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Lee SH, Hyung WSW, Youn CE, Chi S, Youn H, Lee MS, Han C, Jeong HG. Trends in Electroconvulsive Therapy Utilization in South Korea: Health Insurance Review Data From 2008 to 2018. Psychiatry Investig 2024; 21:691-700. [PMID: 39089694 PMCID: PMC11298272 DOI: 10.30773/pi.2024.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE The study aimed to analyze and clinically correlate 10-year trends in the demographic characteristics of patients receiving electroconvulsive therapy (ECT) to provide an overview of ECT utilization in South Korea. METHODS Using health insurance claims data from 2008 to 2018 retrieved from Health Insurance Review and Assessment Service database in South Korea, we identified individuals undergoing ECT based on procedural codes. Descriptive analysis evaluated baseline clinical characteristics, and trend analysis used a linear regression model. RESULTS The prevalence of ECT increased by 240.49% (0.405/105 inhabitants in 2008 to 0.974/105 inhabitants in 2018). The increasing trend was more pronounced in younger and older patients. The proportion of women consistently exceeded that of men. A rise in the proportion of patients with affective disorders, and a decrease in the proportion of psychotic disorders was observed. More antidepressants and atypical antipsychotics were prescribed to patients undergoing ECT. The proportion of ECT sessions conducted in large hospital inpatient settings also decreased during the observation period. Despite increasing global trends, ECT prevalence in South Korea remains significantly lower than worldwide rates. CONCLUSION This study demonstrated an increasing trend of ECT across a wide range of population demographics and in more accessible settings. The comparatively low prevalence of ECT in Korea compared to other countries might be attributed to insufficient mental health literacy and the stigma associated with ECT. Given the elevated suicide rates in Korea, more extensive adoption of ECT appears imperative.
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Won Seok William Hyung
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chae En Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Suhyuk Chi
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea
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Quiles C, Sy H, Verdoux H. Stigmatization towards electro convulsive therapy: Impact of practical teaching on medical and nursing students. L'ENCEPHALE 2024; 50:125-129. [PMID: 37121808 DOI: 10.1016/j.encep.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND This study explored the impact of theoretical and practical teaching on electro convulsive therapy (ECT) on medical and nursing students' stigmatizing attitudes towards ECT and representations of it. METHOD Fourth-year medical students and nursing students answered questions from the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) and from the Mental Illness: Clinicians' Attitudes version 2 (MICA v2) scale. The questionnaires were completed before and after observing a 3-hour practical training session in the ECT unit. The endpoint was the impact of practical training as assessed by MICA and QuAKE scores. Multivariate analyses were used to explore the impact of practical training on MICA and QuAKE total scores. RESULTS Stigmatizing attitudes and representations of both medical and nursing students towards ECT were reduced after practical training (β=-4.43 [95% CI -6.15; -2.70] p=0.0001). The impact was greater in medical students (β=-8.03; 95% CI [-10.71; -5.43], P=0.0001) than in nursing students (β=-2.77; 95% CI [-4.98; to 0.44], P=0.02). Gender, psychiatric history in close persons, and having already followed a psychiatric/ECT course had no independent impact on stigmatizing attitudes towards ECT and representations of it. CONCLUSION Practical training in ECT should be given to all health professionals to improve access to it.
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Affiliation(s)
- Clélia Quiles
- Centre Hospitalier Charles Perrens, 121, rue de la Béchade, CS81285, 33076 Bordeaux Cedex, France; Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000 Bordeaux, France.
| | - Héloïse Sy
- Centre Hospitalier Charles Perrens, 121, rue de la Béchade, CS81285, 33076 Bordeaux Cedex, France
| | - Hélène Verdoux
- Centre Hospitalier Charles Perrens, 121, rue de la Béchade, CS81285, 33076 Bordeaux Cedex, France; Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000 Bordeaux, France
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Samaâli S, Lansari R, Hamdoun J, Larnaout A, Melki W. [Electroconvulsive therapy among Tunisian physicians: Controversies and shortcomings]. L'ENCEPHALE 2024:S0013-7006(24)00021-6. [PMID: 38369427 DOI: 10.1016/j.encep.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Samir Samaâli
- Faculté de médecine de Tunis, El Manar, 2041 Tunis, Tunisie.
| | - Rania Lansari
- Faculté de médecine de Tunis, El Manar, 2041 Tunis, Tunisie; Service de psychiatrie D, CHU Razi, Tunis, Tunisie
| | - Jihene Hamdoun
- Faculté de médecine de Tunis, El Manar, 2041 Tunis, Tunisie
| | - Amine Larnaout
- Faculté de médecine de Tunis, El Manar, 2041 Tunis, Tunisie; Service de psychiatrie D, CHU Razi, Tunis, Tunisie
| | - Wahid Melki
- Faculté de médecine de Tunis, El Manar, 2041 Tunis, Tunisie; Service de psychiatrie D, CHU Razi, Tunis, Tunisie
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Cunningham JE, Bluhm R, Achtyes ED, McCright AM, Cabrera LY. The differential effects of psychiatrists' and patients' prior experiences on views about psychiatric electroceutical interventions. J Psychiatr Res 2024; 170:11-18. [PMID: 38101204 PMCID: PMC10872233 DOI: 10.1016/j.jpsychires.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/19/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
The aim of this study is to examine ways in which prior experiences and familiarity with psychiatric electroceutical interventions (PEI) shape psychiatrists' and patients' views about these interventions. We administered a national survey, with an embedded experiment, to psychiatrists (n = 505) and adults diagnosed with depression (n = 1050). We randomly assigned respondents to one of 8 conditions using a full factorial experimental design: 4 PEI modalities [ECT, rTMS, DBS, or adaptive brain implants (ABIs)] by 2 depression severity levels [moderate or severe]. We analyzed the survey data with ANOVA and OLS linear regression models. Patients having experience with any PEI reported more positive affect toward, but also greater perceived risk from, their assigned PEI than did patients with no such experience. Psychiatrists who referred or administered any PEI reported more positive affect toward and greater perceived influence on self and perceived benefit from their assigned PEI than did psychiatrists with no such familiarity. Limitations of our study include that our participants were randomly assigned to a PEI, not necessarily to the one they had experience with. Moreover, our study did not directly ask about the kind of experiences participants had with a given PEI. Overall, our survey data shows that greater experience with PEIs elicits more positive affect in both stakeholder groups. Beyond this, prior PEI experience shapes attitudes towards these interventions in complex ways. Further research linking different types of experience with a given PEI would help better understand factors shaping attitudes about specific PEIs.
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Affiliation(s)
| | - Robyn Bluhm
- Lyman Briggs College and Department of Philosophy, Michigan State University, East Lansing, MI, USA
| | - Eric D Achtyes
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Aaron M McCright
- Department of Sociology, Michigan State University, East Lansing, MI, USA
| | - Laura Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institute, and Huck Institute of Life Sciences, Pennsylvania State University, University Park, PA, USA.
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Goh SE, Tan XW, Tor PC. Effect of early electroconvulsive therapy on length of stay in patients with bipolar, depressive and psychotic disorders. Schizophr Res 2023; 261:139-144. [PMID: 37722210 DOI: 10.1016/j.schres.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/21/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE There is limited literature examining the effect of early electroconvulsive therapy(ECT) on the length of stay(LOS), especially for psychotic disorders. This study aimed to evaluate the association between early ECT and LOS in three main groups of patients with bipolar, depressive and primary psychotic disorders. METHOD A retrospective descriptive analysis of 464 patients who received inpatient ECT from May 2017 to March 2021 in a large tertiary psychiatric institution was conducted. Early ECT was defined as ECT done before the mean number of days from admission to initiation of ECT by diagnosis. The main outcome measure was LOS, which was examined by diagnosis between the early and late ECT groups, using a linear regression model with adjustment factors chosen based on univariate analysis. RESULTS A strong, significant association was found between early ECT and a shorter LOS (β -28.3, 95 % CI -33.6 to -23.0, p < 0.001), even after accounting for adjustment factors. This association was consistent in all three diagnosis groups: bipolar disorders (β -14.5, 95 % CI -20.1 to -9.0, p < 0.001), major depressive disorder (β -18.2, 95 % CI -27.1 to -9.3, p < 0.001) and psychotic disorders (β -39.0, 95 % CI -46.8 to -31.2, p < 0.001). There was no significant difference in the 30-day readmission rates between the early and late ECT groups trans-diagnostically. CONCLUSION Early ECT is strongly associated with a shorter LOS across a range of diagnostic indications including major depressive disorder, bipolar disorder and schizophrenia. ECT can be considered earlier in treatment-decision algorithms and may offer a reduction in LOS.
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Affiliation(s)
- Shih Ee Goh
- Department of Mood & Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
| | - Xiao Wei Tan
- Department of Mood & Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
| | - Phern Chern Tor
- Department of Mood & Anxiety, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
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Frid LM, Kessler U, Ousdal OT, Hammar Å, Haavik J, Riemer F, Hirnstein M, Ersland L, Erchinger VJ, Ronold EH, Nygaard G, Jakobsen P, Craven AR, Osnes B, Alisauskiene R, Bartsch H, Le Hellard S, Stavrum AK, Oedegaard KJ, Oltedal L. Neurobiological mechanisms of ECT and TMS treatment in depression: study protocol of a multimodal magnetic resonance investigation. BMC Psychiatry 2023; 23:791. [PMID: 37904091 PMCID: PMC10617235 DOI: 10.1186/s12888-023-05239-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Noninvasive neurostimulation treatments are increasingly being used to treat major depression, which is a common cause of disability worldwide. While electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are both effective in treating depressive episodes, their mechanisms of action are, however, not completely understood. ECT is given under general anesthesia, where an electrical pulse is administered through electrodes placed on the patient's head to trigger a seizure. ECT is used for the most severe cases of depression and is usually not prescribed before other options have failed. With TMS, brain stimulation is achieved through rapidly changing magnetic fields that induce electric currents underneath a ferromagnetic coil. Its efficacy in depressive episodes has been well documented. This project aims to identify the neurobiological underpinnings of both the effects and side effects of the neurostimulation techniques ECT and TMS. METHODS The study will utilize a pre-post case control longitudinal design. The sample will consist of 150 subjects: 100 patients (bipolar and major depressive disorder) who are treated with either ECT (N = 50) or TMS (N = 50) and matched healthy controls (N = 50) not receiving any treatment. All participants will undergo multimodal magnetic resonance imaging (MRI) as well as neuropsychological and clinical assessments at multiple time points before, during and after treatment. Arterial spin labeling MRI at baseline will be used to test whether brain perfusion can predict outcomes. Signs of brain disruption, potentiation and rewiring will be explored with resting-state functional MRI, magnetic resonance spectroscopy and multishell diffusion weighted imaging (DWI). Clinical outcome will be measured by clinician assessed and patient reported outcome measures. Memory-related side effects will be investigated, and specific tests of spatial navigation to test hippocampal function will be administered both before and after treatment. Blood samples will be stored in a biobank for future analyses. The observation time is 6 months. Data will be explored in light of the recently proposed disrupt, potentiate and rewire (DPR) hypothesis. DISCUSSION The study will contribute data and novel analyses important for our understanding of neurostimulation as well as for the development of enhanced and more personalized treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05135897.
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Affiliation(s)
- Leila Marie Frid
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, , Psychiatry Research Skåne, Region Skåne, Sweden
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Vera Jane Erchinger
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Gyrid Nygaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Petter Jakobsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Berge Osnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Hauke Bartsch
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Stephanie Le Hellard
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kristin Stavrum
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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De Schuyteneer E, Dewachter B, Vansteelandt K, Pilato E, Crauwels B, Lambrichts S, Verspecht S, Hebbrecht K, Obbels J, Sienaert P. Knowledge and Attitudes of First- and Final-Year Medical Students about Electroconvulsive Therapy: The Impact of Media. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01779-5. [PMID: 37058205 DOI: 10.1007/s40596-023-01779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate medical students' knowledge about and attitudes towards electroconvulsive therapy (ECT) and to assess the impact of information sources (including those within and outside the curriculum) on knowledge and attitudes by comparing first- and final-year medical students. METHODS Two hundred and ninety-five first-year and one hundred forty-nine final-year medical students of the University of Leuven (KU Leuven) in Belgium responded to an anonymous self-administered survey which consisted of questions about sociodemographic background, self-perceived knowledge about medicine, psychiatry and ECT, interest in psychiatry, experience with psychiatric disorders, information sources of ECT, and knowledge about and attitudes towards ECT. RESULTS Compared to first-year medical students, final-year students had better knowledge about and more positive attitudes towards ECT, partially explained by differences in information sources. Nevertheless, both student groups showed an average knowledge score below 50%. Whereas freshmen attributed their knowledge to movies or documentaries, senior students gained knowledge mainly at university courses, scientific journals, and attending live ECT sessions. A significant positive correlation was found between knowledge about and positive attitudes towards ECT. CONCLUSIONS The knowledge of first- and final-year medical students remains limited, potentially due to limited instruction about ECT in medical courses. The use of media as an information source predicted negative attitudes towards ECT. Therefore, the stigma and misinformation provided in the media need to be addressed in the medical curriculum.
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Affiliation(s)
| | - Bram Dewachter
- KU Leuven, University Hospital KU Leuven, Leuven, Belgium
| | | | - Eva Pilato
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Bo Crauwels
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Simon Lambrichts
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Shauni Verspecht
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Kaat Hebbrecht
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium.
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Personalized Diagnosis and Treatment for Neuroimaging in Depressive Disorders. J Pers Med 2022; 12:jpm12091403. [PMID: 36143188 PMCID: PMC9504356 DOI: 10.3390/jpm12091403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/10/2023] Open
Abstract
Depressive disorders are highly heterogeneous in nature. Previous studies have not been useful for the clinical diagnosis and prediction of outcomes of major depressive disorder (MDD) at the individual level, although they provide many meaningful insights. To make inferences beyond group-level analyses, machine learning (ML) techniques can be used for the diagnosis of subtypes of MDD and the prediction of treatment responses. We searched PubMed for relevant studies published until December 2021 that included depressive disorders and applied ML algorithms in neuroimaging fields for depressive disorders. We divided these studies into two sections, namely diagnosis and treatment outcomes, for the application of prediction using ML. Structural and functional magnetic resonance imaging studies using ML algorithms were included. Thirty studies were summarized for the prediction of an MDD diagnosis. In addition, 19 studies on the prediction of treatment outcomes for MDD were reviewed. We summarized and discussed the results of previous studies. For future research results to be useful in clinical practice, ML enabling individual inferences is important. At the same time, there are important challenges to be addressed in the future.
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Kitay BM, Walde T, Robertson D, Cohen T, Duvivier R, Martin A. Addressing Electroconvulsive Therapy Knowledge Gaps and Stigmatized Views Among Nursing Students Through a Psychiatrist-APRN Didactic Partnership. J Am Psychiatr Nurses Assoc 2022; 28:225-234. [PMID: 32727255 DOI: 10.1177/1078390320945778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Knowledge gaps and stigmatized perceptions regarding electroconvulsive therapy (ECT) among patients and health providers contribute to the underutilization of an important therapeutic modality. The proactive education of future advanced practice registered nurses (APRNs) provides an opportunity to optimize the use of this evidence-based clinical practice. AIMS: As part of a general course in psychiatry during the first year of nursing school, we dedicated 1 hour to treatment-refractory depression, including ECT, and a second hour to a summary discussion of mood disorders. We evaluated the efficacy of this didactic offering, which was co-taught by a psychiatrist and a psychiatric APRN. METHOD: At baseline, consenting students (n = 94) provided three words they associated with ECT and then completed three validated instruments: (a) Questionnaire on Attitudes and Knowledge of ECT, (b) Opening Minds Stigma Scale for Health Care Providers, and (c) Self-Stigma of Seeking Help. Among the 67 students who repeated the assessment at endpoint, 39 attended the ECT didactic (Intervention group, 58%) and 28 did not (Control, 42%). RESULTS: After completion of the 3-month course, students showed improvement across all measures (p < .001). The only outcomes that improved differentially between the Intervention and Control groups were the Questionnaire on Attitudes and Knowledge of ECT Attitudes and Knowledge scales (p = .01). Word choice valence associated with ECT shifted favorably by endpoint (p < .001). CONCLUSIONS: An educational intervention co-led by a psychiatric-mental health APRN had a significant impact on nursing students' knowledge and perceptions of ECT. This approach can be readily implemented at other institutions. Future refinements will include the videotaped depiction of a simulated patient undergoing the consent, treatment, and recovery phases of ECT.
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Affiliation(s)
- Brandon M Kitay
- Brandon M. Kitay, MD, PhD, Yale University, New Haven, CT, USA
| | - Tina Walde
- Tina Walde, DNP, APRN, PMHNP, Yale University, Orange, CT, USA
| | - Dilice Robertson
- Dilice Robertson, DNP, APRN, PMHNP, Yale University, Orange, CT, USA
| | - Tammy Cohen
- Tammy Cohen, APRN, Yale Psychiatric Hospital, New Haven, CT, USA
| | - Robbert Duvivier
- Robbert Duvivier, MD, PhD, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrés Martin
- Andrés Martin, MD, MPH, Yale University, New Haven, CT, USA
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Hajak VL, Hajak G, Ziegelmayer C, Grimm S, Trapp W. Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions. Front Psychol 2021; 12:767915. [PMID: 34887815 PMCID: PMC8650631 DOI: 10.3389/fpsyg.2021.767915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT. Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs. Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments. Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.
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Affiliation(s)
- Vivien L Hajak
- Department of Psychology, Medical School Berlin, Berlin, Germany.,Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Christoph Ziegelmayer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Simone Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany.,Department of Psychiatry, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Wolfgang Trapp
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany.,Department of Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.,Department of Psychology, University of Applied Sciences, Bamberg, Germany
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Youssef NA, George MS, McCall WV, Sahlem GL, Short B, Kerns S, Manett AJ, Fox JB, Dancy M, Cook D, Devries W, Rosenquist PB, Sackeim HA. The Effects of Focal Electrically Administered Seizure Therapy Compared With Ultrabrief Pulse Right Unilateral Electroconvulsive Therapy on Suicidal Ideation: A 2-Site Clinical Trial. J ECT 2021; 37:256-262. [PMID: 34015791 PMCID: PMC8606010 DOI: 10.1097/yct.0000000000000776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preliminary data suggest that focal electrically administered seizure therapy (FEAST) has antidepressant effects and less adverse cognitive effects than traditional forms of electroconvulsive therapy (ECT). This study compared the impact of FEAST and ultrabrief pulse, right unilateral (UB-RUL) ECT on suicidal ideation. METHODS At 2 sites, patients in a major depressive episode were treated openly with FEAST or UB-RUL ECT, depending on their preference. The primary outcome measure was scores on the Beck Scale for Suicide Ideation (SSI). Scores on the suicide item of the Hamilton Rating Scale for Depression (HRSD-SI) provided a secondary outcome measure. RESULTS Thirty-nine patients were included in the intent-to-treat sample (FEAST, n = 20; UB-RUL ECT, n = 19). Scores on both the SSI and HRSD-SI were equivalently reduced with both interventions. Both responders and nonresponders to the interventions showed substantial reductions in SSI and HRSD-SI scores, although the magnitude of improvement was greater among treatment responders. CONCLUSIONS Although limited by the open-label, nonrandomized design, FEAST showed comparable effects on suicidal ideation when compared with routine use of UB-RUL ECT. These results are encouraging and support the need for further research and a noninferiority trial.
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Affiliation(s)
| | | | - William V McCall
- From the Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
| | - Gregory L Sahlem
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Baron Short
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Suzanne Kerns
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Andrew J Manett
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | | | - Morgan Dancy
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Daniel Cook
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - William Devries
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
| | - Peter B Rosenquist
- From the Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
| | - Harold A Sackeim
- Departments of Psychiatry and Radiology, Columbia University, NY, NY
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Nard N, Moulier V, Januel D, Guillin O, Rothärmel M. [Electroconvulsive therapy during the perinatal period: Representations of mental health professionals]. Encephale 2021; 47:445-451. [PMID: 34148646 DOI: 10.1016/j.encep.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Psychiatric disorders are common in peripartum and are associated with adverse outcomes for mother and fetus. Electroconvulsive therapy (ECT) is one of the most effective and safe options to treat severe mental illness, including during the perinatal period. Nevertheless, it remains underutilized during this period, possibly due to negative representations. Research has been carried out on the representations and attitudes of caregivers towards ECT, but the specificities of these attitudes during peripartum have not been explored. OBJECTIVES We aimed to assess the attitudes towards ECT during the peripartum among psychiatrists, nurses, social workers and psychologists. The primary objective was to compare the score of favorability for ECT during peripartum according to the profession. The secondary objective was to highlight other factors involved in the favorability for ECT in peripartum. METHODS We investigated mental health professionals' attitudes sending by e-mail an anonymous questionnaire in five hospitals in France. The questionnaire was composed of demographic details, one scale about the attitudes towards ECT (the Questionnaire on Attitudes and Knowledge of ECT (QuAKE)) used in several studies; in this questionnaire, a specific part for perinatal period has been added for our study, both using a Likert scale. The completion time for this online questionnaire was approximately 5 to 7minutes. A score of favorability for ECT in general and in peripartum was established for each participant. These scores represented the percentage of positive responses to favorable items and of negative responses to unfavorable items towards ECT. Comparison of the QuAKE answers with a sample of English caregivers in 2001 has been determined with χ2 tests. A Bonferroni correction was applied due to the large number of tests performed. Factors involved in the favorability for ECT have been studied with Pearson correlation, Kruskall-Wallis and Wilcoxon tests. RESULTS Two hundred and twenty one professionals (80 psychiatrists, 78 nurses, 19 social workers and 44 psychologists) were included in the study. Their answers to the QuAKE questionnaire were comparable or more favorable to ECT than the English sample answered in 2001. The perinatal part of questionnaire had a good internal consistency (Cronbach coefficient: 0,91). Participants were less favorable to ECT in perinatal period (favorability score: 44.2) than in general (63.6). They more often responded « uncertain » to the perinatal questionnaire (44,9 % against 18.4 % for the ECT in general; W=19931,5; P<0,001). The favorability for ECT in general and during peripartum were statistically associated with profession (psychiatrists were more favorable), specific training and experience in ECT. Gender, perinatal specialization, age, and the number of years in professional service were not associated with favorability for ECT in general and during peripartum in this study. CONCLUSIONS In this study, we have found that profession, training and experience in ECT are linked to the attitudes towards ECT, including in the perinatal period. It is necessary to inform professionals about the possibility of prescribing ECT in the perinatal period by training them in the specificities of pregnancy.
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Affiliation(s)
- Noémie Nard
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; Faculté de médecine, université de Normandie, 22, boulevard Gambetta, 76000 Rouen, France
| | - Virginie Moulier
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; EPS Ville-Evrard, unité de Recherche Clinique, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France
| | - Dominique Januel
- EPS Ville-Evrard, unité de Recherche Clinique, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France
| | - Olivier Guillin
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; Faculté de médecine, université de Normandie, 22, boulevard Gambetta, 76000 Rouen, France; CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - Maud Rothärmel
- Service Hospitalo-Universitaire, centre hospitalier du Rouvray, 4, rue Paul Eluard, 76300 Sotteville-lès-Rouen, France; CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France.
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13
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Besse M, Schomburg AK, Simon A, Hesse D, Müller J, Zilles-Wegner D. [Importance of electroconvulsive therapy (ECT) in forensic psychiatry]. DER NERVENARZT 2021; 92:9-17. [PMID: 32642948 PMCID: PMC7808988 DOI: 10.1007/s00115-020-00947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hintergrund und Ziel der Arbeit Für die Elektrokonvulsionstherapie (EKT) liegen Leitlinienempfehlungen zur Behandlung schwerer affektiver und psychotischer Erkrankungen vor, wie sie auch bei Patienten im Maßregelvollzug (MRV) vorkommen. Über die Anwendung der EKT in der forensischen Psychiatrie existieren jedoch keinerlei systematisch erhobene Daten. Ziel der vorliegenden Arbeit ist eine Erhebung des Ist-Zustands sowie des geschätzten Bedarfs an EKT im MRV. Material und Methoden Es wurde ein Fragebogen zur Erhebung der aktuellen Anwendung sowie der Einschätzung des Bedarfs an EKT in dieser Population entwickelt. Dieser wurde elektronisch und bei Bedarf postalisch an die forensischen Kliniken in Deutschland versendet. Ergebnisse Wir erhielten Antwort von 52 Kliniken (66 %). 29 der Kliniken gaben an, Patienten mit EKT behandeln zu können. Eine Behandlungsindikation wurde klinikübergreifend für 3,4 % der untergebrachten Patienten gesehen. In einem Jahr (2018) wurden insgesamt 32 EKT-Behandlungen an 12 Kliniken des Maßregelvollzugs mit durchschnittlich guter Wirksamkeit (Ø CGI‑I 2,32) durchgeführt. Häufigste Begründung für die fehlende Anwendung der EKT waren mangelnde strukturelle Voraussetzungen. Jeweils etwa ein Drittel der Kliniken sehen einen mittleren bzw. hohen Bedarf an EKT im MRV. Diskussion Die EKT kommt im MRV in Deutschland aktuell nur sehr begrenzt zum Einsatz. Auffällig ist, dass die Anzahl der durchgeführten Behandlungen etwa um den Faktor 8 hinter der Indikationshäufigkeit zurücksteht. Ungeachtet dessen sehen zwei Drittel der Kliniken einen mittleren bis hohen Bedarf, womit eine Unterversorgung mit EKT im MRV zu bestehen scheint.
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Affiliation(s)
- Matthias Besse
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Straße 5, 37075, Göttingen, Deutschland.
| | - Anna-K Schomburg
- Institut für Ethik und Geschichte in der Medizin, Universitätsmedizin Göttingen, Humboldtallee 36, 37073, Göttingen, Deutschland
| | - Alfred Simon
- Akademie für Ethik in der Medizin e. V., Humboldtallee 36, 37073, Göttingen, Deutschland
| | - Dirk Hesse
- Maßregelvollzugszentrum Niedersachsen - Moringen, Mannenstraße 29, 37186, Moringen, Deutschland
| | - Jürgen Müller
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Straße 5, 37075, Göttingen, Deutschland.,Asklepios Klinik für forensische Psychiatrie und Psychotherapie, Rosdorfer Weg 70, 37081, Göttingen, Deutschland
| | - David Zilles-Wegner
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Von-Siebold-Straße 5, 37075, Göttingen, Deutschland
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Hadas I, Zomorrodi R, Hill AT, Sun Y, Fitzgerald PB, Blumberger DM, Daskalakis ZJ. Subgenual cingulate connectivity and hippocampal activation are related to MST therapeutic and adverse effects. Transl Psychiatry 2020; 10:392. [PMID: 33173028 PMCID: PMC7655940 DOI: 10.1038/s41398-020-01042-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022] Open
Abstract
Aberrant connectivity between the dorsolateral prefrontal cortex (DLPFC) and the subgenual cingulate cortex (SGC) has been linked to the pathophysiology of depression. Indirect evidence also links hippocampal activation to the cognitive side effects of seizure treatments. Magnetic seizure therapy (MST) is a novel treatment for patients with treatment resistant depression (TRD). Here we combine transcranial magnetic stimulation with electroencephalography (TMS-EEG) to evaluate the effects of MST on connectivity and activation between the DLPFC, the SGC and hippocampus (Hipp) in patients with TRD. The TMS-EEG was collected from 31 TRD patients prior to and after an MST treatment trial. Through TMS-EEG methodology we evaluated significant current scattering (SCS) as an index of effective connectivity between the SGC and left DLPFC. Significant current density (SCD) was used to assess activity at the level of the Hipp. The SCS between the SGC and DLPFC was reduced after the course of MST (p < 0.036). The DLPFC-SGC effective connectivity reduction correlated with the changes in Hamilton depression score pre-to-post treatment (R = 0.46; p < 0.031). The SCD localized to the Hipp was reduced after the course of MST (p < 0.015), and the SCD change was correlated with montreal cognitive assessment (MOCA) scores pre-post the course of MST (R = -0.59; p < 0.026). Our findings suggest that MST treatment is associated with SGC-DLPFC connectivity reduction and that changes to cognition are associated with Hipp activation reduction. These findings demonstrate two distinct processes which drive efficacy and side effects separately, and might eventually aid in delineating physiological TRD targets in clinical settings.
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Affiliation(s)
- Itay Hadas
- Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA, 92093-0603, USA
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M5T1R8, Canada
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Yinming Sun
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Department of Psychiatry, Camberwell, VIC, Australia
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, M5T1R8, Canada
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA, 92093-0603, USA.
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15
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Plahouras JE, Konstantinou G, Kaster TS, Buchman DZ, Foussias G, Daskalakis ZJ, Blumberger DM. Treatment Capacity and Clinical Outcomes for Patients With Schizophrenia Who Were Treated With Electroconvulsive Therapy: A Retrospective Cohort Study. Schizophr Bull 2020; 47:424-432. [PMID: 33145601 PMCID: PMC7965065 DOI: 10.1093/schbul/sbaa144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients with schizophrenia are often found incapable to consent to psychiatric treatment. We evaluated clinical outcomes for incapable and capable patients with schizophrenia treated with electroconvulsive therapy (ECT). METHODS We conducted a chart review of all inpatients treated with an acute course of ECT between 2010 and 2018 at the Centre for Addiction and Mental Health, Toronto, Canada. Short-term outcomes included treatment response and cognitive impairment. We assessed whether incapable patients regained the capacity to consent to treatment. Long-term outcomes included readmissions and subsequent courses of acute or maintenance ECT. RESULTS A total of 159 (67%) incapable and 79 (33%) capable patients were included. Patients experienced treatment response (incapable, n = 108, 67.9%; capable, n = 52, 65.8%; P = .771) and few experienced cognitive impairment (incapable, n = 21, 13.2%; capable, n = 19, 24.1%; P = .043). A minority of patients were treated with a subsequent course of acute ECT (incapable, n = 46, 28.9%; capable, n = 16, 20.3%; P = .162). Incapable patients were more likely to be treated with maintenance ECT for at least 6 months (incapable, n = 46, 28.9%; capable, n = 13, 16.5%; P = .039). Both groups had similar readmission rates (incapable, n = 70, 44.0%; capable, n = 35, 44.3%; P = 1.000). Eight (5.0%) incapable patients regained capacity and 7 consented to further treatment. CONCLUSIONS Irrespective of treatment capacity, the majority of patients demonstrated clinical improvement. Incapable patients experienced less cognitive side effects when compared with capable patients, though they had fewer treatments overall. This study informs clinicians, patients, and substitute decision-makers about the outcomes and challenges of ECT in patients with schizophrenia.
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Affiliation(s)
- Joanne E Plahouras
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gerasimos Konstantinou
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Z Buchman
- Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada,Bioethics Department, Toronto Western Hospital, University Health Network, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - George Foussias
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Campbell Family Mental Health Institute, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Campbell Family Mental Health Institute, Toronto, ON, Canada,To whom correspondence should be addressed; Centre for Addiction and Mental Health, 1001 Queen St. W. Unit 4, Room 115, Toronto, ON M6J 1H4, Canada; tel: 416-535-8501 x 33662, fax: 416-583-4613, e-mail:
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16
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Kitay B, Martin A, Chilton J, Amsalem D, Duvivier R, Goldenberg M. Electroconvulsive Therapy: a Video-Based Educational Resource Using Standardized Patients. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:531-537. [PMID: 32754879 PMCID: PMC7402389 DOI: 10.1007/s40596-020-01292-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/19/2020] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Video-based depictions of electroconvulsive therapy (ECT) can be useful for educational purposes, but many of the readily available resources may worsen already stigmatized views of the procedure. Educators' common reliance on such material highlights the paucity of equipoised depictions of modern ECT well suited for the training of health professionals. The authors developed and tested a new educational module enhanced by videotaped depictions of a simulated patient undergoing the consent, treatment, recovery, and follow-up phases of ECT. METHODS The didactic intervention interspersed 7 short video clips (totaling 14 min) into a 55-min lecture on treatment-resistant depression. The session, part of an intensive course of preclinical psychiatry, was delivered online through synchronous videoconferencing with Zoom. The primary outcome measure was change in the Questionnaire on Attitudes and Knowledge of ECT (QuAKE). RESULTS Fifty-three out of 63 (87%) eligible second-year medical students completed assessments at baseline and after exposure to the didactic intervention. QuAKE scores improved between baseline and endpoint: the Attitudes composite increased from 49.4 ± 6.1 to 59.1 ± 5.7 (paired t 10.65, p < 0.001, Cohen's d 0.69), and the Knowledge composite from 13.3 ± 1.2 to 13.9 ± 0.8 (paired t 3.97, p < 0.001, Cohen's d 0.23). CONCLUSIONS These video-based educational materials proved easy to implement in the virtual classroom, were amenable to adaptation by end-use instructors, were well received by learners, and led to measurable changes in students' knowledge of and attitudes toward ECT.
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Affiliation(s)
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Julie Chilton
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Doron Amsalem
- Tel Aviv University Faculty of Medicine, Ramat Aviv, Israel
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17
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Obbels J, Vansteelandt K, Verwijk E, Lambrichts S, Bouckaert F, Sienaert P. Understanding electroconvulsive therapy-related anxiety: a prospective study. Acta Psychiatr Scand 2020; 142:132-140. [PMID: 32474903 DOI: 10.1111/acps.13198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 12/28/2022]
Abstract
AIMS OF STUDY Although electroconvulsive therapy (ECT)-related anxiety is experienced by a significant proportion of patients, it remains understudied. Our aim was to study the course of ECT-related anxiety during ECT. METHODS Seventy-four patients with unipolar or bipolar depression, referred for ECT, were included. ECT-related anxiety was assessed the morning before each ECT session using the ECT-related Anxiety Questionnaire (ERAQ). RESULTS Female patients reported more anxiety than men (F(1,64.6) = 3.95, P = 0.05). Patients with a psychotic depression were more anxious before the start of ECT (F(64.8) = 4.57, P = 0.04), but experienced a significant decrease in ECT-related anxiety (t(63.9) = -3.63, P = 0.0006), whereas patients with a non-psychotic depression remained stable on anxiety during their ECT course (t(63,9) = 0.76, P = 0.45). In addition, we found a significant correlation between the decrease of ECT-related anxiety and the decrease of depression-severity (r = 0.35; P = 0.04). CONCLUSION There are individual differences in ECT-related anxiety trajectories during ECT. Both female patients and patients with psychotic depression experienced more ECT-related anxiety before the start of ECT. The severity of ECT-related anxiety decreased significantly in patients with a psychotic depression, but remained stable in patients without a psychotic depression during ECT. In addition, patients who showed a stronger decrease in depression-severity also showed a stronger decrease in ECT-related anxiety. A better understanding of ECT-related anxiety trajectories can help in designing anxiety-reducing interventions.
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Affiliation(s)
- J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - K Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - E Verwijk
- Department of Medical Psychology, Neuropsychology Department, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands.,Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - S Lambrichts
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - F Bouckaert
- Old-age Psychiatry, KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
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18
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Martin A, Krause R, Chilton J, Jacobs A, Amsalem D. Attitudes to psychiatry and to mental illness among nursing students: Adaptation and use of two validated instruments in preclinical education. J Psychiatr Ment Health Nurs 2020; 27:308-317. [PMID: 31789466 PMCID: PMC8904187 DOI: 10.1111/jpm.12580] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/09/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Stigma towards psychiatry and people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Internalized stigma among nurses can affect personal self-care and limit help-seeking behaviours. Stigma around mental health nursing can adversely affect recruitment into this already underserved field. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE This is the first report on the adaptation and use in a nursing student sample of two widely used stigma-related instruments that have been normed among medical students. The attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments proved sensitive to change and can be useful in tracking specific anti-stigma curricular interventions. Interactive and participatory student activities in courses such as ours (that include simulation with standardized patients, clinical placements and patient interaction) need to be complemented by exposure to individuals with lived experience with mental illness in order to address stigmatized views of SMI. Nursing educators and fellow nurses willing to share their own experiences with mental illness-including diagnosis, health-seeking, treatment and recovery-may prove especially powerful and germane during nursing school. WHAT ARE THE IMPLICATIONS FOR PRACTICE Even a strong academic curriculum is not sufficient to change stigmatized perceptions about mental illness, psychiatric care and mental health nursing as a profession. Comparison and potential synergy between ATP-30, AMI and OMS-HC (Opening Minds Scale for Health Care Providers) could prove fruitful in identifying a more comprehensive approach to stigma assessment over time. The addition of validated instruments, such as the Self-Compassion Scale-Short Form (SCS-SF) and the Self-Stigma of Seeking Help (SSOSH), which tap into internalized stigma and into health-seeking behaviours and intervening barriers could prove particularly useful in evaluating innovative interventions for stigma-decreasing initiatives in nursing education. Interactive and participatory didactic offerings need to be complemented by exposure to individuals with lived experience with mental illness and ideally to nursing educators and practicing nurses willing to share their histories of diagnosis, help-seeking, treatment and recovery. ABSTRACT Introduction Stigma towards psychiatry and to people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Such stigmatized views can adversely affect recruitment into the already underserved field of mental health nursing. Aim/question We adapted two stigma-related instruments in a sample of nursing students and examined change in scores after participation in an eight-week preclinical psychiatry curriculum. Our goal was to identify stigma-malleable opportunities that would inform refinements in future iterations of a preclinical psychiatry curriculum in nursing. Method We made minor adaptations to the attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments. We invited first-year nursing students to complete assessments at two time points: before and after completion of an eight-week core course in preclinical psychiatry. Results Seventy-one students completed the assessment at both time points. ATP-30 and three of its eight subscale scores improved by course's endpoint. By contrast, AMI scores did not change. Compared with medical student published norms, nursing students in our sample had higher (less stigmatized) average scores. Discussion The ATP-30 and the AMI can be easily adapted to a nursing student population and may prove useful in tracking specific anti-stigma educational interventions. Implications for practice A general psychiatry course during nursing school is, it and of itself, unlikely to change biased views about SMI and should be enhanced with exposure to, and interaction with individuals with lived experiences of mental illness, ideally by nurse educators and practicing nurses.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.,Standardized Patient Program, Yale School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | | | - Julie Chilton
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.,Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Asaf Jacobs
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Doron Amsalem
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Sheba Medical Center, Ramat-Gan, Israel
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A Measure to Assess Perceptions and Knowledge About Electroconvulsive Therapy: Development and Psychometric Properties. J ECT 2020; 36:e1-e6. [PMID: 31192871 DOI: 10.1097/yct.0000000000000609] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although electroconvulsive therapy (ECT) has been found to be one of the most robust and rapid treatments for severe depression, it is widely underused partly because of negative perceptions and inaccurate knowledge about the treatment. METHODS The 18-item ECT Perception and Knowledge (ECT-PK) measure was developed through a systematic review of the literature, subject matter expert ratings, and examination of content validity. The ECT-PK consists of Perception and Knowledge subscales, which were tested on a national sample of 1091 US adults who screened positive for depression in 2018 through Amazon's Mechanical Turk platform. RESULTS Evaluation of the ECT-PK subscales found that both subscales demonstrated good construct validity, criterion validity, and internal consistency reliability. Participants who had higher Perception and Knowledge subscale scores were significantly more likely to report that they were willing to try ECT. The ECT-PK revealed that many participants reported fears about pain, brain damage, and memory loss resulting from ECT, and had inaccurate knowledge about ECT being outdated or lacking scientific evidence. CONCLUSIONS Together, these results showed that the ECT-PK is an efficient and effective contemporary tool to measure the perception and knowledge of ECT, and highlights areas in need of psychoeducation.
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Competency by Design for Electroconvulsive Therapy in Psychiatry Postgraduate Training: Face and Content Validation Study. J ECT 2020; 36:18-24. [PMID: 31990735 DOI: 10.1097/yct.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Samalin L, Yrondi A, Charpeaud T, Genty JB, Blanc O, Sauvaget A, Stéphan F, Walter M, Bennabi D, Bulteau S, Haesebaert F, D'Amato T, Poulet E, Holtzmann J, Richieri RM, Attal J, Nieto I, El-Hage W, Bellivier F, Schmitt L, Lançon C, Bougerol T, Leboyer M, Aouizerate B, Haffen E, Courtet P, Llorca PM. Adherence to treatment guidelines in clinical practice for using electroconvulsive therapy in major depressive episode. J Affect Disord 2020; 264:318-323. [PMID: 32056767 DOI: 10.1016/j.jad.2020.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND ECT is the most effective treatment of major depressive episode (MDE) but remains a neglected treatment. The French Society for Biological Psychiatry and Neuropsychopharmacology aimed to determine whether prescribing practice of ECT followed guidelines recommendations. METHODS This multicenter, retrospective study included adult patients with major depressive disorder (MDD) or bipolar disorder (BD), who have been treated with ECT for MDE. Duration of MDE and number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests. RESULTS Seven hundred and forty-five individuals were included. The mean duration of MDE before ECT was 10.1 months and the mean number of lines of treatment before ECT was 3.4. It was significantly longer for MDD single episode than recurrent MDD and BD. The presence of first-line indications for using ECT was significantly associated to shorter duration of MDE (9.1 vs 13.1 months, p<0.001) and lower number of lines of treatment before ECT (3.3 vs 4.1, p<0.001). LIMITATIONS This is a retrospective study and not all facilities practicing ECT participated that could limit the extrapolation of the results. CONCLUSION Compared to guidelines, ECT was not used as first-line strategy in clinical practice. The presence of first-line indications seemed to reduce the delay before ECT initiation. The improvements of knowledge and access of ECT are needed to decrease the gap between guidelines and clinical practice.
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Affiliation(s)
- L Samalin
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand EA 7280, France.
| | - A Yrondi
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Service de Psychiatrie et de Psychologie Médicale de l'adulte, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - T Charpeaud
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand EA 7280, France
| | - J B Genty
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; University of Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France; AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France
| | - O Blanc
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand EA 7280, France
| | - A Sauvaget
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, INSERM-U1246 SPHERE University of Nantes and University of Tours, Nantes, France
| | - F Stéphan
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - M Walter
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - D Bennabi
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, Besançon, France
| | - S Bulteau
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, INSERM-U1246 SPHERE University of Nantes and University of Tours, Nantes, France
| | - F Haesebaert
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Centre Hospitalier Le Vinatier, Inserm U1028, CNRS UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, University Lyon 1, Lyon, France
| | - T D'Amato
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Centre Hospitalier Le Vinatier, Inserm U1028, CNRS UMR5292, Lyon Neuroscience Research Center, PSY-R2 Team, University Lyon 1, Lyon, France
| | - E Poulet
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry, hospices civils de Lyon, Edouard-Herriot Hospital, Neuroscience Research Center, CNRS UMR5292, PSY-R2 Team, University Lyon, Lyon, France
| | - J Holtzmann
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - R M Richieri
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Pôle Psychiatrie, CHU La Conception, Marseille, France
| | - J Attal
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm, Montpellier 1061, France
| | - I Nieto
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Inserm UMRS 1144, University Paris Diderot, Paris, France 16 UMR 1253, iBrain, University of Tours, Inserm, Tours, France
| | - W El-Hage
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of General and Academic Psychiatry, CH Charles Perrens, Bordeaux, Laboratory Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - F Bellivier
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Inserm UMRS 1144, University Paris Diderot, Paris, France 16 UMR 1253, iBrain, University of Tours, Inserm, Tours, France
| | - L Schmitt
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Service de Psychiatrie et de Psychologie Médicale de l'adulte, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - C Lançon
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Pôle Psychiatrie, CHU La Conception, Marseille, France
| | - T Bougerol
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - M Leboyer
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; University of Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique, Créteil, France; AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie, Créteil, France
| | - B Aouizerate
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of General and Academic Psychiatry, CH Charles Perrens, Bordeaux, Laboratory Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - E Haffen
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, Besançon, France
| | - P Courtet
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Inserm U1061, Montpellier University, Montpellier, France
| | - P M Llorca
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France; Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand EA 7280, France
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Başgül ŞS, Luş MG, Hashimov A. Electroconvulsive therapy in an adolescent with bipolar disorder, substance use, and body dysmorphic disorder comorbidity: case report. Neurocase 2020; 26:51-54. [PMID: 31642388 DOI: 10.1080/13554794.2019.1683210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Our case report is on the use of electroconvulsive treatment (ECT) in an adolescent with Bipolar Disorder (BPD), Substance Use Disorder (SUD) and comorbid Body Dysmorphic Disorder (BDD). In our case, ECT was not considered at the first stage, but we encountered medication noncompliance and treatment resistance. Symptoms of body dysmorphic disorder completely disappeared after ECT, which is consistent with the literature. ECT is a treatment with a low side effect profile in treatment-resistant cases. In addition, it will be useful to increase the knowledge and experience of clinicians on ECT and to provide conditions for ECT in child and adolescent psychiatric clinics.
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Affiliation(s)
- Şaziye Senem Başgül
- Department of Psychology, Administration and Social Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Melek Gözde Luş
- Department of Child and Adolescent Psychiatry, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Phnom Penh, Cambodia
| | - Abas Hashimov
- Cerraahpaşa Medical Faculty, Department of Child and Adolescent Psychiatry, İstanbul University, Istanbul, Turkey
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23
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Rafoul B, Mashiach-Eizenberg M, Hasson-Ohayon I, Roe D. Knowledge about, attitudes toward, and willingness to undergo electroconvulsive therapy among mental health patients, staff, and family members. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2019.1702613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Bahaa Rafoul
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | | | | | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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24
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Bhat B, Dar S, Hussain A, Mir R. Electroconvulsive therapy: Knowledge and attitudes among medical interns and the general public. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2020. [DOI: 10.4103/mjmsr.mjmsr_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Bhat B, Dar S, Hussain A, Mir R. Electroconvulsive Therapy: Knowledge and Attitudes Among Medical Interns and the General Public. MAMC JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mamcjms.mamcjms_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Cheniaux E, Nardi AE. Evaluating the efficacy and safety of antidepressants in patients with bipolar disorder. Expert Opin Drug Saf 2019; 18:893-913. [DOI: 10.1080/14740338.2019.1651291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Elie Cheniaux
- Departamento de Psiquiatria e Medicina Legal, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Departamento de Especialidades Médicas, Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM/UERJ), Rio de Janeiro, Brazil
| | - Antonio E. Nardi
- Departamento de Psiquiatria e Medicina Legal, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
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Factors Influencing Staff's Attitude Toward Electroconvulsive Therapy: A Comparison of New Versus Experienced Electroconvulsive Therapy Clinics. J ECT 2019; 35:106-109. [PMID: 30308568 DOI: 10.1097/yct.0000000000000544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Despite being a highly effective treatment, electroconvulsive therapy (ECT) is still stigmatized even among professionals. The aim of this study was to identify factors associated with a positive attitude toward ECT among health care workers. METHODS We investigated staff's attitude and their self-assessment of knowledge while introducing ECT in 3 German psychiatric clinics. Furthermore, we compared this data to that of a clinic where ECT has been applied with a long tradition. An anonymous questionnaire was answered by n = 182 employees in the ECT-introducing clinics (novices) and n = 68 employees in the clinic with a long history of ECT (experts). RESULTS Irrespective of the clinical history, the majority of participants approved the application of ECT in their clinic. Factors associated with a positive attitude were (a) profession (physicians presented a more positive mindset about ECT than nursing staff), (b) subjective feeling of being adequately informed, and (c) having had contact to patients undergoing ECT. Interestingly, the general attitude toward ECT did not differ between subjects who reported to have seen an ECT and those who had not. CONCLUSIONS When introducing ECT as a new treatment into a clinic, formal information should be adapted to the needs of each profession with a special emphasis on nurses. To further increase acceptance, contact to ECT-experienced patients (professionals taught by patients) might result in a more positive attitude toward ECT than participation in an ECT treatment itself.
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28
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Youssef NA, Ravilla D, Patel C, Yassa M, Sadek R, Zhang LF, McCloud L, McCall WV, Rosenquist PB. Magnitude of Reduction and Speed of Remission of Suicidality for Low Amplitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral Electroconvulsive Therapy: A Pilot Double-Blinded Randomized Clinical Trial. Brain Sci 2019; 9:E99. [PMID: 31035665 PMCID: PMC6562950 DOI: 10.3390/brainsci9050099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Although treatment guidelines support use of electroconvulsive therapy (ECT) for acute suicidality, it is associated with cognitive side effects. The effect of Low Amplitude Seizure Therapy (LAP-ST) on suicidality is unknown. Our prior precision LAP-ST (pLAP-ST) performing titrating in the current domain has provided initial proof of concept data in humans of its advantage in terms of reduction of cognitive side effects. The aims of this report are to: 1) compare LAP-ST (at 500mA) versus standard Right Unilateral (RUL) ECT (at 900 mA) in terms of magnitude of remission of suicidality in a randomized allocation and 2) compare the speed of remission of suicidality between LAP-ST versus RUL ECT. Methods: Patients were randomized to either LAP-ST or RUL ECT. The scores pertaining to the suicidal ideation (SI) item on the Montgomery-Åsberg Depression Rating Scale (MADRS) were analyzed using descriptive analysis and no confirmatory statistical analysis was performed due to a priori sample size limitations for this pilot study. SI item remission was defined as 2 or below on this item. Results: Eleven patients with major depressive episode (MDE) of mainly unipolar or bipolar disorders signed consent. Of these, 7 were eligible and were randomized and included in the analysis; all were actively suicidal at baseline (suicide item above 2), except 1 patient who had suicide item at 2 in the RUL ECT group. Suicidality remitted on average by session 3 and remission occurred for all patients by session 4. The SI mean score improvement from baseline to endpoint for LAP-ST was 5.1 and for RUL ECT was 3.0. Conclusions: LAP-ST has larger effect size and speed of remission of suicidality compared to standard RUL ECT. Future studies are warranted for replicating these findings. (ClinicalTrials.gov ID: NCT02583490).
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Affiliation(s)
- Nagy A Youssef
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
- Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Dheeraj Ravilla
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Cherishma Patel
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Mark Yassa
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Ramses Sadek
- Department of Population Health Science, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
- Georgia Cancer Center, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Li Fang Zhang
- Department of Population Health Science, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Laryssa McCloud
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
| | - Peter B Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.
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Fuchs PA, Peters TE, Benningfield MM. Electroconvulsive Therapy as a Safe, Effective Treatment for Catatonia in an Adolescent with a Nasogastric Tube: A Case Report. Child Adolesc Psychiatr Clin N Am 2019; 28:121-125. [PMID: 30389072 DOI: 10.1016/j.chc.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This case provides support for electroconvulsive therapy as a safe treatment in adolescents with a feeding tube. The patient presented to our hospital with symptoms of catatonia with minimal oral intake. She had stopped eating, had minimal interaction with her environment, and spent weeks with a nasogastric tube for nutritional support. She had been referred for electroconvulsive therapy but was unable to find a local provider who would perform it on an adolescent with a nasogastric tube. She came to our hospital and received 9 rounds of electroconvulsive therapy with improvement of her catatonia and no aspiration or adverse events.
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Affiliation(s)
- Paul A Fuchs
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA.
| | - Todd E Peters
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Margaret M Benningfield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
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Sierawska A, Prehn-Kristensen A, Moliadze V, Krauel K, Nowak R, Freitag CM, Siniatchkin M, Buyx A. Unmet Needs in Children With Attention Deficit Hyperactivity Disorder-Can Transcranial Direct Current Stimulation Fill the Gap? Promises and Ethical Challenges. Front Psychiatry 2019; 10:334. [PMID: 31156480 PMCID: PMC6531921 DOI: 10.3389/fpsyt.2019.00334] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/29/2019] [Indexed: 12/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder most frequently diagnosed in children and adolescents. Although ADHD can be effectively treated with psychostimulants, a significant proportion of patients discontinue treatment because of adverse events or insufficient improvement of symptoms. In addition, cognitive abilities that are frequently impaired in ADHD are not directly targeted by medication. Therefore, additional treatment options, especially to improve cognitive abilities, are needed. Because of its relatively easy application, well-established safety, and low cost, transcranial direct current stimulation (tDCS) is a promising additional treatment option. Further research is needed to establish efficacy and to integrate this treatment into the clinical routine. In particular, limited evidence regarding the use of tDCS in children, lack of clear translational guidelines, and general challenges in conducting research with vulnerable populations pose a number of practical and ethical challenges to tDCS intervention studies. In this paper, we identify and discuss ethical issues related to research on tDCS and its potential therapeutic use for ADHD in children and adolescents. Relevant ethical issues in the tDCS research for pediatric ADHD center on safety, risk/benefit ratio, information and consent, labeling problems, and nonmedical use. Following an analysis of these issues, we developed a list of recommendations that can guide clinicians and researchers in conducting ethically sound research on tDCS in pediatric ADHD.
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Affiliation(s)
- Anna Sierawska
- Division of Biomedical Ethics, Institute of Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | | | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Clinic for Child and Adolescent Psychiatry and Psychotherapy, Medical Center Bethel, Bielefeld, Germany
| | - Alena Buyx
- Institute for History and Ethics in Medicine Medical School, Technical University of Munich, Munich, Germany
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Griffiths C, O'Neill-Kerr A. Patients', Carers', and the Public's Perspectives on Electroconvulsive Therapy. Front Psychiatry 2019; 10:304. [PMID: 31133895 PMCID: PMC6514218 DOI: 10.3389/fpsyt.2019.00304] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/17/2019] [Indexed: 11/30/2022] Open
Abstract
Aims and Method: The aim of this study was to present patients', carers', and the public's perspectives on electroconvulsive therapy (ECT) through a narrative review of the literature. Results: People's perspectives on ECT are often negative due to media and Internet portrayal. Perspectives are influenced by risks, short-term side effects, and the most commonly reported longer-term side effect: memory loss. However, many patients do not report memory loss. Most people who experience ECT and their carers report a positive perspective. In the future, people's perspectives may become more positive with higher service delivery standards and a more balanced, well-informed view of modern ECT presented by the media. However, ECT has risks and side effects, and negative and critical perspectives on the use and effects of ECT will persist. Clinical Implications: Perspectives on ECT are important because of the impact on stigma, patient treatment choice, patient consent, and provision of and referral for ECT.
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Affiliation(s)
- Chris Griffiths
- Innovation and Research Department, Northamptonshire Healthcare NHS Foundation Trust, Northampton, United Kingdom
| | - Alex O'Neill-Kerr
- Innovation and Research Department, Northamptonshire Healthcare NHS Foundation Trust, Northampton, United Kingdom
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Belz M, Besse M, Krech L, Methfessel I, Zilles D. [Effectiveness and tolerability of electroconvulsive therapy : Influence of clinical response from the patient's point of view]. DER NERVENARZT 2018; 89:1271-1276. [PMID: 30171302 DOI: 10.1007/s00115-018-0604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients’ view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response. MATERIAL AND METHODS In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI-II). RESULTS Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients’ rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate. CONCLUSION Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients’ perspective.
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Affiliation(s)
- M Belz
- Klinik für Psychiatrie und Psychotherapie, Station 4193, Universitätsmedizin Göttingen, v. Siebold-Str. 3, 37075, Göttingen, Deutschland.
| | - M Besse
- Klinik für Psychiatrie und Psychotherapie, Station 4193, Universitätsmedizin Göttingen, v. Siebold-Str. 3, 37075, Göttingen, Deutschland
| | - L Krech
- Klinik für Psychiatrie und Psychotherapie, Station 4193, Universitätsmedizin Göttingen, v. Siebold-Str. 3, 37075, Göttingen, Deutschland
| | - I Methfessel
- Klinik für Psychiatrie und Psychotherapie, Station 4193, Universitätsmedizin Göttingen, v. Siebold-Str. 3, 37075, Göttingen, Deutschland
| | - D Zilles
- Klinik für Psychiatrie und Psychotherapie, Station 4193, Universitätsmedizin Göttingen, v. Siebold-Str. 3, 37075, Göttingen, Deutschland
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Kring IS, Bergholt MD, Midtgaard J. The perspectives of former recipients and experts on stigmatization related to electroconvulsive therapy in Denmark: A focus group study. J Psychiatr Ment Health Nurs 2018; 25:358-367. [PMID: 29758121 DOI: 10.1111/jpm.12470] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Electroconvulsive therapy (ECT) has existed worldwide for nearly 80 years. ECT is a fast-working and potentially life-saving treatment, but it is considered controversial. Although frequently mentioned, stigmatization in relation to ECT has not been systematically explored so far. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides new insight into both recipient and expert perspectives on ECT. It identifies several issues of stigmatization related to ECT and suggests that full recovery following ECT might be jeopardized due to both stigmatization and self-stigmatization. The study suggests that most of the stigmatizing behaviors can be ascribed to (a lack of) available knowledge of and experience with ECT. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being aware of and listening to the needs of former ECT-recipients seems essential to increase their treatment options and support care as well as a will to prioritize this patient group. For example, by addressing the potential stigma issues in follow-up groups and helping to distribute sober, factual information about ECT in society. Providing written information and psychoeducation for patients and relatives before, during, and after ECT, in addition to supporting active use of diaries, might be valuable remedies for helping patients feel adequately informed and able to accept the pros and cons of ECT during and after treatment period. ABSTRACT: Introduction Electroconvulsive therapy (ECT) has existed worldwide for nearly 80 years. Although fast-working and potentially life-saving treatment, ECT is regarded as a strongly controversial treatment and stigmatization is frequently mentioned in relation to it. However, no systematic research in this area has taken place so far. Aim The aim of this qualitative study was to explore the experiences and attitudes of former recipients of ECT and of experts professionally involved with ECT to identify potential stigmatization. Method Two focus groups, one comprising four recipients of ECT and the other seven professional experts, were conducted. Data from each focus group were analyzed separately using a framework-analysis. Results The analysis yielded three major themes for the first focus group interview: ambivalent attitudes, discrediting and exclusion, and survival strategies and three major themes for the second focus group interview: dramatic depictions of ECT, an overlooked and rare treatment, and anti-stigmatization strategies. Discussion and implications for practice Stigmatizing attitudes and behaviors in relation to ECT are closely related to one's personal and factual knowledge, and there is a great need for multi-facetted approaches if social acceptance and recognition are to be achieved. This study provides new knowledge on a scarcely examined area while also introducing suitable methods for anti-stigmatization and empowerment.
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Affiliation(s)
| | | | - Julie Midtgaard
- Department of Public Health, University Hospitals' Center of Health Research (UCSF) and Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Wilhelmy S, Rolfes V, Grözinger M, Chikere Y, Schöttle S, Groß D. Knowledge and attitudes on electroconvulsive therapy in Germany: A web based survey. Psychiatry Res 2018; 262:407-412. [PMID: 28923432 DOI: 10.1016/j.psychres.2017.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Saskia Wilhelmy
- Department of History, Theory and Ethics in Medicine, Medical School, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
| | - Vasilija Rolfes
- Department of History, Theory and Ethics in Medicine, Medical School, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Yvonne Chikere
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Sabrina Schöttle
- Department of Social Sciences, Faculty of Arts and Humanities, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.
| | - Dominik Groß
- Department of History, Theory and Ethics in Medicine, Medical School, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany.
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Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is an effective and a safe treatment for several severe psychiatric disorders across the age span. However, its use remains controversial and highly stigmatized especially among patients under 18 years. In this study, we examined current symptoms, attitudes, perception, and functioning of patients treated with ECT when they were less than 18 years old. METHODS Participants had received ECT before age 18, between 1989 and 2015, at a tertiary medical center. Institutional review board-approval was obtained, and study documents (cover letter, consent, self-ratings scales for depression, anxiety, global functioning, and suicidality) were mailed. RESULTS Based on self-rated depression, 59.1% (13/22) participants indicated mild or no depression; 65% (13/20) reported mild or no anxiety; the majority, 84.3% (16/19) perceived ECT as having improved their overall illness; and 27.3% (6/22) among the respondents reported no clinical impairment on a global functioning scale, whereas 72.7% (16/22) reported significant or severe impairment. Despite reports of ongoing impaired global functioning among some participants, adequate academic performance (83.3%, 5/6) and mild or no suicidality (78.3%, 18/23) were endorsed by the majority reported. CONCLUSIONS The majority of participants who had received ECT before age 18 years reported mild or absence of depression and anxiety on self-rated follow-up measures after treatment with ECT. Most notably, the majority reported absence of suicidality and adequate academic performance. A number of respondents, however, continued to endorse global impairment, which may be a reflection of their baseline severe illness, which had warranted treatment with ECT.
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Yamaguchi S, Mizuno M, Ojio Y, Sawada U, Matsunaga A, Ando S, Koike S. Associations between renaming schizophrenia and stigma-related outcomes: A systematic review. Psychiatry Clin Neurosci 2017; 71:347-362. [PMID: 28177184 DOI: 10.1111/pcn.12510] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/30/2022]
Abstract
Renaming schizophrenia is a potential strategy to reduce the stigma attached to people with schizophrenia. However, the overall associations between renaming schizophrenia and stigma-related outcomes have not been fully elucidated. We conducted a systematic review of studies that empirically examined the outcomes between new or alternative terms and old or existing terms for schizophrenia. We searched for relevant articles in eight bibliographic databases, conducted a Google search, examined reference lists, and contacted relevant experts. We found a total of 2601 reference records, and 23 articles were included in this review. Overall, in countries where schizophrenia has been renamed, the name changes may be associated with improvements in adults' attitudes toward people with schizophrenia, and with increased diagnosis announcement. However, studies conducted in countries where schizophrenia has not been renamed report inconsistent findings. In addition, renaming may not influence portrayals of schizophrenia in the media. Most studies included in our review had a risk of bias in their methodology, and we employed a vote-counting method to synthesize study results; therefore, the impacts of renaming are still inconclusive. Future studies are needed to address the following issues: use of univariate descriptive statistics, adjustment for confounding variables, use of reliable measures, and employing a question that addresses the image of split or multiple personalities. Evidence is limited regarding the associations between renaming and stigma experienced by both people with schizophrenia and their families (e.g., perceived stigma, self-stigma, discrimination experience, and burden). Further research in these populations is needed to confirm the effects of renaming schizophrenia.
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Affiliation(s)
- Sosei Yamaguchi
- Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masashi Mizuno
- Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yasutaka Ojio
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Utako Sawada
- Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Asami Matsunaga
- Department of Psychiatric Rehabilitation, Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shuntaro Ando
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, The University of Tokyo, Tokyo, Japan
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Oltedal L, Bartsch H, Sørhaug OJE, Kessler U, Abbott C, Dols A, Stek ML, Ersland L, Emsell L, van Eijndhoven P, Argyelan M, Tendolkar I, Nordanskog P, Hamilton P, Jorgensen MB, Sommer IE, Heringa SM, Draganski B, Redlich R, Dannlowski U, Kugel H, Bouckaert F, Sienaert P, Anand A, Espinoza R, Narr KL, Holland D, Dale AM, Oedegaard KJ. The Global ECT-MRI Research Collaboration (GEMRIC): Establishing a multi-site investigation of the neural mechanisms underlying response to electroconvulsive therapy. NEUROIMAGE-CLINICAL 2017; 14:422-432. [PMID: 28275543 PMCID: PMC5328749 DOI: 10.1016/j.nicl.2017.02.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/12/2022]
Abstract
Major depression, currently the world's primary cause of disability, leads to profound personal suffering and increased risk of suicide. Unfortunately, the success of antidepressant treatment varies amongst individuals and can take weeks to months in those who respond. Electroconvulsive therapy (ECT), generally prescribed for the most severely depressed and when standard treatments fail, produces a more rapid response and remains the most effective intervention for severe depression. Exploring the neurobiological effects of ECT is thus an ideal approach to better understand the mechanisms of successful therapeutic response. Though several recent neuroimaging studies show structural and functional changes associated with ECT, not all brain changes associate with clinical outcome. Larger studies that can address individual differences in clinical and treatment parameters may better target biological factors relating to or predictive of ECT-related therapeutic response. We have thus formed the Global ECT-MRI Research Collaboration (GEMRIC) that aims to combine longitudinal neuroimaging as well as clinical, behavioral and other physiological data across multiple independent sites. Here, we summarize the ECT sample characteristics from currently participating sites, and the common data-repository and standardized image analysis pipeline developed for this initiative. This includes data harmonization across sites and MRI platforms, and a method for obtaining unbiased estimates of structural change based on longitudinal measurements with serial MRI scans. The optimized analysis pipeline, together with the large and heterogeneous combined GEMRIC dataset, will provide new opportunities to elucidate the mechanisms of ECT response and the factors mediating and predictive of clinical outcomes, which may ultimately lead to more effective personalized treatment approaches. A global collaboration for longitudinal neuroimaging of ECT was established. A secure data portal with individual-patient level data. The feasibility of a standardized image analysis pipeline is demonstrated.
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Affiliation(s)
- Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA; Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hauke Bartsch
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA; Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | | | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, USA
| | | | - Max L Stek
- VUmc Amsterdam/GGZinGeest, Amsterdam, Netherlands
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Louise Emsell
- KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Philip van Eijndhoven
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, Netherlands
| | - Miklos Argyelan
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, New York, USA
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, Netherlands
| | - Pia Nordanskog
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | | | - Iris E Sommer
- Brain Center Rudolf Magnus, University Medical Center, Utrecht, Utrecht, Netherlands
| | - Sophie M Heringa
- Brain Center Rudolf Magnus, University Medical Center, Utrecht, Utrecht, Netherlands
| | - Bogdan Draganski
- LREN, Department of Clinical Neurosciences - CHUV, University Lausanne, Switzerland; Max-Planck-Institute for Human Brain and Cognitive Neurosciences, Leipzig, Germany
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Germany; Department of Psychiatry, University of Marburg, Germany
| | - Harald Kugel
- Department of Clinical Radiology, University of Münster, Germany
| | - Filip Bouckaert
- KU Leuven, University Psychiatric Center KU Leuven, Academic center for ECT and Neurostimulation (AcCENT), Kortenberg, Belgium
| | - Pascal Sienaert
- KU Leuven, University Psychiatric Center KU Leuven, Academic center for ECT and Neurostimulation (AcCENT), Kortenberg, Belgium
| | - Amit Anand
- Cleveland Clinic, Center for Behavioral Health, Cleveland, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), CA, USA; Department of Neurology, University of California, Los Angeles (UCLA), CA, USA
| | - Dominic Holland
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA; Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
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