Running Head: Written Assignment 1

Written Assignment

Author Note
This Course Project is being submitted on March 1, 2014 For General Psychology Class.

My topic for my psychology research report, is the topic of electro convulsion therapy, or what is formally known as electro shock therapy. In this paper I will describe what it is, how it is administered, and what psychological disorders it is used for. In my mind this is some sort of barbaric torture that was carried out in the earlier days of psychology, when doctors where not really understanding the full scope of the psychiatric illnesses of their patients. It conjures up images in my mind of old insane asylums and the procedures that were carried out there, with not much understanding as to the patient’s illness, or what the effects the treatments could have on the patients. By the end of this paper, I hope to gain a better understanding of electro convulsion therapy, and its credibility, or not, as a treatment for psychological disorders. Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses (NAMI, 2012). It often works when other treatments are unsuccessful. Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects (NAMI, 2012). ECT is much safer today and is given to people while they're under general anesthesia. Although ECT still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks. Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania. ECT is a brief medical procedure that involves applying short electrical bursts to the brain through external electrode pads on the head. These electrical bursts create a seizure, which has been shown to help relieve symptoms associated with severe depression. The entire procedure lasts about fifteen minutes, although a patient may be in the hospital for about an hour to include time for prep and recovery from the treatment. ECT treatments are usually grouped together in six to twelve treatments at a time, generally given three times a week for two to four weeks. The number of treatments a person will need depends on the severity of their symptoms and how rapidly they improve. Before a patients first ECT treatment, the doctor needs to make sure the procedure is safe for them. The psychiatrist will likely refer them to a physician for a physical examination, an electrocardiogram, ECG, to check their heart health, and laboratory tests, to ensure there are no medical conditions that would preclude them from receiving ECT treatment. The patient may also be referred to an anesthesiologist to go over the risks associated with having anesthesia. Modern electroconvulsive therapy is administered under general anesthesia, to ensure it is a safe and pain-free experience. The patient will be unconscious during the treatment. As with any medical procedure involving general anesthesia, the doctor will talk to the patient about the associated risks and things to avoid before coming in for treatment. Before ECT is administered, the patient will be given an IV. Sometimes the patient will be provided with a mouth guard to help ensure they don’t accidentally bite their tongue, and help protect their teeth during the seizure. Some doctors also may administer oxygen through an oxygen mask. Electrode pads will be placed on the patient’s head, which will be the pads that actually administer the small electrical impulse that will trigger a seizure in the brain. ECT can either be administered unilateral, in which only one side of the brain is subject to electricity, or bilateral, in which both sides of the brain receive electrical currents (bidmc.org). An electroencephalogram, EEG is also connected, which measures the patient’s brain activity. The EEG lets the doctor knows when a seizure is occurring, which can be confirmed by watching for movement in the patients hand or foot.
Short-acting, general anesthesia is injected in the IV to bring about unconsciousness, as well as a muscle relaxant to help prevent the patient’s body from convulsing during the seizure. A blood pressure cuff is placed around the forearm or ankle area, preventing the muscle relaxant from paralyzing those particular muscles (bidmc.org). After the general anesthesia has taken effect and the patient is fully unconscious, the ECT procedure then begins. ECT is administered through an ECT machine, which allows the doctor to prescribe an exact amount of electrical impulse and duration that may differ somewhat from patient to patient depending upon the severity of their symptoms and other factors. The doctor presses a button on the machine which starts the ECT treatment cycle. The machine sends a small amount of electricity through the electrodes on the patient’s head, which then passes into the brain through the skull. This electricity produces a short seizure that lasts no more than sixty seconds. The patient is unconscious during this process, so they do not feel a thing. However, the brain is thought to be resetting itself because of the seizure, clearing its neuropathways and lifting the common symptoms of depression. Sudden, increased activity on the EEG lets the doctor know the start of a seizure, followed by a leveling off that shows the seizure is over. A few minutes later, the effects of the anesthesia and muscle relaxant will begin to wear off. The patient will be taken to a recovery area, where they are monitored and given time to recover from the anesthesia and procedure (bidmc.org). Upon awakening, the patient may experience a period of confusion lasting from a few minutes to a few hours or more. ECT is used to treat many psychological illnesses. It is used to treat severe depression. It is particularly useful when the severe depression is accompanied by detachment from reality, or a desire to commit suicide or refusal to eat (NAMI, 2012). ECT is also used to treat treatment- resistant depression, a severe depression that doesn't improve with medications or other treatments. Severe Mania can also be treated with ECT. Sever Mania is a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder (NAMI, 2012). Other signs of mania include impaired decision making, impulsive or risky behavior, substance abuse, and psychosis. People that are experiencing catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms, can benefit from ECT treatment. It's associated with schizophrenia and some other psychiatric disorders. In some cases, catatonia is caused by a medical illness. Agitation and aggression in people with dementia, can be treated with ECT, which can be difficult to treat and can negatively affect the quality of a person’s life (NAMI, 2012). ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used during pregnancy, when medications can't be taken because they might harm the developing fetus. It is also used in older adults who can't tolerate drug side effects, and in people who prefer ECT treatments over taking medications. People may use ECT when it has been successful in the past. Although ECT is generally safe, risks and side effects can occur. Confusion can occur immediately after an ECT treatment. A person may experience a period of confusion that can last from a few minutes to several hours (Kellner, 2012). Patients also may not know they are or why they are there. Patients undergoing ECT may be able to return to normal activities right away, or they may need to rest for several hours after treatment. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults. Patients may also experience memory loss as a side effect of ECT. ECT can affect memory in several ways. Patients may have trouble remembering events that occurred before treatment began, a condition known as retrograde amnesia (Kellner, 2012). It may be hard for them to remember things in the weeks or months leading up to treatment, although some people do have problems with memories from previous years, as well. Patients may also have trouble recalling events that occurred during the weeks of their treatments. Some people have trouble with memory of events that occur even after ECT has stopped. These memory problems usually improve within a couple of months. There are also physical side effects of ECT. On the days people have their ECT treatments, they may experience nausea, vomiting, headache, jaw pain, muscle ache or muscle spasms (Kellner, 2012). These generally can be treated with medications. ECT also has some medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If a person has heart problems, ECT may be more risky. After 60 years of use, ECT is still the most controversial psychiatric treatment (Kellner, 2012). Much of the controversy surrounding ECT revolves around its effectiveness vs. the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization. Because of the concern about permanent memory loss and confusion related to ECT treatment, some researchers recommend that the treatment only be used as a last resort Kellner, 2012). It is also unclear whether or not ECT is effective. In some cases, the numbers are extremely favorable, citing eighty percent improvement in severely depressed patients, after ECT (NAMI, 2012). However, other studies indicate that the relapse is high, even for patients who take medications after ECT. Some researchers insist that no study proves that ECT is effective for more than four weeks (Kellner, 2012). During the last decade, the typical ECT patient has changed from low-income males under forty, to middle-income women over sixty (Kellner, 2012). This coincides with changing demographics. The increase in the elderly population and Medicare, and the push by insurance companies to provide fast, medical treatment rather than talk therapy. Unfortunately, concerns have been raised concerning inappropriate and even dangerous treatment of elderly patients with heart conditions, and the administration of ECT without proper patient consent. The patient and physician should discuss all options available before deciding on any treatment. If ECT is recommended, the patient should be given a complete medical examination including a history, physical, neurological examination, EKG and laboratory test (NAMI, 2012). Medications need to be noted and monitored closely, as should cardiac conditions and hypertension. The patient and family should be educated and informed about the procedure via videos, written material, discussion, and any other means available before a written consent is signed. The procedure should be administered by trained health professionals with experience in ECT administration as well as a specifically trained and certified anesthesiologist to administer the anesthesia. The seizure initiated by the electrical stimulus varies from person to person and should be monitored carefully by the administration team. Monitoring should be done by an EEG or “cuff” technique. The nature of ECT, its history of abuse, unfavorable medical and media reports, and testimony from former patients all contribute to the debate surrounding its use. Research should continue, and techniques should be refined to maximize the efficacy and minimize the risks and side effects resulting from ECT.

References

Electroconvulsive Therapy. (2013). Retrieved February 9, 2014, from Beth Isreal Deconess Medical Center: A Division of Harvard Teaching Facilities website: http://www.bidmc.org/Centers-and-Departments/Departments/Psychiatry/Electroconvulsive-Therapy-Services.aspx

Freedman, J. L., MD, & Duckworth, K., MD (Eds.). (2012, July). Electroconvulsive Therapy (ECT) [Fact sheet]. Retrieved February 9, 2014, from National Alliance of Mental Illness website: http://www.nami.org

Kellner, C., MD. (2012, February 11). Electroconvulsive Therapy: The Second Most Controversial Medical Treatment. Retrieved February 9, 2014, from Psychiatric Times website: http://www.psychiatrictimes.com/ major-depressive-disorder/electroconvulsive-therapy-second-most-controversial-medical-proc