Hollywood and ECT

Police of the psyche: the psychiatrist and psychiatry in Spanish punk songs

Previous research has revealed that stigma is not restricted to people with mental health problems but extends to the professionals involved in their care and treatment. Unlike other artistic manifestations, the study of the depictions of psychiatry in popular music is still a less-explored topic. This article addresses the subcultural portrayals of the psychiatrist and psychiatric treatments within Spanish popular music. The predominance of negative depictions of mental health professionals as social control agents was a striking finding, given the topicality that characterises punk music. It is suggested that the allegorical role assigned to the psychiatrist in such a specific narrative framework, marked by ideological factors, could potentially explain these findings. In contrast to other cultural manifestations that show a tendency towards more balanced views of psychiatric treatment and practice, the negative representations in Spanish punk songs seem to have evolved little over decades, reflecting outdated views of the psychiatric approach.

Factors Associated With Utilization of Electroconvulsive Therapy During Psychiatric Hospitalization Among Children and Adolescents in China

PURPOSE

Based on a nationally representative sample in China, we examined the demographic and clinical correlates of utilization of electroconvulsive therapy (ECT) in child and adolescent (C/A) patients younger than 18 years during psychiatric hospitalization.

METHODS

As part of a national survey, 41 provincial tertiary psychiatric hospitals in mainland China were selected. Data from 196 C/A patients who were discharged from these psychiatric hospitals from March 19 to 31, 2019, were retrieved and analyzed.

RESULTS

(1) The overall rate of ECT among C/A patients during psychiatric hospitalization was 15.6% (n = 30). (2) Between ECT and non-ECT groups, significant differences were found in sex, age, length of stay, Global Assessment of Functioning at admission, treatment outcome, and self-injurious behavior during hospitalization, and the ratio of marked improvement on discharge. (3) Multiple logistic regression analysis revealed that ECT use was independently and positively associated with an older age, male sex, lower Global Assessment of Functioning, and self-injurious behavior during hospitalization.

CONCLUSIONS

The frequency of ECT use was relatively frequent in C/A patients during psychiatric hospitalization in our nationally representative sample in China. Developing more specific and operational criteria for the use of ECT for C/A patients is needed to provide guidance for the optimal use of ECT in this patient population.

Cross-cultural Comparison of Perceptions and Knowledge About Electroconvulsive Therapy Among Adults Who Screened Positive for Depression in the United States, India, and China

OBJECTIVE

Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world.

METHODS

We recruited participants who screened positive for depression on the Patient Health Questionnaire 9 (PHQ-9) in the United States (n = 1643), India (n = 1469), and China (n = 328) and compared responses on the ECT-Perception and Knowledge Scale.

RESULTS

Although the US sample had significantly higher PHQ-9 scores than the India and China samples, the US sample was less likely to have been offered ECT or to have ever received ECT. Moreover, the US sample scored lower on the ECT Perception and Knowledge subscales than the other samples indicating more negative perceptions and inaccurate knowledge about ECT. Across samples, there were moderate fears about ECT being painful or causing brain damage, and misconceptions about ECT being outdated and adverse effects of induced seizures. Higher PHQ-9 scores were correlated with more negative perceptions.

CONCLUSIONS

Greater public education is needed about ECT, particularly in the United States. Misperceptions and lack of knowledge may hinder utilization of ECT in India, China, and the United States.

Lights, camera, scalpel: a lookback at 100 years of plastic surgery on the silver screen

BACKGROUND

The presentation of medical topics in the cinema can greatly influence the public's understanding and perception of a medical field, with regard to the doctors and surgeons, medical diagnosis, and treatment and outcome expectations. This study aims to evaluate the representation of plastic surgery in commercial films that include a character with a link to plastic surgery, either as a patient or surgeon.

METHODS

The international film databases Internet Movie Database (IMDb), The American Film Institute (AFI), and British Film Institute (BFI) were searched from 1919 to 2019 to identify feature-length films with a link to plastic surgery. Movies were visualized and analyzed to identify themes, and the portrayal of plastic surgery was rated negative or positive, and realistic or unrealistic.

RESULTS

A total of 223 films were identified from 1919 to 2019, produced across 19 countries. Various genres were identified including drama (41), comedy (25), and crime (23). A total of 172 patient characters and 57 surgeon characters were identified as major roles, and a further 102 surgeons as minor roles. Disparities were noted in presentation of surgeons, both in terms of race and gender, with the vast majority of surgeons being white and male. In total only 11 female surgeons were portrayed and only one black surgeon. Thirteen themes emerged: face transplantation, crime, future society, surgeon mental status, body dysmorphic disorder, vanity, anti-aging, race, reconstructive surgery, deformity, scarring, burns, and gender transitioning. The majority of films (146/223) provide an unrealistic view of plastic surgery, painted under a negative light (80/146). Only 20 films provide a positive realistic image (24/77).

CONCLUSIONS

There exists a complicated relationship between plastic surgery and its representation on film. Surgical and aesthetic interventions are portrayed unrealistically, with surgeons and patients presented negatively, perpetuating stigma, particularly with regard to cosmetic surgery. Cinema is also characterized by lack of representation of female and non-white surgeons. Recruitment of surgeons as technical advisors would help present a more realistic, representative view, without necessarily sacrificing creativity.Level of evidence: Not ratable.

Trends for Electroconvulsive Therapy Utilization in Children and Adolescents in the United States From 2002 to 2017: A Nationwide Inpatient Sample Analysis

OBJECTIVES

Electroconvulsive therapy (ECT) is controversial in children and adolescents (C/A). The primary objective of this study was to evaluate baseline characteristics of C/A in the utilization of ECT compared with the non-ECT group with the same primary indication. The secondary objective was to assess the trends in ECT utilization over 16 years and explore the predictors of length of stay.

METHODS

Using the Nationwide Inpatient Sample database from the years 2002 to 2017, we identified patients (age ≤18 years) undergoing ECT in the United States using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification/Procedure Coding System codes and compared with non-ECT C/A patients with the same primary diagnosis. Baseline clinical characteristics were assessed using descriptive analysis methods. Multilevel regression analysis and trend analysis were performed.

RESULTS

Children and adolescent patients (n = 159,158) receiving (ECT: n = 1870) were more likely to be men (43.3% vs 36.7%) and of White race (58% vs 49%) (P < 0.001). The hospital stay was longer (19 days vs 6 days, P < 0.001) for the ECT group than controls. ECT receiving C/A patients were more likely to have private insurance (72% vs 42%, P < 0.001). African American patients undergoing ECT treatment increased in number over the course of years (2002 to 2017), whereas the privately insured C/A patients receiving ECT decreased over the same period (P < 0.001). There was an upward trend in ECT utilization for small bed size hospitals (P < 0.001). Length of stay for C/A receiving ECT was longer for males (P < 0.001) and patients with nonprivate insurance (p: 0.003).

CONCLUSIONS

Electroconvulsive therapy is not optimally used in C/A; therefore, formulated treatment guidelines are required.

The Nomenclature of Electroconvulsive Therapy

ABSTRACT

Electroconvulsive therapy (ECT) is an established but stigmatized psychiatric treatment. The term ECT reflects the treatment's modality and action. Several authors proposed different names for ECT to deal with stigma; however, available literature that promoted different names did not address the risk/benefit ratio or offer evidence-based approach to the efficacy of this approach. We aim to examine proposed names for their specificity, accuracy, understandability, and popularity. In addition, we aim to find evidence-based methods to combat the ECT-related stigma. We reviewed the literature relating to the proposed names using snowballing technique for literature search. Known ECT alternative names were used for search, and whenever another name appears, it was added to our search list. We conducted Medline, PsycINFO, Google Scholar, and PubMed search to check for popularity and cross examine whether proposed terms refer back to ECT. We searched for ECT and stigma, to find evidence for methods to tackle ECT-related stigma. Once, the search stopped yielding newer ideas, we stopped the search at a point of saturation, where no more ideas where generated. Our name search yielded 14 terms. Nine names avoided "electricity" and "convulsion," because of perceived associated stigma. Presence of different terminology can affect the clarity of patient-doctor communication, with no evidence of added benefit. Alternative names may affect doctor-doctor communication about this treatment. We concluded that it is safer to retain the term ECT for the sake of consistency and clarity of communication. Education and experience are evidence-based effective methods of tackling ECT-related stigma.

"We are like a goat": the theme of madness in Spanish punk songs

INTRODUCTION

The analysis of songs as discursive practices contributes to the understanding of the social representations of mental disorders in specific populations, as has been suggested in the literature. The aim of this article is to expand the knowledge about the depictions of madness (a broader but less delimited concept than psychosis) in the popular music focussing on emerging themes and their cross relations within the discourses of the madness in Spanish punk.

MATERIAL AND METHODS

Qualitative research method. After the review of 3653 songs (1981-2010) insights from the Thematic Analysis of all the 163 identified lyrics of Spanish punk songs with the terms 'mad,' 'madness' or other related words are provided.

RESULTS AND DISCUSSION

After a thorough discussion of the main themes, the expression of subculture's identity became evident. Its otherness was recognizable on the exaltation of madness as loss of control or unpredictability as well as its links with crime, substance abuse or ideological opposition, among others.

CONCLUSIONS

The idea of dangerousness linked to 'madness' emerges as a final pathway of different identified themes, suggesting a potential explanation for the general population attitudes towards the theme of madness.

Professional Stigma of Mental Health Issues: Physicians Are Both the Cause and Solution

After a medical student prompted medical faculty to tell their stories of depression and related mental health issues, the author wrote this article with the aim of decreasing the stigma of mental illness and encouraging treatment, as needed, in the medical profession. The professional culture of the house of medicine not only mimics society in attributing stigma to people with mental health issues but may also contribute to high rates of suicide in the ranks of health care professionals by leading to a delay in seeking treatment. Acculturation accelerates in the first year of medical school such that medical students experience an increase in burnout and depressive symptoms from prematriculation levels. It follows that faculty have a responsibility to improve the learning environment. Survey data from medical faculty at the author's institution showed that depression decreased respondents' willingness to seek mental health treatment because of the stigma and issues of access to help. Faculty attitudes toward mental health issues, including reluctance to admit having such issues, may be conveyed to medical students in the hidden curriculum that teaches them to keep depression hidden. Moreover, the fear of mental disorders is manifested in licensing and privileging applications under the guise of patient safety, contributing to a culture of shame and silence. As creators and guardians of this professional culture, medical faculty and other physicians must be the ones who change it. The same faculty who play a part in causing and perpetuating stigma related to mental health issues have the power to derive and enact some of the solutions. In addition to giving voice to a personal experience of mental health issues, this article offers suggestions for normalizing moderate to severe depression as a medical disorder, decreasing the stigma of mental health issues, and encouraging faculty to seek treatment.

Image of Electroconvulsive Therapy in YouTube Videos

OBJECTIVES

Image of electroconvulsive therapy (ECT) in TV shows and movies have been studied before. However, there is no study about image of ECT on YouTube as one of the most commonly used social media platforms for disseminating health information. Our study aims to study the image of ECT in YouTube videos.

METHODS

Key word "Electroconvulsive therapy and ECT" were used to search on Youtube.com and only videos over 50,000 view counts and in English were selected. Above videos were reviewed by an ECT physician and were classified into neutral, negative, and positive groups based on the image of ECT.

RESULTS

There were 41 YouTube videos selected based on the criteria as stated above, among which 14 were unrelated with ECT treatment, 8 were neutral, 9 were positive, and 10 were reflecting negative image about ECT. There was no significant difference among view counts of the positive, negative and neutral videos (χ = 2.746, P = 0.253). Furthermore, the most viewed 3 videos showed negative image of ECT. Additionally, only 6 videos showed the modified ECT and one showed both modified and nonmodified ECT.

CONCLUSIONS

This is the first study conducted on image of ECT in YouTube videos. We found the stigma against ECT may persist in digital video platforms, such as YouTube.

A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States

OBJECTIVE

Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment.

METHODS

This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation.

RESULTS

Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT.

CONCLUSIONS

These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.

'Delusional' consent in somatic treatment: the emblematic case of electroconvulsive therapy

Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient's motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient's inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the 'error' committed for which the depressed patient blames himself and the social repression of the maniacal patient's affirmation of his inflated self-esteem.

Location of Power within Psychiatry: A Fifty-Year Journey as Represented in Film

Over the last half of the twentieth century, many advances in the field of psychiatry and mental health have occurred and continue today. Among these developments are the increasing recognition of patient rights and the expanding role of psychiatric nurses. This paper presents a view of how these changes have been reflected in film over a period of fifty years in both documentary and Hollywood movies. Discussion of advances in psychiatry, as identified in the selected films, is presented against the background of social change that was occurring in the United States and Western Europe during this period.

Competency by Design for Electroconvulsive Therapy in Psychiatry Postgraduate Training: Face and Content Validation Study

INTRODUCTION

Psychiatry is in the process of shifting curricula in postgraduate training to a competency-by-design approach. One core aspect of postgraduate psychiatry training is the knowledge and practice of electroconvulsive therapy (ECT). The aim of this study was to develop and validate the corresponding set of competencies that need to be developed during postgraduate training in psychiatry.

METHODS

This study involves the proposal of a set of competencies by an ECT curriculum committee from the University Department of Psychiatry, based on the competency-by-design principles, followed by a modified Delphi process, to reach expert consensus on the proposed, modified, and added competencies.

RESULTS

Six ECT experts meeting the preset criteria were recruited to the study from 6 academic centers across Canada and participated in the 2 Delphi rounds. Thirty-one competencies were proposed in the first round. Twenty-three proceeded to the second round by meeting 80% agreement on a score of ≥4 using a 5-point Likert scale. Three competencies required rewording based on qualitative feedback; accordingly, 10 new competencies were suggested. Thirty-five competencies were rated by experts and reached the threshold of agreement and rating. Cronbach α increased from 0.89 after the first round to 0.95 after the second iteration.

DISCUSSION

Consensus was generated on 35 competencies that need to be achieved during postgraduate training in psychiatry. These competencies can serve as the basis for developing ECT curricula in postgraduate psychiatry training. The method used is feasible and can be adopted for the development of other competencies and curricula in psychiatry and other medical fields.

Effects of video psychoeducation on perceptions and knowledge about electroconvulsive therapy

This study examined the effects of video psychoeducation about electroconvulsive therapy (ECT) on perceptions and knowledge about ECT. A pre-post design was used with a national sample of 1,068 adults who screened positive for depression. Participants' perceptions and knowledge about ECT were assessed before and after watching a psychoeducational video about ECT. Participants showed significant increases in positive perceptions and accurate knowledge about ECT after watching the psychoeducational video. In the perception domain, the items "ECT can be lifesaving" and "fears that ECT can be painful" showed the largest positive increases. In the knowledge domain, items related to "ECT is one of the safest procedures performed" and "ECT can be given safely to older persons" showed the largest increases. Over 20% of participants changed their mind and reported they were willing to try ECT after watching the video. Together, these findings suggest video psychoeducation about ECT holds great potential to improve perceptions and knowledge about ECT, particularly as new technologies are developed to create, distribute, and host videos to reach large audiences.

"We are like a goat": the theme of madness in Spanish punk songs (1981-2010)

INTRODUCTION

The analysis of songs as discursive practices contributes to the understanding of the social representations of mental disorders in specific populations, as has been suggested in the literature. The aim of this article is to expand the knowledge about the depictions of madness (a broader but less delimited concept than psychosis) in the popular music focussing on emerging themes and their cross relations within the discourses of the madness in Spanish punk.

MATERIAL AND METHODS

Qualitative research method. After the review of 3,653 songs (1981-2010) insights from the Thematic Analysis of all the 163 identified lyrics of Spanish punk songs with the terms 'mad,' 'madness' or other related words are provided.

RESULTS AND DISCUSSION

After a thorough discussion of the main themes, the expression of subculture's identity became evident. Its otherness was recognizable on the exaltation of madness as loss of control or unpredictability as well as its links with crime, substance abuse or ideological opposition, among others.

CONCLUSIONS

The idea of dangerousness linked to 'madness' emerges as a final pathway of different identified themes, suggesting a potential explanation for the general population attitudes towards the theme of madness.

Electroconvulsive therapy: 80 years old and still going strong

Electroconvulsive therapy (ECT), which is among the oldest and most controversial treatments in the field of psychiatry, has its 80^th birthday this year. In this brief historical overview, the discovery of the therapeutic effects of convulsive therapy by Laszló Meduna, and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described. Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT. The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications, including catatonia, and pre- and postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving. Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed. The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys. This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT, which constitutes a violation of psychiatric patients’ right to an effective treatment.

Use of electroconvulsive therapy in adolescents with schizophrenia in China

BACKGROUND

Electroconvulsive therapy (ECT) is an effective treatment for psychiatric disorders such as schizophrenia, major depression and bipolar disorder. However, few studies have addressed the use of ECT in adolescents with schizophrenia. The aims of our study were to investigate the frequency of ECT, and its relationship with clinical and demographic correlates among adolescents with schizophrenia in China.

METHODS

The study was a retrospective study and conducted in the Child and Adolescent Psychiatry Department of Beijing Anding Hospital, and adolescents with schizophrenia over a period of 10 years (2007-2016) were enrolled. The demographic and clinical data were collected from the electronic chart management system.

RESULTS

A total of 835 patients were included, 411/835 (49.2%) of the adolescent inpatients diagnosed with schizophrenia were in ECT group. There were significant differences in the sex, age, high risk for aggression and suicide, family history of psychiatric disorders and concomitant psychotropic medication (antidepressants and benzodiazepines) between the ECT and non-ECT groups. Multiple logistic regression analysis revealed that ECT use was independently and positively associated with sex, high risk for suicide.

CONCLUSIONS

In a major psychiatric center in China, the use of ECT was common, and reasons for the high use of ECT for adolescent patients in this hospital should warrant urgent investigations.

Prácticas, actitudes y conocimientos en relación a la terapia electroconvulsiva

Introducción. A pesar de la utilidad de la terapia electroconvulsiva (TEC), existe prevención hacia su uso en varios grupos poblacionales.Objetivos. Explorar y describir, desde el punto de vista de psiquiatras, médicos no psiquiatras y comunidad en general, los conocimientos, prácticas y actitudes respecto a la TEC.Materiales y métodos. Este fue un estudio de grupos focales en el que se hizo un análisis temático de las entrevistas.Resultados. Se evidenció que en la población general hay opiniones diversas, la mayoría negativas, y poco conocimiento, el cual proviene de la industria cinematográfica. Aceptar un tratamiento de TEC es siempre la última opción, pero con mayor información al respecto podría ser más considerado. Aunque los médicos muestran interés por conocer estudios sobre TEC, refieren que no han recibido formación y entrenamiento al respecto, además desconocen los avances en el tema. En el grupo de psiquiatras, los conocimientos, prácticas y actitudes dependieron de la experiencia y contacto con la TEC, pues aunque conocen su existencia, la mayoría no la usa ni la recomienda.Conclusión. Las prácticas y actitudes respecto a TEC en las poblaciones estudiadas varían según las experiencias y conocimientos que se tengan de este procedimiento.

Knowledge and attitudes on electroconvulsive therapy in Germany: A web based survey

OBJECTIVE

The aim of this article is to examine knowledge and attitudes on electroconvulsive therapy (ECT) among the German population.

METHOD

A web-based population survey based on a standardized questionnaire was used to examine knowledge and attitudes towards ECT as a treatment of severe depression among the general public (sample of 1000; representative in terms of age, gender and federal states of the German population).

RESULTS

ECT is not well known and negatively connoted among the German population. A higher level of awareness and knowledge about ECT correlates with higher agreement to treatment with it. The analysis of feedback from the open question underlines the complexity of ECT: on the one hand, negative attitudes, stereotypes, and associations, and on the other hand interest, willingness, and acceptance to deal with the method were shown.

CONCLUSION

The results suggest an urgent need for more information about the basic facts, psychiatric applications, and effectiveness of ECT in order to increase the level of awareness and knowledge, and thus the method's acceptance. An increase in acceptance would expand the therapeutic spectrum for the mentally ill. Correspondingly, persons affected and their relatives as well as physicians and healthcare professionals should be involved in awareness-raising measures.

Thinking About Electroconvulsive Therapy: The Opinions of Parents of Adolescents with Schizophrenia Spectrum Disorders

OBJECTIVE

To assess the experience with, knowledge of, and attitudes toward electroconvulsive therapy (ECT) among parents of adolescents with schizophrenia spectrum disorders (SSD) who have received ECT.

METHODS

A self-administered questionnaire was used to assess the experience with, knowledge of, and attitudes toward ECT in a sample of parents of adolescents diagnosed with SSD. Parents of adolescents treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of parents of adolescents treated only with antipsychotics (No ECT group; n = 20).

RESULTS

Most parents in the ECT group claimed that they had received adequate information about the ECT procedure (94.7%), most of them thought it had been helpful for their children (73.7%) and none thought that it had made things worse. The large majority of parents in the ECT group (80%) thought that the illness had been worse than ECT or medication, and none thought that ECT was the worst. Parents in the ECT group generally had better knowledge of what ECT is and its indications. All the parents in the ECT group (100%) and almost all of those in the No ECT group (94.7%) would agree to the treatment for their children if recommended in the future by a doctor, there being no differences between the groups in this respect (p = 0.447). Most parents in the ECT group (88.9%) thought it was a legitimate treatment when used appropriately, an opinion that was held by a much smaller proportion of parents in the No ECT group (52.6%), although the remaining parents in that group were unsure about it (47.4%).

CONCLUSIONS

Most parents of adolescents with SSD treated with ECT had positive views about the treatment. Parents of adolescents treated only with antipsychotics tended either to have positive views about ECT or claimed to have no knowledge about it, with negative views being uncommon.

Madness in the movies: An evaluation of the use of cinema to explore mental health issues in nurse education

The research literature on the use of cinema in nurse education is relatively small. This study evaluates student nurses' learning experiences of a new undergraduate elective module called Madness in the Movies. Ethical approval was granted to conduct the study. Data were collected through an online survey and a social media discussion forum. The anonymous online survey responses were collated via Survey Monkey. Content analysis was conducted on the data from the Facebook discussion threads to understand, interpret and conceptualise the meanings from the data. All study participants agreed that their understanding of mental health issues was enriched, their attitudes and beliefs enhanced and their confidence to talk about mental health concerns increased significantly. This module provides a fruitful approach to encourage critical reflection on mental health issues in a safe environment that closely mirrors authentic practice experiences. The module facilitates the development of students' knowledge, values and attitudes in relation to person-centred mental healthcare.

Based on a True Story? The Portrayal of ECT in International Movies and Television Programs

BACKGROUND

Movies and television (TV) programs are an important source of public information about ECT.

OBJECTIVE

To narratively review the portrayal of ECT in international movies and TV programs from 1948 until present.

METHODS

Several Internet movie databases and a database of phrases appearing in movies and TV programs were searched, supplemented with a Medline-search. No language restrictions were applied.

RESULTS

ECT was portrayed in 52 movies (57 scenes), 21 TV programs (23 scenes), and 2 animated sitcoms (2 scenes). In movies, the main indication for ECT is behavioral control or torture (17/57, 29.8%), whereas in TV programs, the most frequent indication is erasing memories (7/25, 28%). In most scenes (47/82; 57.3%) ECT is given without consent, and without anesthesia (59/82; 72%). Unmodified ECT is depicted more frequently in American scenes (48/64, 75%), as opposed to scenes from other countries (11/18; 64.7%). Bilateral electrode placement is used in almost all (89%, 73/82) scenes. The vast majority of movies (46/57, 80.7%) and TV programs (18/25, 72%) show a negative and inaccurate image of the treatment.

CONCLUSION(S)

In the majority of scenes, ECT is used as a metaphor for repression, mind and behavior control, and is shown as a memory-erasing, painful and damaging treatment, adding to the stigma already associated with ECT. Only a few exceptions paint a truthful picture of this indispensable treatment in modern psychiatry.

An international perspective on the acceptability and sustainability of electroconvulsive therapy

There is robust evidence that electroconvulsive therapy is an effective treatment for some mental illnesses. Despite this, its use remains controversial and is declining in some countries, with a consequent loss of skills and knowledge. This, and the view of it as a 'treatment of last resort', may undermine its sustainability.

Patients' Opinions About Electroconvulsive Therapy: What Do Adolescents with Schizophrenia Spectrum Disorders Think?

OBJECTIVE

The purpose of this study was to assess, in patients with schizophrenia spectrum disorders (SSD) who received electroconvulsive therapy (ECT) prior to the age of 18, their experience, knowledge, and attitudes toward ECT, and to compare the findings with those obtained in adolescents treated only with antipsychotics.

METHODS

Patients diagnosed with SSD (n = 19) and treated with ECT before the age of 18 years (ECT group; n = 19) were compared with a randomly selected group of patients with SSD treated only with antipsychotics (non-ECT group, n = 21). A self-administered questionnaire was used to assess their experience, knowledge, and attitudes.

RESULTS

Most adolescents in the ECT group thought that the intervention had been helpful (78.9%) and believed that their illness had been worse than ECT or medication (68.4%). Similarly, almost three quarters of these patients did not believe the treatment to be cruel (73.7%) or outdated (73.7%), or that it should be illegal (68.4%). Patients in the non-ECT group often chose "don't know" as their response to the survey questions, and significant differences between the groups were observed. Most patients in both the ECT group (84.2%) and the non-ECT group (80%) said that they would accept the treatment in the future if necessary, there being no differences between the groups in this respect (p = 0.2).

CONCLUSIONS

Most adolescents in the ECT group had positive views about ECT. By contrast, most adolescents in the non-ECT group either did not know or did not have a clear opinion regarding ECT treatment, although they did not have negative views about it.

Childhood cancer in the cinema: how the celluloid mirror reflects psychosocial care

OBJECTIVE

This study aims to evaluate the childhood cancer experience in commercially produced, readily available films that include a character with childhood cancer, with a particular focus on psychosocial care.

METHODS

We reviewed 29 films, using quantitative and qualitative content analysis, to identify the medical and psychosocial characteristics of the cinematic childhood cancer experience. We rated psychosocial support on a 5-point scale (0 to 4) based on the availability and efficacy of support characters in the categories of nonprofessional internal (eg, parent), nonprofessional external (eg, friend), professional medical (eg, oncologist), and professional psychosocial (eg, social worker) supports.

RESULTS

Film depicts an unrealistic, bleak picture of childhood cancer, with a 66% mortality rate among the 35 characters evaluated. Psychosocial supports portrayed in film are generally limited to resources already available to families before the cancer diagnosis: mean ratings across films were 2.4 for both nonprofessional, 1.6 for professional medical, and 0.3 for professional psychosocial supports (Kruskal-Wallis χ3=43.1051, P<0.0001). Seven main themes emerged: disruption, social impact, psychological impact, physical toll, struggle/war/fight, coping, and barren landscape. Film generally depicts images of an isolated family courageously battling cancer alone with limited support from a treatment team solely dedicated to medical care.

CONCLUSIONS

Commercially available films minimize the importance of the psychosocial dimension of care, which can perpetuate stigma around psychosocial needs and interventions. These films can be used to encourage discussion about how to optimize psychosocial care in pediatric oncology so that such care is not abandoned in actual practice as it is, for entertainment purposes, on the screen.

Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

PURPOSE

Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself.

METHODS

We treated 5 cases of severe protracted delirium in our ICU with electroconvulsive therapy (ECT) after failure of conventional medical therapy.

RESULTS

The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma.

CONCLUSION

Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative.

Does art imitate death? Depictions of suicide in fiction

OBJECTIVE

To determine whether fiction (narrative products) deals with the issue of suicide and, if so, what it tells us about suicide "drivers".

METHOD

Accounts of suicide in narrative products were sought through web-based lists, book club members, other active readers and a prize-winning film writer and producer.

RESULTS

Seventy-one depictions of fictional suicidal events were identified. In 12 suicides, the author appeared to indicate that the death was directly or indirectly due to mental disorder. In 15 suicides, the motivation could not be determined by the reader, and in 44 cases the motivation was social/situational factors.

CONCLUSIONS

Suicidal events are depicted in fiction, and the features are broadly similar to the features of suicide in the real world. Should it be determined that cultural influences, including fiction, are important in suicide, any preventive activities aimed at modifying cultural influences will need to consider all forms of narrative product.

Public attitudes towards electroconvulsive therapy in the Chuvash Republic

BACKGROUND

Public attitudes towards a given medical procedure can have a significant influence on the employment of that method. Electroconvulsive therapy (ECT) is a medical procedure that has received an exceptionally ambiguous public reception since its inception.

AIM

To survey the level of information about and attitudes towards ECT in a general population sample of the Chuvash Republic of the Russian Federation.

METHODS

A randomly selected cohort of 5,373 people was contacted by telephone. The respondents were asked three closed and three open questions.

RESULTS

The response rate was 74.7%. Only 35.2% of those interviewed said they knew anything about ECT. Health professionals and younger respondents were better informed. The two main sources of information about ECT were foreign films and the mass media. The main indication of ECT was thought to be schizophrenia. The majority (63.3%) of the respondents had negative opinions and emotions about ECT.

CONCLUSION

Limited information about and generally negative attitudes towards ECT were found in the general population of the Chuvash Republic. Gender, age, education level, employment in the health industry, and information source were found to be the determining factors in the knowledge of and attitudes towards ECT.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

The depiction of electroconvulsive therapy in Hindi cinema

BACKGROUND

There is little literature on the depiction of electroconvulsive therapy (ECT) in movies. In India, Hindi cinema is an important source of public information and misinformation about ECT.

METHODS

We identified depictions of ECT in Hindi cinema through inquiries with e-communities, video libraries, and other sources. We also searched the PubMed database using search terms related to ECT and movies.

RESULTS

Between 1967 and 2008, 13 Hindi movies contained referrals to or depictions of ECT. By and large, the depictions were inaccurate, distorted, and dramatized. Electroconvulsive therapy was administered to punish, to obliterate identity, to induce insanity, and for other rarely clinically valid indications. Electroconvulsive therapy was almost always administered by force. Premedication was rare. Genuine ECT devices were uncommonly used. Electroconvulsive therapy stimulation almost invariably appeared to cause pain. Multiple shocks were frequently delivered in the same session. The convulsions were usually bizarre. The treatment caused mental disturbance, amnesia, weakness, and even a zombielike state, thought not mortality; clinical improvement was rare. There was no pattern of increasing accuracy of depiction of ECT with recency of movie release.

DISCUSSION

We examine the extent to which the identified inaccuracies are practically important and offer reasons for the inaccuracies. Although the inaccuracies are a cause for concern, we suggest that because Hindi cinema is generally hyperbolic, the public may be willing to distinguish real life from reel life when facing clinical decisions about ECT. Nevertheless, considering the potential for harm in the dissemination of misinformation, filmmakers should exhibit a greater sense of ethics when creating impressions that might adversely influence health.