Electroconvulsive Therapy is widely demonized or idealized. Some detractors consider its very use to be a human rights violation, while some promoters depict it as a miracle, the "penicillin of psychiatry." This book traces the American history of one of the most controversial procedures in medicine, and seeks to provide an explanation of why ECT has been so controversial, juxtaposing evidence from clinical science, personal memoir, and popular culture. Contextualizing the controversies about ECT, instead of simply engaging in them, makes the history of ECT more richly revealing of wider changes in culture and medicine. It shows that the application of electricity to the brain to treat illness is not only a physiological event, but also one embedded in culturally patterned beliefs about the human body, the meaning of sickness, and medical authority.
Since the development of pharmacoconvulsive therapy in 1934 and of electroconvulsive therapy (ECT) in 1938, ECT has proven far more valuable than just the intervention of last resort. In comparison with psychotropic medications, we now know that ECT can act more effectively and more rapidly, with substantial clinical improvement that is often seen after only a few treatments. This is especially true for severely ill patients -- those with severe major depression with psychotic features, acute mania with psychotic features, or catatonia. For patients who are physically debilitated, elderly, or pregnant, ECT is also safer than psychotropic medications. The findings of the American Psychiatric Association (APA) Task Force on ECT were published by the APA in 1990 as the first edition of The Practice of Electroconvulsive Therapy, inaugurating the development of ECT guidelines by groups both within the United States and internationally. Since then, advances in the use of this technically demanding treatment prompted the APA to mandate a second edition. The updated format of this second edition presents background information followed by a summary of applicable recommendations for each chapter. This close integration of the recommendations with their justifications makes the material easy to read, understand, and use. To further enhance usability, recommendations critical to the safe, effective delivery of treatment are marked with the designation "should" to distinguish them from recommendations that are advisable but nonessential (with the designations "encouraged," "suggested," "considered"). The updated content of this second edition, which spans indication for use of ECT, patient evaluation, side effects, concurrent medications, consent procedures (with sample consent forms and patient information booklet), staffing, treatment administration, monitoring of outcome, management of patients following ECT, and documentation, as well as education, and clinical privileging. This volume reflects not only the wide expertise of its contributors, but also involved solicitation of input from a variety of other sources, including applicable medical professional organizations, individual experts in relevant fields, regulatory bodies, and major lay mental health organizations. In addition, the bibliography of this second edition is based upon an exhaustive search of the clinical ECT literature over the past decade and contains more than four times the original number of citations. Complemented by extensive annotations and useful appendixes, this remarkably comprehensive yet practical overview will prove an invaluable resource for practitioners and trainees in psychiatry and related disciplines.
This is a pioneering book about the use of ECT in adolescents who are diagnosed with severe, disabling psychiatric disorders or fail conventional treatment. Included are a review of the literature, firsthand experience of the authors and case descriptions making it an invaluable guide to treatment.
Even with the rise of newer neuropsychiatric brain stimulation methods, electroconvulsive therapy (ECT) remains a widely used treatment for severe mental illness--and perhaps the most effective for serious mental illness. Optimal treatment requires that psychiatrists be skilled in diagnosis and familiar with the techniques of treatment. That's where Principles and Practice of Electroconvulsive Therapy comes in. With its up-to-date, comprehensive coverage of all aspects of ECT, this is an unrivaled resource for psychiatrists, whether in practice or still in training, striving for maximum treatment efficacy. The book begins with an overview of what ECT is and how it is carried out, followed by a brief history of the therapy, from its earliest applications to its use in modern times. The guide follows the typical course of treatment, discussing the following: - Understanding the indications for ECT and selecting patients who might benefit from this therapy--whether they suffer from depression, mania, schizophrenia, or catatonia- Educating patients and their families on ECT and obtaining patient consent- Conducting a pretreatment medical evaluation and understanding the role of anesthesia- Managing an individual ECT treatment, including choosing the electrical stimulus dose and parameter combination, delivering the electrical stimulus, assisting with recovery problems, etc.- Overseeing the course of treatments, particularly for practitioners not personally conducting the treatments- Managing patients after a course of treatments and preventing relapse- Assessing and managing the memory side effects of ECT The final chapter examines other neuropsychiatric stimulation therapies in relation to ECT and explains how to choose among them. All chapters conclude with easily referenced key points that summarize the most salient ideas. Readers seeking to further educate themselves on ECT will also benefit from the exhaustive reference list. Though particularly useful for psychiatrists and psychiatric residents, Principles and Practice of Electroconvulsive Therapy, with its straightforward style, is a ready resource for any mental health or medical professionals interested in ECT.
Increasingly, electroconvulsive therapy (ECT) is recognized as a proven, effective, and even life-saving intervention in certain mood and thought disorders when other treatments have had little or no effect. Despite the proven efficacy and safety of this standard treatment in psychiatry, its availability is variable. Part of this disparity in access is related to misunderstanding by laypersons regarding the treatment and its potential adverse effects. Adequate education and training of psychiatrists and their support staff are essential to ensuring patients' access to this vital treatment tool. The authors of Clinical Manual of Electroconvulsive Therapy offer this expansive yet reader-friendly volume to help psychiatrists successfully incorporate ECT into their clinical practices. It is also a valuable resource for medical students and psychiatric residents, as well as experienced clinicians and researchers. The book updates the 1985 original and 1998 second edition of Electroconvulsive Therapy: A Programmed Text, and provides readers with a scheduled approach to understanding the fundamental concepts of ECT while offering practical guidance for establishing and maintaining an ECT program. Topics include the history of ECT, indications for use, patient referral and evaluation, the basics of ECT, clinical applications, anesthetics and other medications, seizure monitoring and management, ictal motor and cardiovascular response, adverse effects, and maintenance ECT. Included are detailed descriptions of recent advances including ultra-brief pulse ECT, oxygenation, muscle relaxation, and other modifications that have made this very effective treatment much safer and more acceptable to patients. Currently, it is estimated that more than 100,000 people receive ECT treatments each year in the U.S. Indications for use of ECT are for mood disorders such as major depressive disorder and mania, and thought disorders including schizophrenia and schizoaffective disorder. Indications for use in other psychiatric disorders and general medical disorders such as Parkinson's disease, which appears to respond especially well to ECT, are reviewed as well. This highly-readable manual is a must-have for the library of any clinician interested in or currently practicing ECT: Provides background information on the origins of psychiatric treatments preceding ECT, including efforts using hydrotherapy and insulin comas Includes an algorithm for the management of ECT seizure adequacy Discusses contraindications as well as the potential adverse effects of ECT, including cognitive changes and cardiovascular complications Provides specific information about ECT device manufacturers, reprintable patient information sheets, and a written informed consent form This clinical manual comprehensively explores and explains the available knowledge regarding ECT -- based on extensive research over the past 70 years -- in order to help potential ECT clinicians make informed choices about the development and management of their ECT program.
In this fully-revised fourth edition of what has long been the standard textbook for the field, Dr. Richard Abrams once again demonstrates his unique ability to analyze and present a wealth of new(and often technical) material in a lucid, compelling, and highly readable fashion. Hundreds of new clinical studies called from the more than 1500 published since the third edition appeared have been analyzed in depth and incorporated throughout the book. An important new chapter has been added on Transcranial Magnetic Stimulation(TMS) therapy, a treatment for depression that is widely-used in Europe and expected to become available soon for clinical use in the United States. Dr. Abrams exposes the scientific flaws in several widely-cited reports, while focusing on the few carefully-controlled studies that provide solid support for the results claimed. The sections on the electrical stimulus, seizing introduction, seizure quality, and treatment electrode placement have been completely revised and updated with new information on those clinical and technical issues that are presently of greatest concern to practitioners and researchers. A comprehensive critical assessment of the nature of the seizure threshold and the validity of the stimulus titration method for ECT dosing is presented for the first time, with conclusions and recommendations that many will find surprising. The continued controversy over the relative efficacies of unilateral and bitemporal ECT is revisited in light of the latest dosing strategies and treatment outcomes reported, and of the latest results obtained with bifrontal ECT. The potential clinical and theoretical advantages of the recently-rediscovered technique of ultrabrief pulse therapy are explained in detail. The chapter on the memory and cognitive consequences of ECT has been expanded to focus on the subjective memory effects of treatment, with new analysis of the possible biological basis for the improvement in subjective memory so often reported. Recently-published claims of persistent or permanent memory effects of ECT are refuted in detail. In full accordance with the American Psychiatric Association's new guidelines for the practice of ECT, Dr. Abrams' book remains the essential practical guide and reference work for all those who prescribe, perform, or assist with ECT, or are interested in learning more about the subject.
This volume uncovers the roots of electroshock in America, an outgrowth of western patriarchal medicine with primarily female patients, with a new epilogue bringing the research up to the present.
Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. -- Provided by publisher.
Since the development of pharmacoconvulsive therapy in 1934 and of electroconvulsive therapy (ECT) in 1938, ECT has proven far more valuable than just the intervention of last resort. In comparison with psychotropic medications, we now know that ECT can act more effectively and more rapidly, with substantial clinical improvement that is often seen after only a few treatments. This is especially true for severely ill patients -- those with severe major depression with psychotic features, acute mania with psychotic features, or catatonia. For patients who are physically debilitated, elderly, or pregnant, ECT is also safer than psychotropic medications. The findings of the American Psychiatric Association (APA) Task Force on ECT were published by the APA in 1990 as the first edition of The Practice of Electroconvulsive Therapy, inaugurating the development of ECT guidelines by groups both within the United States and internationally. Since then, advances in the use of this technically demanding treatment prompted the APA to mandate a second edition. The updated format of this second edition presents background information followed by a summary of applicable recommendations for each chapter. This close integration of the recommendations with their justifications makes the material easy to read, understand, and use. To further enhance usability, recommendations critical to the safe, effective delivery of treatment are marked with the designation "should" to distinguish them from recommendations that are advisable but nonessential (with the designations "encouraged," "suggested," "considered"). The updated content of this second edition, which spans indication for use of ECT, patient evaluation, side effects, concurrent medications, consent procedures (with sample consent forms and patient information booklet), staffing, treatment administration, monitoring of outcome, management of patients following ECT, and documentation, as well as education, and clinical privileging. This volume reflects not only the wide expertise of its contributors, but also involved solicitation of input from a variety of other sources, including applicable medical professional organizations, individual experts in relevant fields, regulatory bodies, and major lay mental health organizations. In addition, the bibliography of this second edition is based upon an exhaustive search of the clinical ECT literature over the past decade and contains more than four times the original number of citations. Complemented by extensive annotations and useful appendixes, this remarkably comprehensive yet practical overview will prove an invaluable resource for practitioners and trainees in psychiatry and related disciplines.
This volume uncovers the roots of electroshock in America, an outgrowth of western patriarchal medicine with primarily female patients. The authors trace the history of electroshock in the United States in three historic stages: from an enthusiastic reception in 1940, to a period of crisis in the 1960s, to its resurgence after 1980. Early American experiments with electrical medicine are also examined, while the development of electroshock in America is considered through the lens of social, political, and economic factors. The revival of electroshock in recent decades is found to be a product of growing materialism in American psychiatry and the political and economic realities of managed medical care. The new material in the Updated Paperback Edition describes the resurgence of electroshock in the private psychiatric sector as a treatment of choice for depression.
