Awareness and perceptions of electroconvulsive therapy among psychiatric patients: A cross-sectional survey from teaching hospitals in Karachi, Pakistan

Aga Khan University, Karachi, Pakistan.
BMC Psychiatry (Impact Factor: 2.21). 02/2007; 7(1):27. DOI: 10.1186/1471-244X-7-27
Source: PubMed


Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients.
This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan.
We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001).
We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.

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Available from: Murad Khan, Oct 14, 2014
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    • "The poor knowledge about ECT among patients observed in the present study was no different from studies of patients who have actually undergone ECT.[111315171819] Such studies from developing countries suggest that less than a-quarter of patients (0-23%) have complete or near-complete knowledge and understanding of the procedure of ECT.[19212223] Patients are usually not aware of the various intricate aspects of ECT (e.g. different indications, techniques, adverse effects, mechanism, etc.). "
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    ABSTRACT: 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.
    Full-text · Article · Jul 2014 · Indian Journal of Psychological Medicine
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    • "Systematic review on this aspect has concluded that only about half of the patients are satisfied by amount of information they receive prior to ECT22. In this study, the proportion of patients who felt that they had not received sufficient information regarding ECT prior to treatment was higher than that reported in previous studies from India and other developing countries81723–25. "
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    ABSTRACT: Electroconvulsive therapy (ECT) is used frequently in developing countries, but investigations of patients' awareness and perception of ECT are rare. The present study thus attempted a comprehensive examination of knowledge, experience and attitudes concerning ECT among patients treated with brief-pulse, bilateral, modified ECT, and their relatives. Of the 153 recipients of ECT, 77 patients and relatives were eventually assessed using questionnaires designed to evaluate their awareness and views about ECT. Patients were middle-aged, poorly-educated, often unemployed, with chronic, severe, and predominantly psychotic illnesses. Relatives were mainly parents, older, better-educated and usually employed. Apart from the very rudimentary aspects, patients were largely unaware of the procedure. Though most did not find the experience of ECT upsetting, sizeable proportions expressed dissatisfaction with aspects such as informed consent, fear of treatment and memory impairment. Although patients were mostly positive about ECT, ambivalent attitudes were also common, but clearly negative views were rare. Relatives were significantly likely to be more aware, more satisfied with the experience and have more favourable attitudes towards ECT, than patients. The results endorse the notion that recipients of ECT are generally well-disposed towards the treatment, but also indicate areas where practice of ECT needs to be improved to enhance satisfaction among patients and relatives.
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    ABSTRACT: Despite the wide consensus over the safety and efficacy of electroconvulsive therapy (ECT), it still faces negative publicity and unfavorable attitudes of patients and families. Little is known about how the experience with ECT affects the patients' and their families' attitude toward it. The aim of this study was to examine a sample of Iranian patients and their families regarding their experience with ECT and to compare their knowledge and attitude toward ECT before and after this experience and their satisfaction with it. We surveyed 22 patients with major depressive disorder about to undergo ECT and 1 family member of each patient for their knowledge and attitude toward ECT and then surveyed them again after the trial of ECT to compare those variables while assessing their experience and satisfaction with ECT. Patients were rated using the Hamilton Depression Rating Scale and Mini-Mental Status Examination before and after the treatment. We found that, before ECT, family members had a more favorable attitude toward ECT than patients, but after ECT, the patients' attitude changed more positively compared with their families. Both patients and their families had a poor knowledge of ECT before the ECT trial, but their total knowledge increased afterward, although not in the areas of indications and therapeutic effects. The majority of patients and their families found ECT to be beneficial and were satisfied with it. Satisfaction with ECT was independent of treatment outcome. There was a high rate of perceived coercion to consent to ECT. Attention should be paid toward educating patients and their families about the ECT process, indications, risks, safety, and effects as well as informing them about their freedom of choice and right to refuse.
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