Knowledge and attitudes of adolescents with psychiatric disorders and their caregivers towards electroconvulsive therapy in China

Knowledge and attitudes towards electroconvulsive therapy for psychiatric conditions in a single-center Jordanian hospital: a cross-sectional study

Background

Knowledge and attitude toward electroconvulsive therapy (ECT) play crucial roles in determining the acceptance of ECT as a viable and effective treatment option.

Results

This study involved 400 participants (57.3% female), aged 18–25 years (36.8%) and predominantly single (49.8%), with a bachelor’s degree or higher (78.8%). Only 1.8% had undergone ECT before. While 32.0% relied on social media for ECT information, only 9.5% had a family history of psychiatric illness, and 5.8% had previous psychiatric visits. Knowledge about ECT was moderate (4.51 ± 1.76). Attitudes were less favorable (2.45 ± 2.47), with concerns about ECT as punishment or inhumane treatment. Public stigma towards mental illness was moderate (mean score: 17.77 ± 6.89), with some disagreement on stereotypes. Significant differences were observed in the knowledge scale based on residing governorates and sources of information (p = 0.003 and < 0.001, respectively). Additionally, significant differences in the attitude scale were reported for sources of information (p = 0.002), and significant differences in public stigma were found among age groups (p = 0.023). Spearman’s correlation revealed moderate positive associations between knowledge and attitudes (0.314, p < 0.001) and weak positive associations between knowledge and public stigma (0.185, p < 0.001).

Conclusion

Patients with stigma and poor knowledge of ECT may affect their choice in undergoing or advising family members to take on ECT if medically prescribed.

Electroconvulsive therapy knowledge and attitudes among patients and caregivers in South China: A preliminary study

Background

Electroconvulsive therapy (ECT) is a safe and effective therapy for individuals suffering from major psychiatric disorders, but attitudes towards ECT among patients and caregivers have not been well studied. This study was conducted to elucidate patient and caregiver knowledge and attitudes concerning ECT in South China.

Methods

The sample comprised 92 patients diagnosed with major psychiatric disorders and their caregivers (n = 92). Participants completed questionnaire measures of knowledge and attitudes related to ECT.

Results

Information before ECT was inadequately provided to both caregivers and patients (55.4% versus 37.0%, p &lt; 0.05). Caregivers reported receiving more adequate information about the therapeutic effects (50.0% versus 44.6%), side effects (67.4% versus 41.3%), and risks (55.4% versus 20.7%) of ECT when compared to patients (all p &lt; 0.05). However, less than half of patients and caregivers believed that ECT was effective (43.5% versus 46.7%, p &gt; 0.05), while more than half of them believed that ECT was beneficial (53.3% versus 71.7%, p &lt; 0.05), and approximately half of them believed that ECT was safe (50.0% versus 51.1%, p &gt; 0.05). A total of 32.6% of patients and 55.4% of caregivers (p &lt; 0.05) reported that ECT was used only for critically ill patients. A total of 62.0% of patients experienced side effects, with memory impairment being the most commonly reported.

Conclusion

Clinicians should develop a systematic health education program before ECT treatment and ensure that patients and caregivers have an accurate understanding of ECT, particularly the treatment process, its therapeutic effects and potential side effects prior to administering this treatment.

What are the ethical dilemmas in the decision-making processes of nursing people given electroconvulsive therapy? A critical realist review of qualitative evidence

WHAT IS KNOWN ON THE SUBJECT?: ECT is a treatment which has a long and complicated history. There is no consensus on its effectiveness and there is a great deal of polarized debate as to whether it should be used. MHNs are asked to work with people who are receiving ECT as part of their duties. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper seeks to move beyond the polarized arguments and to consider how MHNs can work with people where ECT is being considered or administered as part of their treatment in a manner which satisfies their professional obligations. IMPLICATIONS FOR PRACTICE: MHNs may need to broaden their understanding of ethics beyond the traditional biomedical ethics model of beneficence, non-maleficence, justice and autonomy, as well as improving their understanding of social and political factors which may have an unseen effect of the use of ECT as a treatment in order to meet their professional obligations when working with people being administered ECT. ABSTRACT: INTRODUCTION Electroconvulsive therapy (ECT) has a complex and contentious place in psychiatric care. Mental health nurses (MHNs) are of obligated to be part of this practice despite ethical concerns. Aim To consider the ethical dilemmas and decision-making processes facing MHNs involved in the administration of ECT. Method A critical realist review of the literature surrounding ethical considerations and ECT was undertaken using thematic analysis. Findings Four key themes emerged: the MHN as an advocate and conflict in their role, issues surrounding consent, questionable efficacy and unknown method of action, side effects, and legal issues and clinical guidelines. Discussion Using a critical realist framework for understanding, the decision-making process and ethical considerations are viewed as part of the empirical and actual parts of reality, while the potential for other, unseen causal powers to be at play is acknowledged. Implications for practice MHNs need to ensure they have an adequate ethical underpinning to their practice to enable them to navigate contentious areas of practice such as ECT to practice effectively and preserve safety. This may require moving beyond the traditional biomedical model of ethics. Developing an appreciation of unseen causal factors is also an essential part of MHNs' developing professional competency.

Serum BDNF levels and the antidepressant effects of electroconvulsive therapy with ketamine anaesthesia: a preliminary study

Objective

To firstly examine the relationship between serum brain-derived neurotrophic factor (BDNF) levels and antidepressant response to ketamine as an anaesthesia in electroconvulsive therapy (ECT) in Chinese patients with treatment-refractory depression (TRD).

Methods

Thirty patients with TRD were enrolled and underwent eight ECT sessions with ketamine anaesthesia (0.8 mg/kg) alone. Depression severity, response and remission were evaluated using the 17-item Hamilton Depression Rating Scale (HAMD-17). Enzyme-linked immunosorbent assay (ELISA) was applied to examine serum BDNF levels in patients with TRD at baseline and after the second, fourth and eighth ECT sessions. Baseline serum samples were also collected for 30 healthy controls.

Results

No significant differences were observed in serum BDNF levels between patients with TRD and healthy controls at baseline (p > 0.05). The remission rate was 76.7% (23/30) after the last ECT treatment, although all patients with TRD obtained antidepressant response criteria. Serum BDNF levels were not altered compared to baseline, even between remitters and nonremitters (all p > 0.05), despite the significant reduction in HAMD-17 and Brief Psychiatric Rating Scale (BPRS) scores after ECT with ketamine anaesthesia (all p < 0.05). The antidepressant effects of ECT with ketamine anaesthesia were not correlated with changes in serum BDNF levels (all p > 0.05).

Conclusion

This preliminary study indicated that serum BDNF levels do not appear to be a reliable biomarker to determine the antidepressant effects of ketamine as an anaesthesia in ECT for patients with TRD. Further studies with larger sample sizes are warranted to confirm these findings.