to scribble. I love to read, so I wrote this book like a novel, instead of like a self-help book. I’m not a fan of self-help books as most of them claim to be “the answer.” The older I get, the more I realize how little I know. I do know there is no single answer for managing mental illness. This is a life-long task, where we all have to figure out our own quirks and how to manage them. If my story can help you figure this out—great. Each time I speak about my experience, I find people are often one step removed from the devastation of mental illness or even suicide. Stories about mothers, fathers, brothers, sisters, spouses, and children all make me wonder: Could we have stopped those deaths? If we are more aware, can we see the signs earlier and save a life? ​I think we can. In that belief, I offer my story. Proceeds from this book will be donated to programs and research to battle mental illness.

Consideration of ethics has established a firm place in the affairs of psychiatrists. An increased professional commitment to accountability, together with a growing "consumer" movement has paved the way for a creative engagement with the ethical movement. Psychiatric Ethics has carved out a niche for itself as a major comprehensive text and core reference covering the many complex ethical dilemmas which face clinicians and researchers in their everyday practice. This new edition takes a fresh look at recent trends and developments at the interface between ethics and psychiatric practice.For this edition, Sydney Bloch and Paul Chodoff are joined by Stephen Green, a clinical professor in ethics and psychiatry at Georgetown University, in leading 29 of the finest scholars in the field from around the world. Eleven new contributors join the team of authors. They include Drs. Beauchamp, Gutheils, Sabin, McGuffin, Szmulter, Gabbard and Holmes. Since the second edition, the editors have observed several emerging aspects of psychiatric practice requiring coverage. As a result, six new chapters have been added covering the ethical aspects of community psychiatry, managed care, psychiatric genetics, resource allocation, codes of ethics and boundary violations. All others chapters have been fully revised and updated.The book will continue to be essential reading for psychiatrists and other mental health professionals, as well as of interest to ethicists, policy makers, managers and lawyers.