Experience Of Electroconvulsive Therapy Research Articles

Attitude regarding electroconvulsive therapy among psychiatric patients

IntroductionElectroconvulsive therapy (ECT) is one of the few non-pharmacological stimulation treatment which is cost effective, effecious and lifesaving in various psychiatric disorders. Although myths and misconceptions prevailed in a society undermine the usefulness of such treatment.ObjectivesAttitude towards Electroconvulsive therapy (ECT) among psychiatric patients.Methods It was a descriptive cross-sectional study conducted at the Department of Psychiatry and Behavioural sciences, Jinnah Postgraduate Medical Centre (JPMC), Karachi from 22-Oct-2019 to 21-April-2020 and a total of 250 psychiatric patients were enrolled.Methode; Attitudes toward ECT were assessed using ECT attitude questionnaire6 (Annexure III). A 15 items questionnaire, each item has three alternatives based on which responses were categorized into positive, negative, or ambivalent attitudes. Mean score was calculated for each.Patients who were given 8 positive answers out of 15 were labeled as having a positive attitude. Patients who were given 8 negative answers out of 15 were labeled as having a negative attitude. Patients who were given 8 I don’t know answers out of 15 were labeled as having ambivalent attitude.Inclusion CriteriaAge 18-65 yearsEither genderPsychiatric patients, having awareness regarding their nature of illness and could give consent for study.Patients with duration of illness >3 months.Exclusion CriteriaPsychiatry patients who have no awareness regarding their illness.Patients with impaired cognitiveResultsForty-four (45.83%) patients had positive attitude, 36 (37.50%) had negative attitude and 16 (16.67%) had ambient attitude. Further stratification was also performed on the basis of educational status, occupational status, duration of illness, psychiatric diagnosis, and previous experience of ECT. There was no significant association was found of these variables with attitude regarding ECT.Mean age was 39.58±12.48 years included in this study. There were 55 (57.29%) female and 41 (41.71%) male patients. There were 72 (75.00%) patients were household workers, 04 (4.17%) students, 06 (5.25%) unskilled labour, 3 (3.13%) skilled labour, 10 (10.42%) professionals and just 01 (1.04%) were law enforcement worker. 19 (19.79%) patients were diagnosed with schizophrenia, 62 (64.58%) were diagnosed with unipolar depression and 15 (15.63%) were diagnosed with bipolar disorder. Source of ECT information was 11 (11.46%) electronic media, 09 (9.38%) print media, 19 (19.79%) social media and 57 (59.38%) was from health professionals. Forty-four (45.83%) patients had positive attitude, 36 (37.50%) had negative attitude and 16 (16.67%) had ambient attitude.ConclusionsKnowledge regarding electroconvulsive therapy (ECT) was low in psychiatric patients in Pakistan. Only 45.83% patients showed positive attitude towards ECT.Reference(s)Carney S, Geddes J. Electroconvulsive therapy. Br Med J. 2003;326:1343-4Gangadhar BN., Kapur RL., Kalyanasundaram S. Comparison of electroconvulsive therapy with imipramine in endogenous depression: a double blind study. Br J Psychiatry.1982;141:367–71.Kellner CH., Fink M., Knapp R., Petrides G., Husain M., Rummans T., et al. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry. 2005;162:977–82.Baghai T C, Moller HJ. Electroconvulsive therapy and its different indications. Dialogues Clin Neurosci. 2008 Mar; 10(1): 105–17.Weiner RD., Coffey CE., Folk J., Fochtmann LJ., Greenberg RM., et al. American psychiatric association committee on electroconvulsive therapy, The practice of electroconvulsive therapy. 2nd ed. Washington, DC: American Psychiatric Association; 2001Disclosure of InterestNone Declared

‘The Great Oblivion’—An Autoethnographic Depiction of Social and Personal Recovery After Electro-convulsive Therapy (ECT)

Abstract This article aims to shed light on cognitive disabilities after electroconvulsive therapy (ECT) from an expert-by-experience perspective. It illuminates the living conditions that may follow, with a particular focus on epistemic injustice, societal attitudes, narration and recovery. Since personal narratives about ECT are scant, an autoethnographic method was used through which I weave together my own experiences of ECT and the need for support from, for example, social services, with research in various nearby areas. These experiences were then placed in a wider psycho-social context. Three themes emerged when analysing own experiences of ECT, revealing both risks and important aspects of managing side effects such as cognitive disabilities: (i) At the social services office; (ii) Alienation in society; and (iii) Excerpt from a friendly conversation. Subjective experiences may broaden the understanding of a certain phenomenon which calls for greater (societal) knowledge regarding cognitive disabilities after ECT. It also emphasises the importance of different professionals, including social workers and psychiatric staff, working to promote recovery, legitimise users’ narratives and not seeing disabilities as given obstacles in everyday life.

Attitudes Toward Electroconvulsive Therapy Among Involuntary and Voluntary Patients.

We aimed to examine attitudes toward electroconvulsive therapy (ECT) among involuntary patients, voluntary patients, and their relatives. Patients experiencing a major depressive episode and receiving ECT and their relatives were recruited for the survey. Patients and their relatives answered the self-rating questionnaires with a 7-point Likert scale. We explored differences in the survey results between involuntary and voluntary patients, as well as differences in the survey results between patients and their relatives. We recruited 97 participants (53 patients and 44 relatives) for the survey. Approximately 80% of the patients showed positive attitudes toward ECT. There were no statistically significant differences between involuntary (n = 23) and voluntary (n = 30) patients across multiple aspects of the ECT experience, including treatment satisfaction, positive or adverse effects of ECT, and treatment preference in the future. Relatives were more satisfied with the positive effects of ECT and with the information offered before ECT treatment than the patients themselves. Approximately 80% of the patients showed overall satisfaction with ECT irrespective of consent status. Relatives were more satisfied with ECT than patients. Electroconvulsive therapy can be a lifesaving treatment for severely depressed patients, and the subjective experience of involuntary patients should be taken into consideration when discussing involuntary ECT treatment.

Decision making and support available to individuals considering and undertaking electroconvulsive therapy (ECT): a qualitative, consumer-led study

BackgroundElectroconvulsive 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.MethodThis 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.ResultsSeventeen 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.ConclusionThis 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.

The experience of electroconvulsive therapy and its impact on associated stigma: A meta-analysis.

Despite its efficacy and safety, electroconvulsive therapy (ECT) is underutilized, in part due to stigma associated with the treatment. The aim of this study was to test the hypothesis that experiencing ECT has an impact on associated stigma, as measured by patient and family knowledge of and attitudes toward ECT. A comprehensive literature search was conducted using MEDLINE, EMBASE and PsycINFO. Studies with cross-sectional and/or longitudinal designs were identified. Studies were further categorized into subcategories based on participant type (patients or patient family members) and outcome domain (knowledge or attitudes). Effect size (Cohen's d) was calculated for each study and then integrated into each subcategory (participant type by outcome domain) using a random effect model. Eight studies were identified as being eligible for analysis. Two studies were cross-sectional, five were longitudinal and one incorporated both designs. Analysis of the longitudinal studies indicated that experiencing ECT both increased knowledge of and improved attitudes toward ECT in patients; in family members of patients, analysis showed significant positive change in knowledge of ECT, but no significant change in attitudes toward ECT. Experience with ECT may have a positive impact on knowledge of and attitudes toward ECT. However, the quality of evidence of included studies was low; further research is required in order to clarify the relationship and to identify information of use to individuals considering ECT as a treatment option.

Electroconvulsive Therapy in Italy: Will Public Controversies Ever Stop?

The use of electroconvulsive therapy (ECT) is still very limited in Italy for ideological rather than scientific reasons. To describe the public controversies surrounding ECT in Italy and to propose a plan of action to resolve the dispute. 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. 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. 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.

First experience of electroconvulsive therapy in Belarus

Electroconvulsive therapy (ECT) – a method of psychiatric and neurological treatment in which a large epileptiform seizure caused by passing an electric current through the brain of the patient in order to achieve a therapeutic effect. Clinical research of efficiency of application ECT with anesthesia, muscle relaxation and hardware analysis of EEG in patients with resistant forms of mental and behavioral disorders was held in the Republic of Belarus. The duration of the course of ECT, the frequency of sessions, as well as the method of applying electrodes for stimulation were determined by the doctor conducting the sessions of ECT. Sessions were conducted with general anesthesia with the use of muscle relaxants. Analysis of EEG data (Average Seizure Energy Index [ASEI]; Postictal Suppression Index [PSI]; COH–Maximum Sustained Coherence), on the basis of which the dose of stimulation was corrected, was conducted to assess the duration and quality of convulsive seizure during ECT. Significant clinical improvement in patients who underwent ECT sessions was achieved as a result of the study. Application of the method allowed to achieve persistent clinical remission in a short time. The clinical study showed that the use of ECT with anesthesia, muscle relaxation and hardware analysis of the EEG in the Republic of Belarus may be effective against drug-resistant forms of mental and behavioral disorders.

Teaching Therapeutic Seizure Criteria to Psychiatrists

Following on from our previous work looking at the interrater reliability of assessing seizure adequacy for electroconvulsive therapy (ECT), we sought to examine whether a specific teaching module could improve the reliability of visual inspection of electroencephalography (EEG) recordings for specific features of seizure length, presence of polyspike, δ wave activity, and post-ictal suppression. Twelve medical practitioners at varying levels of training and ECT experience rated 15 EEG traces after minimal training and a further set of 15 EEG traces after a more detailed training. Results were analyzed to examine the interrater reliability of the EEG features and the overall assignment of traces as meeting "old" (1995) or "new" (2005) Royal College of Psychiatrists criteria for therapeutic seizures compared with the agreed ratings of 2 experienced ECT practitioners ("standard ratings"). There was evidence for a specific training effect for the "old" criteria with an improvement in the interrater reliability (generalized κ, 0.590 vs 0.813) associated with a significantly better estimation of seizure length as assessed by comparison of the root mean square difference from the standard ratings (mean, 7.83 vs 4.49; P < 0.003). The interrater reliability for the new criteria did not improve (generalized κ, 0.599 vs 0.581) but was already at quite a good standard. Examination of individual features did demonstrate improvement in the rating of δ activity (generalized κ, 0.564 vs 0.655) and post-ictal suppression (generalized κ, 0.553 vs 0.611) after the training. When these 2 criteria were grouped together (δ suppression), interrater reliability was shown to be significantly improved after the training (generalized κ, 0.568 vs 0.659). Although not statistically significant, the participants reported that the training improved their confidence in using both criteria for therapeutic seizures (old: 49% vs 67%; new: 27% vs 48%). The reliability of assessments of seizure length, presence of δ activity, and post-ictal suppression can be measurably improved with a specific teaching module. Using the δ suppression criteria together with the accurate estimation of seizure length on EEG may have greater clinical utility when it comes to instructing trainees in ECT administration, assessment of therapeutic seizures, and developing protocols for dose adjustment.

Knowledge and Attitude of Patients with Psychiatric Disorders and their Relatives Toward Electroconvulsive Therapy.

Objective:Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives.Materials and Methods:Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives.Results:Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73).Conclusions:Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment.

I was told it restarts your brain: knowledge, power, and women’s experiences of ECT

Background: A discrepancy exists between clinician-led studies of people’s experience of electroconvulsive therapy (ECT) and consumer-led studies, with the former typically being much more positive about the efficacy and side effects of ECT compared with the latter. Qualitative in-depth explorations of people’s experiences of ECT are relatively rare, particularly those looking specifically at women’s experience of ECT.Aims: The aim of this qualitative study was to explore women’s experiences of ECT, particularly their experience of knowledge and power related to ECT.Results: Qualitative analysis of the interviews with nine women resulted in four main themes emerging from the interviews with the women: (i) “he really didn’t say much,” (ii) “I’m going to be very upset with you,” (iii) “I was just desperate,” and (iv) “it was like we were cattle.”Conclusions: Overall, participants found their experiences with ECT to be quite negative, and characterized by a lack of knowledge during the procedure, and a lack of power throughout the entire process.

The Electroconvulsive Therapy and Anesthesia Exercise (ECTAE)

Demonstration of the effectiveness for medical student teaching of the electroconvulsive therapy (ECT)-anesthesia exercise (ECTAE). The ECTAE is a self-directed, interdisciplinary (psychiatry and anesthesia) learning exercise. Students are taught the assessment of mood and cognition using structured interviewing methods (psychiatry), basic airway and pharmacologic management (anesthesia), and informed consent and interdisciplinary communication (both). There are online pre-exercise and postexercise assessments. Third-year medical students reviewed educational reference materials, participated in ECT clinical encounters with both psychiatry and anesthesia, and debriefed after completion of the interdisciplinary exercise. The impact of the exercise was evaluated through online pre- and postexercise assessments. Quantitative and qualitative results for 3 student cohorts (2007 through 2010) were analyzed. Thirty-eight students participated the study over 3 years. Mean scores for 21 true-false questions increased from 14.3 to 17.5 (n = 30) with P < 0.0001. Similarly, mean scores for 11 multiple choice questions increased from 6.8 to 8.9 (n = 22) with P < 0.0001. Thirty of 31 students who completed the program evaluation reported greater comfort level discussing and recommending ECT after participation in ECTAE. The ECTAE is an effective learning activity for medical students, which incorporates cross-disciplinary learning objectives through self-directed exercises, online assessments, and actual clinical experience of ECT. It improves student knowledge of both psychiatry and anesthesia learning objectives, as well as increasing comfort about ECT. Further research could determine if this activity is easily transportable to other academic settings.

1600 – Establishment of a regional register for neurstimulation treatment in the western part of norway

Introduction Electroconvulsive therapy (ECT) is a highly effective treatment option mainly in severe depression. ECTs longterm effects on cognitive function are currently unknown, limiting its use. Transcranial magnet stimulation (TMS), is considered less effective than ECT in treatment of severe depression, but is without cognitive side effects. TMS is studied to a less degree than ECT. Objectives There is a need of large scale studies of effect, side effects and patients’ subjective experience of ECT and TMS. Aims Generate data to better predict which patients will benefit from ECT and TMS by establishing a regional register including all patients referred to ECT and TMS as part of an ordinary clinical treatment practice in the western part of Norway. Methods All patients referred to ECT and TMS in Bergen and Stavanger will be asked to participate in the study. There are no exclusion criteria. Demographics and course of illness factors will be recorded before start of ECT. Severity of the depressive disorder and treatment effects will be evaluated with a mix of self evaluation and clinician administrated standardized rating instruments. There will be a follow up at 6 months. Date from the described register will be merged with other relevant central Norwegian health registers. Results We expect the described regional register to offer an opportunity to determine predictors for effect, side effects and subjective satisfaction of the treatments. Conclusion This register is investigator initiated, with the aim to investigate which patient will benefit from ECT and TMS without serious side effects.

Psychological factors related to the experience of and reaction to electroconvulsive therapy

BackgroundAside from the focus on satisfaction levels, psychological aspects of the experience of electroconvulsive therapy (ECT) have not traditionally been the focus of significant research. Given that clinical psychologists work closely with professionals involved in administering ECT, and have increasing involvement with decisions about ECT, there is a potential role for clinical psychologists in this area.AimsTo review the diverse sources of literature regarding how patients psychologically experience, and react to, ECT.MethodA literature search identified relevant published papers related to the patient experience of ECT. Reviewed articles included clinician and service user led research, comprising qualitative and quantitative research approaches and policy documents.ResultsPatients have multiple and diverse reactions to ECT. These can be considered under the themes of consent, fear, powerlessness, memory and identity. The experience of ECT can significantly impact on patients and this can have a negative long-term influence.ConclusionsClinical psychologists need to be actively involved in consent procedures, use clinical formulation to understand the perspective of patients, and empower patients to share their views of ECT with mental health professionals and service developers. Further research into how patients experience ECT, particularly using qualitative methods, is recommended.

Evidence‐based electroconvulsive therapy

Evidence‐based electroconvulsive therapy

Looking at ECT Through Different Lenses

Beginning with a paper by nurse researcher Marilyn Smith and her colleagues (2009) about the lived experience of electroconvulsive therapy (ECT), followed by a literature review in our April 2011 i...

ECT: An investigation of lay attitudes and experiences in an Irish sample.

Electroconvulsive therapy (ECT) is one of the most controversial psychiatric treatments of the modern era. Few studies have used validated scales to examine attitudes and knowledge regarding ECT in lay people. We examined attitudes, knowledge and experience of ECT using standardised questionnaires in Irish lay people, and compared the present results with the findings from a similar study reported over 25 years previously. A total of 103 lay people were recruited from a variety of settings and completed a questionnaire. Data were analysed using independent samples t-tests, χ2 tests and Pearson correlations. Attitudes to ECT among Irish lay people are negative and knowledge of the treatment is poor. A significant correlation (r = 0.32) was found between knowledge and attitudes, with higher levels of knowledge associated with more positive attitudes. People with relatives who experienced ECT had a significantly higher ECT knowledge than the people without such relatives (p < 0.05). Results confirmed previous findings and revealed novel statistically significant factors that contributed to attitudes towards ECT. Further replications are required to examine the findings' robustness and the relationship between attitudes, knowledge and experience. Such research can help increase the understanding of ECT and remove the stigmatisation associated with ECT. Mental health education programmes should consider the relation between knowledge and attitudes to better inform programme focus and content.

Does the Experience of Electroconvulsive Therapy Improve Awareness and Perceptions of Treatment Among Relatives of Patients?

Evidence suggests that the actual experience of electroconvulsive therapy (ECT) has a positive impact on perceptions regarding the treatment among patients and their relatives. This assumption was tested by comparing relatives of patients treated with ECT with those of patients treated by other means. Knowledge about and attitudes toward ECT were assessed using specifically designed questionnaires among 206 relatives of patients who were undergoing psychiatric treatment but had never received ECT (non-ECT group). The results were compared with those obtained among 77 relatives of patients who had undergone the treatment (ECT-treated group). The relatives of the ECT-treated group were more likely to have acquired their information about ECT from physicians, whereas relatives of the non-ECT group usually relied on the media for this purpose. The relatives who obtained their information from physicians were more aware and more positive about ECT than those who obtained their information from the media. Knowledge about ECT was greater among relatives of the ECT-treated group than those of the non-ECT group. The relatives of the ECT recipients had significantly more positive attitudes toward the treatment, whereas the relatives of the non-ECT group were more often either ambivalent about ECT or critical of the treatment. Although the groups differed on certain clinical and demographic variables, these differences were unlikely to have influenced the results significantly. Thus, it was possible to conclude that sharing the experience of ECT with the patient had a significant and positive impact on the relative's knowledge and attitudes concerning the treatment.

Effect of an Educational Video on the Accuracy of Surrogate Decisions

Under the amended Mental Health Act 2007, electroconvulsive therapy (ECT) can only be authorized in an incapacitated patient providing it is not in conflict with the decision of the donee of lasting power of attorney. To assess the ability of surrogates to correctly predict a subject's preference for treatment with ECT both before and after viewing an educational video. The effect of the educational video on attitudes to ECT was also examined. Twenty-five subject-surrogate pairs were recruited from relatives of psychiatric patients. The subjects' treatment preferences regarding the ECT and the surrogates' predictions of these preferences were assessed by means of 2 hypothetical scenarios before and after viewing an educational video. An attitude to ECT questionnaire (Questionnaire on Attitudes and Knowledge of ECT) was completed by all participants before and after the video. Subject-surrogate concordance was high, 84% for scenario 1 (treatment-resistant depression) before and after the video. In scenario 2 (life-threatening depression), concordance rose from 80% before the video to 96% after the video. The greatest increase in concordance occurred in pairs in which neither subject nor surrogate had previous experience of ECT. Attitude scores were significantly more positive after the video. Surrogates were able to predict the subjects' preference for ECT with high levels of accuracy. This finding is contrary to similar studies involving end-of-life treatment. Providing surrogates with clear, detailed, and accurate information about the proposed treatment may improve surrogate accuracy particularly in treatments such as ECT where widespread misperceptions prevail.

The patient perspective of the consent process and side effects of electroconvulsive therapy

Background: Electroconvulsive therapy (ECT) is an effective yet controversial treatment. It is thus important to explore patients' experiences of ECT.Aims: To assess patients' experience of ECT, focusing on the consent process and treatment side effects.Method: Three-hundred-and-eighty-nine patients completed a questionnaire about their experience of ECT as part of a quality assurance programme. Quantitative and qualitative data were obtainedResults: Almost half the patients reported memory loss after ECT. Overall the consent process was reported as having been adequate, with a possible exception in the provision of written information and discussion about alternatives to ECT and the consequences of not having it. Seventy-two percent of those patients who commented on whether ECT worked, said the treatment improved their condition.Conclusions: Psychiatrists need to improve the informed consent process. Subjective memory loss is very common and persistent memory complaints occurred in a minority. Memory should therefore be closely monitored before, during and after a course of ECT.

Nurses' Knowledge of and Attitude to Electroconvulsive Therapy

The relationship between the nurse and patient is usually close. The nature of nursing means that nurses spend more hours with patients than other health care professionals. Therefore, nurses' knowledge of and attitude to electroconvulsive therapy (ECT) is important because it is likely formed through close contact with patients; conversely, nurses' knowledge and attitudes will be conveyed to patients. There have been several studies exploring the topic of nurses' knowledge of and attitudes to ECT, but results are contradictory. To explore nurses' knowledge of and attitude to ECT and to find whether knowledge and experience of ECT correlated with more positive attitudes to the treatment. This was a questionnaire study including 211 registered and student nurses working in a London Mental Health Trust. It included knowledge and attitude scales and questions about experience and demography. There was a highly significant correlation between knowledge of and more positive attitudes to ECT. The more years in mental health, higher grade, and the greater number of patients undergoing ECT they had had contact with correlated with more knowledge. The number of patients they had had contact with and the closeness of that contact correlated with more positive attitudes. Registered nurses had more knowledge and more positive attitudes than student nurses. The relationship between attitudes and knowledge is complex. However, for nurses to provide appropriate support to patients undergoing ECT, they need to gain knowledge and experience of the therapy early in their careers.