User:Xyn1/ect pt 1

Electroconvulsive therapy (ECT), (also known as electroshock), is a controversial psychiatric treatment where electrodes are placed on the brain to induce electrical seizures for treating psychiatric illnesses such as depression and schizophrenia. The efficacy of ECT has been debated by psychiatrists as it was shown that persons even receiving placibo (or 'fake') ECT recovered at an almost equal rate. Therefore, ECT is usually used as a last line of intervention for major depressive disorder, schizophrenia, mania and catatonia. A standard ECT involves administrations across weeks, months and years and ECT in itself doesn't usually have a sustained benefit, thus, drug therapy is continued during and after ECT. It was first introduced in 1938 by Italian neuropsychiatrists Ugo Cerletti and Lucio Bini, and gained widespread popularity among psychiatrists as a form of treatment in the 1940s and 1950s.

Although it is depicted as a painful procedure in western fiction, a majority of ECT is administered under general anestesia.

Due to various side effects associated with the treatment such as short term and long term memory loss, The World Health Organization discourages its use on children and advises that it should only be given after informed consent is taken from the patient. But, in exceptional circumstance, such as in emergencies, it permits the patient's guardian to offer consent for the procedure.

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Since more women are diagnosed with depression, about 70% of ECT patients are women. Although a large amount of research has been carried out, the exact mechanism of action of ECT remains elusive, and ECT on its own does not usually have a sustained benefit. Administration is most commonly bilateral, in which the electrical current is passed across the whole brain, and which seems to have greater efficacy but greater risk of memory loss, or less commonly, unilateral, which has less efficacy but also reduced risk of memory loss. The World Health Organization (2005) advises that it should only be used with the informed consent of the patient or their proxy, only with adequate analgesia and muscle relaxants, and never on children. Psychiatrists and other mental health professionals differ on when and if ECT should be used as a first-line treatment or if it should be reserved for patients who have not responded to other interventions such as medication and psychotherapy. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women.

Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT. In the United Kingdom and Ireland, drug therapy usually is continued during ECT.

History
As early as the 16th century, agents to induce seizures were used to treat mental illness. In 1785, this was documented in the London Medical Journal. Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who incorrectly believed that schizophrenia and epilepsy were disorders which couldn't co-occur, He first induced seizures first with camphor and then metrazol (cardiazol). During this time It was known that inducing convulsions aided in helping those with schizophrenia like symptoms. Ladislas Meduna is considered to be the father of convulsive therapy. The first international meeting on convulsive therapy was held in 1937, in Switzerland by the Swiss psychiatrist Muller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide. Italian neuropsychiatrist Ugo Cerletti and Lucio Bini used electric shocks to produce seizures in animal experiments, and developed the idea of using electricity as a substitute for metrazol in convulsive therapy in humans. In 1937 they experimented for the first time on a human. Cerletti had noted a shock to the head produced convulsions in dogs. To use the same idea on humans came to Cerletti when he saw pigs were given an electric shock to put them in an anesthetized state, before being slaughtered. Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on humans they found that after 10 to 20 treatments, the results were positive. Although they noted that the reason that their patients were more receptive to ECT (compared to other means of seasure induction) was due to the side effect of autobiographical memory loss or retrograde amnesia. ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient. Cerletti and Bini were even nominated for a Nobel Prize. By 1940, it was introduced to both England and the US. In Germany and Austria it was promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread to treat various forms of mental illness.

In the early 1940s, in an attempt to reduce the memory disturbance and confusion also known as retrograde amnesia, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted. In the 1940s and early 1950s ECT was usually given in "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s psychiatrists began to experiment with curare, the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. Thus, a short-acting anesthetic was usually given along with a muscle relaxant to prevent feelings of suffocation that can be experienced with muscle relaxants.

Later on, due to the emergence of antidepressant medications including SSRIs such as Prozac, which was depicted in the mass media more positively compared to the negative depictions of ECT to a marked decline in its use during the 1950s to the 1970s. The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media." The New York Times described the public's negative perception of ECT as being caused mainly by one movie. It stated:"For Big Nurse in One Flew Over the Cuckoo's Nest, it was a tool of terror, and, in the public mind, shock therapy has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused"

In 1976, Dr. Blatchley developed and demonstrated the efficacy of his constant current, brief pulse ECT device. It replaced earlier devices because of the reduction in cognitive side effects such as memory loss. Although very few clinics still use sine-wave ECT devices, even to this day.

In the 1970s the American Psychiatric Association (APA) published its report on ECT which were followed up by two others in 1990 and 2001. All of these endorsed the use of ECT in the treatment of depression. The critics during this time pointed to shortcomings such as side effects (such as memory loss) as well as it being used as a form of abuse or being unevenly used. The use of ECT declined until the 1980s, when the New York Times, reported:

"[its] use began to [again] increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression""

In 1985 the government agencies, National Institute of Mental Health and National Institutes of Health staged a conference on ECT for developing a consensus. It concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it has been shown to be effective for a narrow range of severe psychiatric disorders.

Along with the pre-existing criticisms, national institutions also reviewed prior practices and set new standards. In 1978, The American Psychiatric Association released its first task force report in which new standards for consent were introduced which stipulated that ECT cannot be given to children and involuntary ECT can only be adminstried in emergency settings. It also recommended the use of unilateral electrode placement. The conference organized by the NIMH also confirmed the efficacy of ECT in certain circumstances. The second report on ECT released by the American Psychiatric Association in 1990 documented the specific details on the delivery, education, and training of ECT. The last report on ECT, by the APA in 2001 emphasized the importance of informed consent, and the expanded role that the procedure has in modern medicine.