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Wednesday, June 15, 2011

Electro Convulsive Therapy: Restoring the Mind

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Electroshock Therapy, Restoring The Mind


By Ellen Bloom


Modern psychiatry began in the latter half of the 1th century with the identification, by European neuropsychiatrists, of separate mental disorders. At the time three mental illnesses dominated the clinical scene, neurosyphisis, described as dementia paralytica, dementia praecox (schizophrenia today), and manic depressive insanity. Caretakers of the mentally ill commonly resorted to chains, restraining chairs, cold and hot baths, and seclusion. Morphine, bromides, barbiturates, and chloral hydrate kept patients asleep but did little to heal their illnesses. The mentally ill were housed in large state supported hospitals with full authority to treat inmates. Many experimental and unsafe treatments were done. Bodily infections were considered a cause of mental disorder, so teeth, tonsils, gall bladder and large sections of the colon were removed. Many patients died. Surgical removal of sexual organs, salpingectomy and vasectomy was another treatment. It became mandatory to sterilize criminals, idiots, imbeciles and rapists in 0 states in 1040.


Ladislas Meduna, a physician trained in neurology and neuropathology, was examining human postmortem specimens at the Hungarian Psychiatric Research Institute in Budapest. He observed that patients with dementia had fewer than the normal number of neuroglia and that the brains of patients with epilepsy had markedly more. The neuroglia are the myriads of branched cells in the central nervous system that provide a supporting network for the neurons, the main cells of the brain that are the basis for thought, memory, emotion and action. He surmised that if he could develop epileptic seizures in patients he would reduce dementia. The first seizure therapy was done by injecting camphor-in-oil and his patient recovered without harm, and improved mental state. The Metrazol therapy was a frightening event because of the severe side effects, and at the University Hospital in Rome a year old man was admitted for the first ECT procedure ever done. A team headed by Ugo Cerletti and Luigi Bini applied a current that produced a grand mal seizure and the patient improved and recovered.


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Now electroshock is a treatment for severe and persistent emotional disorders. The physician, following a prescribed procedure, induces an epileptic seizure in the brain,. By making sure that the patient’s lungs are filled with oxygen, the physician precludes the gasping and difficult breathing that accompanies an epileptic seizure. The physiologic functions of the body are monitored, and anything out of the ordinary is immediately treated.


The treatment is safe for patients of all ages, from children to the elderly, for people with debilitating systemic illnesses and for pregnant women. It relieves symptoms more quickly and lastingly than the use of psychotropic drugs. Treatments are usually given three times a weed for two to seven weeks. To sustain recovery, weekly or biweekly treatments are administered for several months. The duration of a course of electroconvulsive therapy is similar to that of the psychotropic medications frequently used for the same condition.


Electroshock treatment is an option when the emotional disorder is acute in onset, when there are pronounced changes in mood, thought, and motor activities, when the cause is believed to be biochemical or physiological, when the condition is so severe that it interferes with the patient’s daily life, or when other treatments have failed.


Modern ECT uses a square-wave form of energy which has a slight, effect on memory. The frequency of the square waves varies from 0 to 60 cycles per second, with a pulse of 0.5, 1.0, or .0 milliseconds. The duration of the stimulation varies between 0. to 8.0 seconds, and delivers from 5 to 500 millicoulombs of energy. Amplifiers record the EEG and the ECG during the seizure, permitting the doctor to evaluate the quality of each treatment.


Treatments are usually given in the morning. Because some people become nauseated by anesthetic, the patient consumes no food or liquid after midnight. The patient is administered a general anesthetic, and monitoring electrodes are attached to the body. After the preparations are completed, the patient is asked to breathe deeply as oxygen is given through a mask. A sedative is administered through the intravenous line and puts the patient to sleep. Blood pressure is monitored. A stimulator, applied to a nerve in the face, arm or leg will show whether the muscle is relaxed. When the twitches stop the muscles are properly relaxed for treatment. The mouth guard is put in the mouth to prevent damage to the teeth or jaw during the electrical stimulus. The stimulus is then passed, and the brain seizure stimulate. The patient is not aware of the passage of current, the seizure or any aspect of the actual treatment.


The patient breaths unassisted within three minutes after the treatment is completed. As he awakens, he is asked to give his name, date and the mane of the hospital. Awareness improves rapidly within 15 minutes. Older patients, however may require observation for a few days. If the patient complains of a backache or muscle stiffness, the muscle relaxant was not adequate.


Melancholic patients with psychosis who are adequately treated have an immediate and excellent response. For those who experience a sudden onset of a manic delirium or rapid-cycling manic, the results are excellent, provided the treatment course is intensive. Frequently that means daily treatments. Patients who have been psychotic for months and years may respond so slowly that the course will not show effects until they have had three to five weeks of treatment. The catatonic patient treated almost always finds relief after two or four sessions. Absence of relief is probably the result of inadequate treatment.


What most people don’t know is that ECT has fewer risks than does treatment with psychotropic drugs. Sixty years ago patients risked fractures, recurrent seizures, and memory changes, but modern procedures have eliminated those risks. Fractious or recurrent seizures are rare and usually reflect technical errors. The risk of death during ECT is rare.


The prevalent belief that ETC impairs memory is based on the early experiences of patients who were treated without anesthesia or ventilation. Such treatments were associated with sever and persistent memory losses. But present practice is no longer associated with those devastating complaints. It is the mental illness that impairs the knowledge of the patient.


ECT therapy has long suffered from a controversial and bizarre public image, a reputation that has effectively removed it as treatment options for many patients. But 45 years of clinical and research experience says that ETC therapy is now a safe, effective, painless and sometimes lifesaving treatment for emotional and mental disorders.


References


Convulsive Therapy


Lothar Kalinowsky 188


Sage Publications


Fifty Years in Neurology


AE Bennet


Continental Book Publishing Company 17


Convulsive Therapy Theory and Practice


M. Fink


Raven Press 18


Undercurrents A Therapist’s Reckoning with Depression


M. Manning


Harper Collins, New York 14


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