Article

Shock treatment, brain damage, and memory loss: a neurological perspective

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

The author reviews reports of neuropathology resulting from electroconvulsive therapy in experimental animals and humans. Although findings of petechial hemorrhage, gliosis, and neuronal loss were well established in the decade following the introduction of ECT, they have been generally ignored since then. ECT produces characteristic EEG changes and severe retrograde amnesia, as well as other more subtle effects on memory and learning. The author concludes that ECT results in brain disease and questions whether doctors should offer brain damage to their patients.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... While in previous cases symptoms tended to appear in the immediate postictal period (Leniel and Crovitz 1987; Squire 1977 ), in our case, the symptoms appeared 48 hours after treatment, making a causal relationship less convincing. One possible explanation for the delay in the appearance of clinical symptoms is that the memory disturbances displayed here were related to minor brain damage which had developed slowly, causing the clinical symptoms to appear after a period of time (Friedberg 1977). The normal results of CT, eye fundus, LP, other laboratory tests, and the normal neurological examination, ruled out the possibility of anatomic brain injury. ...
... However, none of these tests can definitely exclude brain damage, and only MRI or PET scan can exclude organic brain injury at such an early stage. EEG abnormalities are frequent among patients who have undergone ECT and, as in the case of our patient, these disorders are probably of a functional nature only (Friedberg 1977). ...
Article
Memory-related effects of electroconvulsive therapy (ECT) are known to appear immediately after the treatment. The case of a 39-year-old woman who underwent a course of ECT because of a recurrent major depressive disorder is described. After a symptom-free period of 48 hours, transient amnesia developed. Her condition appeared to be associated with the electroconvulsive therapy, thereby raising questions about its pathogenicity and management.
... Evidence that the adverse effects of ECT are not imaginary or subjective' is provided by studies documenting brain damage (Breggin, 1984;Frank, 1978;Friedberg, 1976;1977;Sterling 2000). In what is best described as a diatribe against "the old myth about ECT and brain damage" Shorter & Healy (2007) cite (amid studies of convulsive therapies prior to ECT or of ECT on animals) just one human ECT study (Coffey et al., 1991). ...
Article
To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. These placebo controlled studies show minimal support for effectiveness with either depression or 'schizophrenia' during the course of treatment (i.e., only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.
... • loss of artistic, musical or creative ability • brain damage (Breggin,1997(Breggin, , 1998Frank,1990Frank, , 2006Friedberg, 1976Friedberg, ,1977Sackeim et al, 2007) ...
... Despite this evidence, shock promoters including the Canadian Psychiatric Association and American Psychiatric Association irresponsibly minimize permanent memory loss as a "side effect" or "transient". In a recent position paper, the Canadian Psychiatric Association greatly minimized permanent memory loss claming "a small minority of patients… [have] subjective complaints" and flatly denied brain damage--" [ECT] causes no detectable evidence of irreversible structural brain damage" (Enns & Reiss, 2001) However, in the United States and Ireland, several physicians have publicly called for a ban on electroshock and severely criticized its continued use (Friedberg, 1977;Breggin, 1997;Breeding, 2001;Sterling, 2002;Corry 2008). In sharp contrast, Canadian psychiatrists continue to fraudulently promote 'ECT' as a "safe and effective" or "lifesaving" treatment for depression. ...
... But we might well ask ourselves whether we, as doctors sworn to the Hippocratic Oath, should be offering it. (Friedberg, 1977(Friedberg, , p.1013 These sentiments have been strongly echoed by service users: 'It is not justifiable to give people something that harms their brains and gives them an epileptic fit on the NHS. ...
Article
Full-text available
... ECT is considered the most effective treatment for medication-resistant depression (American Psychiatric Association, 2001). It continues to hold this status in psychiatry even though the damage to the brain and the memory loss have been researched and documented for decades (Breggin, 1998;Calloway, Dolan, Jacoby, & Levy, 1981;Donahue, 2000;Frank, 1990;Friedberg, 1977;Sackeim et al., 2007). Shortly after the ECT course, most patients manifest deficits in retaining newly learned information (anterograde amnesia) and recalling events that occurred in the weeks or months preceding the ECT course (retrograde amnesia; Sackeim et al., 2007). ...
Article
Full-text available
This article reviews historical and current examples of harmful and forced treatments as well as scientific discrimination that have been applied to people diagnosed with mental illness. It discusses anti-psychiatric social action in North America from 1970 to the present. A review of social work's foundations in social justice, empowerment, and person-in-the-environment perspectives highlights the congruencies and communal benefits for both the social work profession and psychiatric-survivor movements. Through this discussion, it is apparent that the professed values of the social work profession are actually more compatible with psychiatric-survivor movements than with any allegiances to the biomedical model of psychiatry.
... Immediate unwanted effects may occur, however, including headache, confusion, and memory disturbance. Such effects are mild and transient in most cases, but they continue to give some basis for allegations that ECT, even with modern equipment and modified techniques of admin istration, causes brain damage (Friedberg, 1977). Brain-type creatine phosphokinase (CPK BB) is an enzyme involved in energy utilization, which Thomp son et al (1980a) found chiefly in the astrocyte cells of the brain. ...
Article
Full-text available
Brain-type creatine phosphokinase isoenzyme (CPK BB) was measured by radioimmunoassay in the serum of 31 depressed patients undergoing bilateral ECT. Samples were taken shortly before and at one hour, two hours, and six hours following ECT. ECT did not cause a significant alteration in serum CPK BB concentration during the six hours following the treatment. Similarly, there was no difference in mean pre-ECT concentration of serum CPK BB between patients receiving the first ECT of their current admission and those receiving subsequent treatments. These findings do not support suggestions that ECT causes alteration in permeability of the blood-brain barrier, nor that it causes detectable brain injury.
... Although ECT is an effective treatment for patients with the most severe and treatment-resistant psychiatric disorders, it is has been regarded by some as controversial or stigmatizing, mainly due to misconceptions about how modern ECT is administered, its efficacy, and an exaggerated view of side effects. Misconceptions regarding the clinical conduct of ECT include that it is not effective, or rather works by inducing forgetfulness, or that it leads to brain damage, or that ECT is administered without informed consent [6][7][8][9]. These misconceptions are also reflected in the public opinion [8,10]. ...
Article
Full-text available
Introduction: Controversy surrounding ECT creates skepticism about the ethics of conducting ECT research. This paper discusses the ethical conduct of clinical research and then focus on the ethics as applied to ECT.
... The energy model also predicts that adding energy to the field will distort the structure of awareness to a degree dependent on the amount of energy added. We can see this with electrical stimulation such as that used in electroconvulsive therapy, which at low levels causes conscious sensations, at higher levels seizures, unconsciousness and amnesia (Friedberg, 1977). Incidentally, similar interference occurs when energy is transferred to the skull and brain by a blow on the head. ...
Article
Full-text available
Much of neuroscience is currently dominated by an information processing metaphor which is largely conceptualized in discrete terms. An alternative metaphor conceptualizes information flow as continuous. A qualitative set of hypotheses based on this metaphor, the energy model, is described here. This model considers information transfer in terms of the flow of an abstract variable, energy, between points in a field comprising the extent of the nervous system. Although extremely simple, it generates some intriguing consequences. In particular, it provides a useful way in which to look at consciousness. Traditional problems of consciousness, such as qualia and the unity of consciousness, are briefly addressed, and outlines are sketched of the answers given by the energy model.
... [17] EKT'de ciddi morbidite ve mortalite nadir olmakla birlikte; kalp-damar bozuklukları, oluşmamış, uzamış, gecikmiş ya da yetersiz nöbet, bellek sorunları, kas ağrıları, sağaltımın neden olduğu mani ve konfüzyon, nöbet içi ya da nöbet sonrası deliryum en sık rastlanan yan etkiler olarak sayılabilir. [18,19] EKT'nin beyin hasarına yol açtığı günümüze kadar gösterilememiştir. [20,21] EKT uygulamalarının erken dönemlerinde önemli olanın nöbet oluşturulması olduğu, elektriksel uyarının parametrelerinin klinik duruma etki etmediği yaygın bir düşünceydi. ...
Article
Full-text available
Effects and side effects of electroconvulsive therapy have been a subject of debate since the begininng of its use to treat psychiatric disorders. As its antidepressant mechanism of action have been topic of many researches, many valuable findings were obtained ever since. However, methodological differences and different application protocols limited the accumulation of scientific data. Anticonvulsant effect and elevation of seizure threshold have been taken as outcome measures in many researches although it is still controversial. Some variables of treated disorders also may have affected researches. The aim of this article was to investigate current literature regarding application protocols and mechanism of action of electroconvulsive therapy.
... Although ECT is an effective treatment for patients with the most severe and treatmentresistant psychiatric disorders, it is has been regarded by some as controversial or stigmatizing, mainly due to misconceptions about how modern ECT is administered, its efficacy, and an exaggerated view of side effects. Misconceptions regarding the clinical conduct of ECT include that it is not effective, or rather works by inducing forgetfulness, or that it leads to brain damage, or that ECT is administered without informed consent [6][7][8][9]. These misconceptions are also reflected in the public opinion [8,10]. ...
Article
Introduction: Controversy surrounding ECT creates skepticism about the ethics of conducting ECT research. This paper discusses the ethical conduct of clinical research and then focus on the ethics as applied to ECT. Methods: PubMed was searched for articles related to the ethical conduct of research and that of ECT research published in English. Results: ECT research is ethically justified and should always continue to be conducted with the highest ethical standards. ECT research entails few ethical peculiarities such as involving multiple sessions were capacity to consent can change. It would be unethical not to conduct ECT research. Conclusion: ECT research must be based on sound hypotheses in the presence of a clinical equipoise in well-designed studies. ECT studies must select a fair and non-biased sample of participants. It is important that participants represent the broad population of the people that would be receiving ECT for that specific indication. ECT research is ethical; and more research in this field could help decrease stigma and barriers to treatment, and/or reduce side effects and improve efficacy of a potentially life-saving intervention.
... C oncerned professionals and critics of electroconvulsive therapy (ECT) have argued that ECT is causing brain damage. [1][2][3][4] Since the past 2 decades, new evidence for brain plasticity 5 has caused a shift in both preclinical and clinical ECT research from falsifying the "brain damage hypothesis" 6-10 toward exploring ECT's enabling brain (neuro)plasticity effects. ...
Article
Since the past 2 decades, new evidence for brain plasticity has caused a shift in both preclinical and clinical ECT research from falsifying the "brain damage hypothesis" toward exploring ECT's enabling brain (neuro)plasticity effects. By reviewing the available animal and human literature, we examined the theory that seizure-induced structural changes are crucial for the therapeutic efficacy of ECT. Both animal and human studies suggest electroconvulsive stimulation/electroconvulsive therapy (ECT)-related neuroplasticity (neurogenesis, synaptogenesis, angiogenesis, or gliogenesis). It remains unclear whether structural changes might explain the therapeutic efficacy and/or be related to the (transient) learning and memory impairment after ECT. Methods to assess in vivo brain plasticity of patients treated with ECT will be of particular importance for future longitudinal studies to give support to the currently available correlational data.
Article
Full-text available
Objective: The aim of this study was to determine the frequency of ECT use, the features of patients who underwent ECT treatment, short term treatment response to ECT, differences in efficacy and complications between modified and unmodified ECT, and the rate of complications among inpatients in a university hospital setting in-between 1990 to 2001. Method: Three hundred eighty four patients (183 men, 201 women) who had been hospitalized in Cukurova University Faculty of Medicine Psychiatry Service between 1990 and 2001 and received ECT were included in the study. The sociodemographic features, DSM diagnosis, ECT indications, the features of ECT course, complications and clinical response rate were recorded and evaluated. Results: During a 12 year period, 14.4% of inpatients received ECT as a part of their treatment. Among these patients 44.8% were treated with a diagnosis of psychotic disorder, whereas 49% treated for affective disorder and 6.3% for other diagnoses. Patients received an average of 7.8 bilateral ECT treatment and 82.3% of them showed moderate to marked improvement after ECT treatment. There were no differences between responders and non-responders to ECT with regards to age, sex, number and type of ECT treatment, hospitalization period and complication rate. Only variable showing significant difference was the presence of an axis II disorder. Forty six percent of patients developed a complication as a result of ECT. The most common complications observed were memory disturbances and confusion, all of which disappeared three weeks after the last round of ECT. Discussion and Conclusion: The results of this study confirmed the results of previous studies indicating the short term-efficacy, safety and reliability of ECT among psychiatric patients in all age groups.
Article
Electroconvulsive therapy (ECT) is becoming primarily a tool for treating major depressive illness, where there is substantial evidence for its success. The use of ECT to treat schizophrenia, mania and other conditions has markedly decreased, reflecting the development of effective drug treatment. Recommended indications for ECT are suicidal patients and those who refuse to eat or who are otherwise seriously disturbed or unmanageable. ECT is also indicated when chemotherapy has or is likely to fail or is contraindicated because of cardiac difficulties or pregnancy. ECT compares favorably with chemotherapy in terms of safety and effectiveness. The only absolute contraindication is raised intracranial pressure. Unilateral electrode placement using brief pulse current minimizes post treatment confusion and memory impairment.
Chapter
Enlistment of brain (cerebrum) signals can be arranged by a few techniques, for example, invasive and non-invasive. On the off chance that the biosensor is inserted in the cerebrum, at that point, the invasive procedure, has the advantage of high-frequency parts will estimate clearly and exact, yet because of wellbeing dangers and a few moral angles, they are essentially utilized in animal experimentations. If there should arise an occurrence of non-invasive technique, the surface electrodes are made available at the outer portion of the cerebrum, as per 5 to 15 global norms and standards. This application technique is substantially more likely utilized on people (human beings) since it doesn’t jeopardize them because of the implantation, however, it has the detriment, that the deliberate signals are noisier. This noisy signal can be removed by using a digital filter, named: Finite Impulse Response (FIR). In the previous years, a few electroencephalography headsets have been created not just for clinical use, which is worked from own batteries to guarantee versatile use. Presently some across the board Electroencephalography headsets are being presented, which are additionally reasonable for accomplishing one of a kind created Brain-Computer Interface. This kind of Headsets can be developed with the architecture of the Internet of Robotic Things (IoRT), where it can analyse the incoming electroencephalographic signals for corresponding actions of human beings. These recordings can be sent to the remote area and stored in the server through Bluetooth or Wi-fi mediums using the Gateway.
Article
Despite widespread belief that violence begets violence, methodological problems substantially restrict knowledge of the long-term consequences of childhood victimization. Empirical evidence for this cycle of violence has been examined. Findings from a cohort study show that being abused or neglected as a child increases one's risk for delinquency, adult criminal behavior, and violent criminal behavior. However, the majority of abused and neglected children do not become delinquent, criminal, or violent. Caveats in interpreting these findings and their implications are discussed in this article.
Article
Although the safety and efficacy of electroconvulsive therapy (ECT) is acknowledged by most, concern has repeatedly been expressed that the treatment may have some lasting effects on the brain. To study potential morphological changes, 22 patients with a history of ECT were submitted to a detailed clinical evaluation and a brain CT scan examination. Age- and sex-matched control subjects comprised a group of comparable patients, none of whom had received ECT, and a second control group of healthy volunteers. Patients had larger ventricle/brain ratios and cortical "atrophy" scores than normal controls, but no association was found between these radiological measures and a previous history of ECT. Hence, the present data are consistent with recent reports that affective disorders may be associated with enlarged brain ventricles, although the clinical significance of such findings remains unclear. In line with previous investigations age correlated significantly with cortical "atrophy" scores and ventricle/brain ratios for all subjects. Statistical tests of correlations between duration of illness, previous psychotropic drug exposure and CT scan appearances were mainly inconclusive.
Article
This report documents a unique case, in which over 1,250 ECTs produced no observable gross or histological sign of brain damage. The patient was an 89 year-old female with chronic psychiatric illness; neuropathological examination revealed a healthy CNS, in spit of the massive ECT exposure, and there was no sign of oxygen deficiency in spite of numerous, repeated anaesthesia inductions and seizures for each of the many courses of treatment.
Article
Electroconvulsive therapy is a safe and effective treatment for severe depression. Its advantages are its rapid onset of action and its effectiveness when other treatments have failed. Recent follow-up investigations have found no evidence of damage to the central nervous system. The most troublesome adverse effect is a transient amnestic syndrome in some patients, which clears but leaves a mild deficit in retrograde memory. The frequency of this disorder can be reduced by treatment modifications, but its occurrence cannot be eliminated altogether. Although the majority of patients with amnestic symptoms do not find them bothersome, some do, and patients should be apprised of the common adverse effects, as well as the benefits, of electroconvulsive therapy.
Article
One hundred and seventy-eight subjects completed a questionnaire regarding ECT. The sample comprised three groups of approximately equal size: a group of patients who had received ECT, a group of visitors to ECT-treated psychiatric patients, and a group of visitors to non-ECT-treated psychiatric patients. Misconceptions about ECT were common throughout, particularly in the young, those giving films and television as a source of information and those visiting patients not receiving ECT. Fewer misconceptions occurred among those who were more highly educated or had experience of ECT either personally or via a visited friend or relative. Less fear of the procedure was expressed by those given the treatment and those who had the treatment explained to them by a doctor. Over half of the patient group denied having had ECT explained to them.
Article
Five hundred and ten patients receiving long-term in-patient care for schizophrenia were examined in terms of their current mental state, cognitive functioning, neurological status and behavioural performance. The abnormalities of these areas of their present state were related to historical factors, personal details, the features of the illness at its worst and physical treatment received. Significant associations between the present state and historical factors are few and mainly concerned time and the features of the illness at its worst. Current abnormalities were not related to past physical treatment, but highly significant correlations were found between the impairments of the four areas of the present state. It is concluded that these impairments are likely to be an integral part of the disease.
Article
Electroconvulsive therapy (ECT) is regarded as one of the most effective treatments for major depressive disorder but has also been associated with cognitive deficits possibly reflecting brain damage. The aim of this study was therefore to evaluate whether ECT induces cerebral damage as reflected by different biochemical measures. The concentrations in the cerebrospinal fluid (CSF) of three established markers of neuronal/glial degeneration, tau protein (tau), neurofilament (NFL) and S-100 beta protein, were determined in nine patients who fulfilled DSM-IV criteria for major depression. CSF samples were collected before and after a course of six ECT sessions. The CSF/serum (S) albumin ratio reflecting potential blood-brain barrier (BBB) dysfunction was also determined at these time points. The treatment was clinically successful with a significant decline of depressive symptoms in all patients as assessed by the Montgomery-Asberg Rating Scale for Depression. Several patients had signs of BBB dysfunction and/or neuronal damage before the start of treatment. Levels of CSF-tau, CSF-NFL and CSF-S-100 beta levels were not significantly changed by ECT. Also the CSF/S albumin ratio was found to be unchanged after the course of ECT. In conclusion, no biochemical evidence of neuronal/glial damage or BBB dysfunction could be demonstrated following a therapeutic course of ECT.
Article
Synopsis Using computed tomography, lateral ventricular size was studied in a sample of 112 institutionalized chronic schizophrenic patients (selected from 510 cases to investigate the correlates of the defect state and intellectual decline and the effects of insulin, electroconvulsive and neuroleptic treatment), and compared with matched groups of non-institutionalized schizophrenics, patients with first schizophrenic episodes, institutionalized and non-institutionalized patients with primary affective disorder, and neurotic out-patients. Age was significantly correlated ( P < 0·0002) with lateral ventricular size, but the institutionalized schizophrenic patients had significantly larger ( P < 0·025) lateral ventricles than the neurotics when age was taken into account. Ventricular enlargement was unrelated to past physical treatment (neuroleptics, insulin coma and electroconvulsive therapy). Within the group of institutionalized schizophrenic patients few correlates of ventricular enlargement were identified; thus in this population increased ventricular size was not clearly associated with the features of the defect state (negative symptoms and intellectual impairment). however, there was a curvilinear (inverted-U) relationship between intellectual function and ventricular size was significantly related to absence of hallucinations, impairment of social behaviour, inactivity and the presence of abnormal involuntary movements. The findings confirm that structural brain changes do occur in chronic schizophrenia, but illustrate some of the difficulties in elucidating the clinical significance of ventricular enlargement. Lateral not bimodal; the relationship to particular features of the disease is complex and likely to emerge only in studies with a large sample size.
Article
After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior.
Article
Electroconvulsive Therapy (ECT) practitioners and anti-ECT activists have divergent interpretations of both the treatment and its history. Despite claims by ECT opponents that practitioners do not acknowledge memory side effects, the published literature on the procedure demonstrates psychiatrists' awareness of this issue. And though current ECT practitioners claim that memory side effects were mostly the result of outmoded methods, investigators continue to publish studies that indicate ongoing memory problems. This article explores the conflict between pro- and anti-ECT groups around the issue of memory side effects in the broader context of changes in American psychiatry and society.
Article
Full-text available
Electroconvulsive therapy is the most effective treatment for endogenous depression. Possible adverse effects include confusion, memory loss, headache, hypotension, and tachycardia. We describe a 22-year-old woman treated for unconsciousness four hours after electroconvulsive therapy. She had no history of recent head trauma, hypertension or cerebrovascular symptoms. Complete blood count, platelet count, prothrombin and partial thromboplastin time were normal. Multiple intracerebral hemorrhages were seen on computed tomography. This unusual finding has not been reported previously.
Article
In the decade or so after the introduction of electroconvulsive therapy (ECT), scattered reports of neuropathological changes found among people who died after treatment began to appear. Such reports, combined with laboratory studies purporting to show neurological damage in experimental animals and the demonstration of memory changes (particularly retrograde amnesia) after ECT treatment, have suggested to some that ECT must somehow result in physical damage to the brain. Although such concerns still appear to influence popular attitudes toward ECT, use of modern technique does not appear to be commonly associated with any evidence of central nervous system damage.
Chapter
Die EKT stellt weltweit eine sehr sichere, hochwirksame und relativ nebenwirkungsarme Behandlung bei schweren psychischen Erkrankungen dar. Trotzdem wird sie außerhalb eines engen Kreises von psychiatrischen Fachkollegen und Betroffenen häufig als überkommen angesehen und mit Zwangsmaßnahmen assoziiert. Irrationale Vorbehalte verhindern den evidenzbasierten Einsatz. Tatsächlich hat sich die EKT durch kontinuierliche Innovationen zu einer modernen medizinischen Maßnahme entwickelt. Sie sollte deshalb als selbstverständlicher Bestandteil der psychiatrischen Versorgung integriert werden. In den deutschsprachigen Ländern nimmt die Akzeptanz der Methode in den letzten Jahrzehnten allmählich zu. Steigende Behandlungszahlen machen deutlich, dass Ärzte und Patienten sich zunehmend von ideologischen Barrieren befreien. Ziel ist es, die Kontroverse um die EKT darzustellen, Erklärungsmodelle anzubieten und Strategien aufzuzeigen, um die Verzerrungen in der öffentlichen Wahrnehmung zu korrigieren.
Article
The electroconvulsive therapy (ECT) probably just from beginning of its clinical applying provokes numerous fears and oppositions - both part of medical milieu, as and of the public opinion. These are connected with potential side effects - mainly cognitive nature. Not to overestimating are also irrational apprehensions before image of current passing by a patient's head, that it has executed convulsions in time of ECT treatment without of drug modification. The paper presents cardinal objections and reason of controversies what the electroconvulsive treatment arouse up to today. The effectiveness, as also the safety, of electroconvulsive therapy are the most important counterargument.
Article
Migraine with aura is considered as an etiologic factor in ischemic cerebrovascular disorders. While, intracerebral hemorrhage occurs in rare instances during or after migraine attack. A thirty-four year-old female patient has migraine without aura for ten years with a frequency of 3-4 attacks monthly. She underwent electroconvulsive therapy for seven times in the psychiatry department because of obsessive-compulsive disorder a week ago. Following a migraine attack a left hemiparesis syndrome occurred, and computed tomography, which was performed at the same day, revealed a right parietal lobar hematoma. In this paper, lobar hemorrhage in a young patient and its etiologic causes in relation to migraine and/or electroconvulsive therapy were discussed.
Article
When properly administered for appropriate indications, electroconvulsive therapy (ECT) is a safe and effective treatment for several severe mental disorders. Nonetheless, ECT is referred to as the “controversial” treatment and is subjected to regulatory legislation and even banning unheard of for other standard treatments. Histories of clinical practice, litigation, cinematic portrayal of ECT, popular and professional literature, and antipsychiatric ideologies that contributed to visceral misperceptions of ECT and the perceived need for increased legal regulation are briefly summarized. The practice of ECT has been affected not only by negative imagery, but also by a passionate anti-ECT movement, the ultimate goal of which is to abolish the use of ECT altogether. After a capsular history of ECT legislation, a more extensive account of the extreme regulatory law in Texas is explained. This is followed by the more moderate and typical approach of Missouri. Rational approaches to ECT legislation would include (a) providing no more statutory regulation than is applied to treatments with comparable risks and benefits and (b) ensuring that any legislation provides adequate informed consent based on fact and reason and protects the patient's autonomy rights as is done for psychotropic medication, while it supports availability of ECT for individuals who would benefit. Paracelsus said the difference between a medicine and a poison is the dose. ECT, like other modern treatments, is safe and effective when used properly.
Chapter
Full-text available
Neuromodulation techniques have been part of psychiatry since the introduction of electroconvulsive therapy over 60 years ago, but their applications remain controversial. In particular, they are disregarded for their invasiveness, risk of changing personal identity or resemblance to early psychosurgery. Here we show that stringent ethical analyses are hampered rather than facilitated by these concepts and issues. Instead, ethical implications of neuromodulation techniques are more productively analyzed by use of widely shared ethical criteria that, in addition, can easily be applied to empirical evidence and thus allow to turn from speculative, rhethoric to evidence-based ethics. This will be shown for each neuromodulation technique, namely electroconvulsive therapy (ECT), psychiatric repetitive transcranial magnetic stimulation (rTMS) and psychiatric deep-brain stimulation (DBS). We will argue that each neuromodulation technique has to be thoroughly assessed for its benefit, harm and respect of the patient’s will. However, not only the application per se needs special ethical attention, but also their perception and portrayal in the public. This analysis will prepare the ground for ethically justified, empirically comprehensive neuromodulation in the highly vulnerable population of psychiatric patients and allow stringent future societal discussions about its legitimation.
Article
Concern remains among many that electroconvulsive therapy (ECT) causes "brain damage." This ambiguous term presumably refers to lesions that could, in principle, be observed either grossly or microscopically in postmortem studies, and the assertion that it occurs appears to be based largely on old reports with dubious relevance to modern practice. Fortunately, using modern technique, ECT is so safe that mortality around the time of treatment is extraordinarily rare and as a result there has been little opportunity for postmortem examination of individuals who had recently had ECT. We report a case in which postmortem brain examination was performed roughly a month after the patient's last treatment.
Article
toabstract thinking and judgment. The ECT-induced persistent brain dysfunction was global. In addition to the loss of autobiographical memories, the most marked cognitive injury occurred in “retention of newly learned information,” “simple reaction time,” and most tragically, “global cognitive status” or overall mental function. In other words, the patients continued to have trouble learning and remembering new things, they were slower intheir mental reaction times, and they were mentally impaired across a broad range of faculties. Probably to disguise the wide swath of devastation, the Sackeim study did not provide the percentages of patients affl icted with persistent cognitive defi cits; but all of the mul- tiple tests were highly significant (p< .0001 on 10 of 11 tests and p< .003 on the 11th). Also, the individual measures correlated with each other. This statistical data indicates that a large percentage of patients were significantly impaired.
Article
Initially, this paper briefly introduces the work of my colleague, Nina Farhi, who was a highly respected psychoanalytic psychotherapist in London and who sadly died last year. After her death, I was invited to discuss both her paper, “The Hands of the Living God,” and the three commentaries by North American analysts, all published in this issue. As part of my commentary, I provide an appreciative yet critical discussion of the way Farhi uses the term “intersubjectivity.” I argue that there is a need for paternal function or a third position to be found in the mind of the analyst in the later phases of work with deeply disturbed patients. I also contribute to the hypothetical debate about whether or not experiences in the womb can be subject to analytic work, using the Lacanian concept of the “Real” and Piontelli's work on fetal and child observation. After this, I explore some of the ways Lacan revised drive theory and discuss these in relation to psychic devolution in later life, essential aloneness and creative human destiny. Finally, I look at how Farhi's paper's posthumous publication may have affected the commentary.
Article
Electroconvulsive treatment (ECT) is increasingly used in North America and there are attempts to promote its further use world-wide. However, most controlled studies of efficacy in depression indicate that the treatment is no better than placebo with no positive effect on the rate of suicide. ECT is closed-head electrical injury, typically producing a delirium with global mental dysfunction (an acute organic brain syndrome). Significant irreversible effects from ECT are demonstrated by many studies, including: (1) Inventories of autobio- graphic and current events memories before and after ECT; (2) Retrospective subjective observations on memory; (3) Autopsy studies of animals and some of humans. ECT causes severe and irreversible brain neuropathology, including cell death. It can wipe out vast amounts of retrograde memory while producing permanent cognitive dysfunction. Contemporary ECT is more dangerous since the current doses are larger than those employed in earlier clinical and research studies. Elderly women, an especially vulnerable group, are becoming the most common target of ECT. Because of the lopsided risk/benefit ratio, because it is fundamentally traumatic in nature, because so many of the patients are vulnerable and unable to protect themselves, and because advocates of ECT fail to provide informed consent to patients - ECT should be banned.
Article
The rapid growth of psychotherapeutic movements in recent years has led to a free market. Vast numbers of psychotherapists of different theoretical persuasions are now on offer. While such a choice has its obvious advantages, it creates bewildering confusions in the minds of potential clients. How can the clients tell which psychotherapist or psychotherapeutic entepise to opt for? How can they know whether they have made an appropriate choice? How do they know which therapy works best under which conditions? Are there a set of criteria laid down which might guide the client in making a judicious choice? Can they be assured that after a senes of agreed sessions, they will get better? These are extremely serious issues. The paper discusses the practical and ethical implications underlying these issues and offers specific suggestions and guidelines as to how the clients might safeguard their own interests when it comes to choosing an appropriate psychotherapist.
Article
Full-text available
Magnetic brain stimulation used as a method of psychological interventions in the treatment of diseases. This method functions used in the treatment of clinical disorder such as speech and movement disorders caused by stroke, tinnitus, Parkinson's disease, nervous tics. Applications in the field of psychological therapy, it is possible to stimulate specific brain area involved in certain mental illnesses including schizophrenia. Proven scientific results based on magnetic stimulation of the brain showed: this way, cure diseases such as addiction, depression, bipolar disorder, obsessive-compulsive disorder. On the other hand, this method is one of the ways of studying the brain function. In the method by the law of electromagnetic induction, induced currents varying shapes and winding, in the brain. The advantage of this method is that brain stimulation has the least pain and discomfort. Magnetic stimulation of the brain in terms of pulse split into three categories: single pulse, pulse magnetic stimulation pair repeatedly. Research has shown the procedure to increase or reduce brain excitability and plasticity. It also has a significant effect in the treatment of mental illness.
Article
The author reviews literature pertaining to the efficacy and safety of electroconvulsive therapy (ECT), with emphasis on the controversy concerning whether ECT causes brain damage. ECT does appear to be effective in the treatment of severe depression and possibly mania. The types of memory problems caused by ECT are discussed, and evidence suggests that most of these deficits are transitory. Although most evidence points toward modern ECT not causing brain damage, there are still some findings that raise questions about safety. Ethical issues involving this treatment's use, its availability to the public, and informed consent procedures are discussed.
ResearchGate has not been able to resolve any references for this publication.