Electroconvulsive therapy Matt Jarvis Hodder Stoughton 2020 The

Electroconvulsive therapy Matt Jarvis Hodder & Stoughton © 2020

The background to ECT Nineteenth-century researchers noticed high density of glial cells in epileptic brains and low density in brains of people with schizophrenia. Later, camphor was used to induce fits in an attempt to replicate the effect of higher glial cell density Hodder & Stoughton © 2020 Glial cells

ECT By the late 1930 s, chemically induced convulsions were replaced by electrically induced convulsions. Because the treatment involved electricity and convulsions it was called electroconvulsive therapy, or ECT for short. Hodder & Stoughton © 2020

Varieties of ECT Anaesthetic Indirect ECT: with anaesthetic Direct: without Duration Sine wave: continuous Brief pulse: 0. 5– 1. 5 ms Ultrabrief pulse: <0. 3 ms Laterality Unilateral: administered to one side Bilateral: both side Choice of ECT mode To reduce side-effects, ECT treatment in the UK is generally indirect, brief or ultrabrief, and unilateral. Hodder & Stoughton © 2020

The process of ECT To prepare for ECT, patients are usually given a general anaesthetic and muscle relaxants, and a tongue guard is inserted. Electrodes are placed on the scalp and a shock is given, leading to a seizure lasting around 15 seconds. Hodder & Stoughton © 2020

Evaluation of ECT • ECT can be effective (e. g. Van Dierman et al. (2018)), and works more quickly than drugs. For major depression it may be the most effective treatment. • There can be serious — though usually temporary — sideeffects • There are other ethical considerations, for example around capacity to consent. • There are various possible mechanisms by which ECT works but the major reason(s) are not clear. Hodder & Stoughton © 2020