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Martin E, Purushothaman S, Ballard E, Blake JA, Burke K, Scott JG. Electroconvulsive therapy in a tertiary Australian mental health facility between 2009 and 2020. Aust N Z J Psychiatry 2024; 58:713-720. [PMID: 38831553 DOI: 10.1177/00048674241256839] [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] [Indexed: 06/05/2024]
Abstract
BACKGROUND Despite electroconvulsive therapy being one of the most effective treatments in psychiatry, few studies report trends in the provision of electroconvulsive therapy over time. This study aims to investigate the use of electroconvulsive therapy between 2009 and 2020 in an Australian public tertiary mental health facility, and to describe the electroconvulsive therapy patient population and change in courses of treatment. METHODS Routinely collected data for 677 patients who received 1669 electroconvulsive therapy courses of treatment at an Australian public tertiary mental health facility between 2009 and 2020 were examined. RESULTS The provision of acute electroconvulsive therapy was stable across the study period; however, the number of maintenance electroconvulsive therapy courses commenced declined over the study. Schizophrenia was the most common indication for index treatment (37.4%). The majority of patients (85.7%) received acute electroconvulsive therapy only. Voluntary provision of electroconvulsive therapy declined over the study period, reducing from 44.9% in 2009 to 16.3% in 2020. CONCLUSION Over the study period, there was a significant reduction in the number of maintenance electroconvulsive therapy courses commenced, and a large increase in involuntary treatment. The provision of electroconvulsive therapy was more likely to occur in males with a diagnosis of schizophrenia. Further studies are needed to generate a greater understanding of the factors influencing the provision of electroconvulsive therapy within differing geographical, social and healthcare landscapes.
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Affiliation(s)
- Emily Martin
- Metro North Mental Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
| | | | - Emma Ballard
- Brain and Mental Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Julie A Blake
- Brain and Mental Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Child and Youth Mental Health Research, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Child and Youth Mental Health Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Kylie Burke
- Metro North Mental Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
- School of Psychology, The University of Queensland, South Brisbane, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, Institute for Social Science Research, The University of Queensland, South Brisbane, QLD, Australia
| | - James G Scott
- Brain and Mental Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
- Child and Youth Mental Health Research, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Child and Youth Mental Health Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Yrondi A, Blanc O, Anguill L, Arbus C, Boudieu L, Patoz MC, Arnould A, Charpeaud T, Genty JB, Abidine R, Redon M, Rey R, Aouizerate B, Bennabi D, El-Hage W, Etain B, Holtzmann J, Leboyer M, Molière F, Richieri RM, Stéphan F, Vaiva G, Sauvaget A, Poulet E, Haffen E, Courtet P, Fossati P, Llorca PM, Samalin L. Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients. BMC Psychiatry 2024; 24:487. [PMID: 38961386 PMCID: PMC11223384 DOI: 10.1186/s12888-024-05933-7] [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: 01/05/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However, ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international guidelines. METHODS In this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the 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 We identified 335 patients. The mean duration of MDEs before ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using ECT from guidelines did not reduce the duration of MDEs before ECT, except where there was a previous response to ECT. The first-line indications reduced the number of lines of treatment before starting ECT. CONCLUSION Even if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.
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Affiliation(s)
- Antoine Yrondi
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France.
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France.
| | - Olivier Blanc
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Loic Anguill
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Christophe Arbus
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Marie-Camille Patoz
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Adeline Arnould
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | | | - Jean-Baptiste Genty
- Université 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 Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Racan Abidine
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Maximilien Redon
- Service de Psychiatrie Et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - Romain Rey
- INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, Bron, France
| | - Bruno Aouizerate
- Pôle de Psychiatrie Générale Et Universitaire, Centre de Référence Régional Des Pathologies Anxieuses Et de La Dépression, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, Laboratoire Nutrition Et Neurobiologie Intégrée (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Djamila Bennabi
- Université de Franche-Comté, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, CHU de Besançon, F-25030, Besançon, France
| | - Wissam El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, CHRU de Tours, Tours, France
| | - Bruno Etain
- Département de Psychiatrie Et de Médecine Addictologique, Lariboisière-Fernand Widal GHU APHP Nord Université Paris Cité Paris, Paris, France
| | - Jérôme Holtzmann
- Service de Psychiatrie de L'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Marion Leboyer
- Université 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 Fondation FondaMental, Fondation de Cooperation Scientifique, Créteil, France
| | - Fanny Molière
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Raphaelle Marie Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Florian Stéphan
- Service Hospitalo-Universitaire de Psychiatrie Générale Et de Réhabilitation Psycho Sociale 29G01 Et 29G02, Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Guillaume Vaiva
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition & Centre National de Ressources Et Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), F-59000, Lille, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement, Interactions, Performance, MIP, UR 4334, 44000, Nantes, France
- French Society for Biological Psychiatry and Neuropsychopharmacology, STEP Section (Stimulation Transcrânienne en Psychiatrie), Saint-Germain-en-Laye, France
| | - Emmanuel Poulet
- Psychiatric Emergency Service, Hospices Civils de Lyon, F-69005, Lyon, France
- France Centre Hospitalier Le Vinatier, Bron; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, F-69000, Lyon, France
- University Lyon 1, Villeurbanne, F-69000, Villeurbanne, France
| | - Emmanuel Haffen
- Université de Franche-Comté, UMR INSERM 1322 LINC, Service de Psychiatrie de L'adulte, CIC-1431 INSERM, CHU de Besançon, F-25030, Besançon, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Philippe Fossati
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Control-Interoception Attention Team, Paris Brain Institute (ICM), Sorbonne University, INSERM, CNRS, APHP, Hôpital de La Pitié-Salpêtrière, DMU Neuroscience, Paris, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludovic Samalin
- French Society for Biological Psychiatry and Neuropsychopharmacology, Saint Germain en Laye, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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Chaudhri SI, Amin A, Panjiyar BK, Al-Taie DS, AlEdani EM, Gurramkonda J, Hamid P. A Comparison of the Efficacy and Adverse Effects of Ketamine and Electroconvulsive Therapy in the Management of Treatment-Resistant Depression: A Systematic Review. Cureus 2024; 16:e55596. [PMID: 38576655 PMCID: PMC10994654 DOI: 10.7759/cureus.55596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Ketamine has been repeatedly demonstrated to be an effective treatment in the management of patients with treatment-resistant depression (TRD). An important question is whether it is equally or more effective than the current gold standard of electroconvulsive therapy (ECT), as the adverse effects of ECT can lead to memory loss and neurocognitive deficits. A literature search was conducted for trials that directly compared the efficacy and adverse effects of ketamine and ECT via PubMed and Google Scholar. A total of 56 articles were identified with six included in this review. The studies included differed significantly in their quality and with differing levels of potential for bias. Ketamine has a more immediate effect when compared to ECT, but the antidepressant effects are shorter-lasting. Cognitive deficits were less pronounced in patients undergoing ketamine therapy. Many studies had a small number of participants and varied widely in the type of ECT used. Allocation bias seems likely in nonrandomized studies. Follow-up times were also short in some studies. The existing literature does not provide sufficient evidence to support the usage of ketamine over that of ECT for TRD, as remission rates were significantly higher over extended periods in ECT groups. Cognitive adverse effects were more pronounced in patients undergoing ECT. More high-quality randomized controlled trials (RCTs) directly comparing these two treatment modalities are required before drawing any firm conclusions.
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Affiliation(s)
- Shaan I Chaudhri
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amina Amin
- General Surgery, Shifa International Hospital, Islamabad, PAK
| | - Binay K Panjiyar
- Global Clinical Scholars Research Training, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhuha S Al-Taie
- Plastic Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Esraa M AlEdani
- Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jahnavi Gurramkonda
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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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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Lundin RM, Berk M, Østergaard SD. ChatGPT on ECT: Can Large Language Models Support Psychoeducation? J ECT 2023; 39:130-133. [PMID: 37310145 DOI: 10.1097/yct.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Robert M Lundin
- From the Barwon Health MHDAS, Change to Improve Mental Health (CHIME), University Hospital Geelong, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT)
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Tang VM, Goud R, Zawertailo L, Selby P, Coroiu A, Sloan ME, Chenoweth MJA, Buchman D, Ibrahim C, Blumberger DM, Foll BL. Repetitive transcranial magnetic stimulation for smoking cessation: Next steps for translation and implementation into clinical practice. Psychiatry Res 2023; 326:115340. [PMID: 37454610 DOI: 10.1016/j.psychres.2023.115340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Tobacco smoking is a significant determinant of preventable morbidity and mortality worldwide. It is now possible to modulate the activity of the neurocircuitry associated with nicotine dependence using repetitive Transcranial Magnetic Stimulation (rTMS), a non-invasive neurostimulation approach, which has recently demonstrated efficacy in clinical trials and received regulatory approval in the US and Canada. However there remains a paucity of replication studies and real-world patient effectiveness data as access to this intervention is extremely limited. There are a number of unique challenges related to the delivery of rTMS that need to be addressed prior to widespread adoption and implementation of this treatment modality for smoking cessation. In this paper, we review the accessibility, scientific, technological, economical, and social challenges that remain before this treatment can be translated into clinical practice. By addressing these remaining barriers and scientific challenges with rTMS for smoking cessation and delineating implementation strategies, we can greatly reduce the burden of tobacco-related disease worldwide.
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Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Centre for Addiction and Mental Health, Temerty Centre for Therapeutic Brain Intervention, Canada.
| | - Rachel Goud
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada
| | - Laurie Zawertailo
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Peter Selby
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Adina Coroiu
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada
| | - Matthew E Sloan
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Meghan Jo-Ann Chenoweth
- Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Christine Ibrahim
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Temerty Centre for Therapeutic Brain Intervention, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
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Bluhm R, Sipahi ED, Achtyes ED, McCright AM, Cabrera LY. Stakeholders' Ethical Concerns Regarding Psychiatric Electroceutical Interventions: Results from a US Nationwide Survey. AJOB Empir Bioeth 2023; 15:11-21. [PMID: 37343219 PMCID: PMC10733552 DOI: 10.1080/23294515.2023.2224592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders' perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI). METHODS We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs. RESULTS Participants' ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies. CONCLUSIONS To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs.
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Affiliation(s)
- R Bluhm
- Philosophy and Lyman Briggs College, Michigan State University, East Lansing, MI, USA
| | - E D Sipahi
- College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - E D Achtyes
- School of Human Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - A M McCright
- Sociology, Michigan State University, East Lansing, MI, USA
| | - L Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
- Rock Ethics Institute, The Pennsylvania State University, University Park, PA, USA
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Demchenko I, Tassone VK, Dunnett S, Balachandar A, Li S, Anderson M, Daskalakis ZJ, Foley K, Karkouti K, Kennedy SH, Ladha KS, Robertson J, Vaisman A, Koczerginski D, Parikh SV, Blumberger DM, Flint AJ, Bhat V. Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic. BMC Psychiatry 2023; 23:327. [PMID: 37165333 PMCID: PMC10170445 DOI: 10.1186/s12888-023-04832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). METHODS A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). RESULTS Clinical operations of ECT programs were disrupted across all four regions - however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. CONCLUSIONS The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians' activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.
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Affiliation(s)
- Ilya Demchenko
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Sarah Dunnett
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Arpana Balachandar
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Sophie Li
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Karen Foley
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Jamie Robertson
- Centre for Clinical Ethics, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alon Vaisman
- Department of Infection Prevention and Control, University Health Network, Toronto, ON, Canada
| | - David Koczerginski
- Department of Psychiatry, North York General Hospital, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alastair J Flint
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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9
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Tyron JM, Bluhm R, Achtyes ED, McCright AM, Cabrera LY. The influence of prior awareness on views about psychiatric electroceutical interventions among non-clinician stakeholders. NPJ MENTAL HEALTH RESEARCH 2023; 2:6. [PMID: 38609645 PMCID: PMC10955864 DOI: 10.1038/s44184-023-00028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/18/2023] [Indexed: 04/14/2024]
Abstract
Psychiatric electroceutical interventions (PEIs) are emerging interventions in the treatment of depression and other mood disorders. The uptake of PEIs is strongly influenced by public, caregiver, and patient views. This study examines the influence of prior awareness and of trust in the medico-scientific establishment with respect to non-clinicians' views on PEI among a cohort of U.S. respondents. About 3098 U.S. caregivers, patients, and members of the general public completed an online survey with an embedded experiment to evaluate PEI views by stakeholder, modality, and disease severity. ANOVA statistical tests and logistic regression models were used to identify significant differences between groups and moderating factors. Overall, respondents had greater awareness of antidepressant medication (73-84%) and psychotherapy (68-76%) than of any PEI, and ECT garnered the most prior awareness (29-40%) within each group. Non-clinical respondents most often used websites or social media as information sources, and the least trusted sources included those with notable financial interests. Considering the low awareness level among non-clinicians, the implementation of programs to target and advance awareness levels about the use of PEIs in depression among this population may contribute to reducing negative views around these interventions. Fostering trust in the medico-scientific establishment may also increase public support for PEIs as well as uptake of these treatment modalities.
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Affiliation(s)
- J M Tyron
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, 49548, USA
| | - R Bluhm
- Lyman Briggs and Philosophy, Michigan State University, East Lansing, MI, 48824, USA
| | - E D Achtyes
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, 49548, USA
- Division of Psychiatry & Behavioral Medicine, Michigan State University, Grand Rapids, MI, 49503, USA
| | - A M McCright
- Sociology, Michigan State University, East Lansing, MI, 48824, USA
| | - L 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, 16802, USA.
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10
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Sarma S, Hussain B, Gigante T, Davies A, Watson R, Branjerdporn G. Challenging stigma and attitudes towards ECT via an educational video. Int J Ment Health Nurs 2023; 32:884-892. [PMID: 36861759 DOI: 10.1111/inm.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
While electroconvulsive therapy (ECT) is an effective therapeutic modality for the treatment of mental illness, negative attitudes and stigma exist about ECT in the general community and even within health services. Investigating interventions that improve the attitudes of health professionals towards ECT is beneficial as this reduces stigma and increases the acceptability of ECT for consumers. The primary aim of this study was to evaluate the change in attitude of nursing graduates and medical students towards ECT by watching an educational video. The secondary aim was to compare health professional attitudes to those of the general community. An educational video was co-designed with consumers and members of the mental health Lived Experience (Peer) Workforce Team about ECT outlining the procedure, side effects, treatment considerations and lived experiences. Nursing graduates and medical students completed the ECT Attitude Questionnaire (EAQ) prior to and after watching the video. Descriptive statistics, paired samples t-tests and one sample t-tests were completed. One hundred and twenty-four participants completed pre- and post- questionnaires. Attitudes towards ECT significantly improved after watching the video. Positive responses towards ECT increased from 67.09% to 75.72%. Participants in this study reported higher positive attitudes towards ECT than members of the general public before and after watching the intervention. Results indicated that the video educational intervention was effective in improving attitudes towards ECT for nursing graduates and medical students. While the video is promising as an educational tool, further research is required to explore the use of the video in reducing stigma for consumers and carers.
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Affiliation(s)
- Shanthi Sarma
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Besalat Hussain
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Titta Gigante
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Angela Davies
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rebecca Watson
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Grace Branjerdporn
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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11
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de Anta L, Alvarez-Mon MA, Donat-Vargas C, Lara-Abelanda FJ, Pereira-Sanchez V, Gonzalez Rodriguez C, Mora F, Ortega MA, Quintero J, Alvarez-Mon M. Assessment of beliefs and attitudes about electroconvulsive therapy posted on Twitter: An observational study. Eur Psychiatry 2023; 66:e11. [PMID: 36620994 PMCID: PMC9970148 DOI: 10.1192/j.eurpsy.2022.2359] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective and safe medical procedure that mainly indicated for depression, but is also indicated for patients with other conditions. However, ECT is among the most stigmatized and controversial treatments in medicine. Our objective was to examine social media contents on Twitter related to ECT to identify and evaluate public views on the matter. METHODS We collected Twitter posts in English and Spanish mentioning ECT between January 1, 2019 and October 31, 2020. Identified tweets were subject to a mixed method quantitative-qualitative content and sentiment analysis combining manual and semi-supervised natural language processing machine-learning analyses. Such analyses identified the distribution of tweets, their public interest (retweets and likes per tweet), and sentiment for the observed different categories of Twitter users and contents. RESULTS "Healthcare providers" users produced more tweets (25%) than "people with lived experience" and their "relatives" (including family members and close friends or acquaintances) (10% combined), and were the main publishers of "medical" content (mostly related to ECT's main indications). However, more than half of the total tweets had "joke or trivializing" contents, and such had a higher like and retweet ratio. Among those tweets manifesting personal opinions on ECT, around 75% of them had a negative sentiment. CONCLUSIONS Mixed method analysis of social media contents on Twitter offers a novel perspective to examine public opinion on ECT, and our results show attitudes more negative than those reflected in studies using surveys and other traditional methods.
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Affiliation(s)
- L de Anta
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Medicine and Medical Specialities, University of Alcala, Madrid, Spain
| | - M A Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Medicine and Medical Specialities, University of Alcala, Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - C Donat-Vargas
- ISGlobal, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - F J Lara-Abelanda
- Department of Medicine and Medical Specialities, University of Alcala, Madrid, Spain.,Departamento Teoria de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Escuela Tecnica Superior de Ingenieria de Telecomunicación, Universidad Rey Juan Carlos, 28942 Fuenlabrada, Spain
| | - V Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - C Gonzalez Rodriguez
- Centro de Salud Mental Infanto Juvenil Cornellá, Hospital Sant Joan de Deu, Barcelona, Spain
| | - F Mora
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Legal and Psychiatry, Complutense University, Madrid, Spain
| | - M A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - J Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Legal and Psychiatry, Complutense University, Madrid, Spain
| | - M Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
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12
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Qureshi H, Jain L. Late to respond, but early to relapse - An abnormal course of electroconvulsive therapy in treatment-resistant schizophrenia during times of COVID-19. PSYCHIATRY RESEARCH CASE REPORTS 2022; 1:100052. [PMID: 36188755 PMCID: PMC9511015 DOI: 10.1016/j.psycr.2022.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Haris Qureshi
- Department of Psychiatry, UConn School of Medicine, Farmington, CT, United States
| | - Lakshit Jain
- Department of Psychiatry, UConn School of Medicine, Farmington, CT, United States
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13
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Muraoka H, Kodaka F, Hasegawa N, Yasui-Furukori N, Fukumoto K, Kashiwagi H, Tagata H, Hori H, Atake K, Iida H, Ichihashi K, Furihata R, Tsuboi T, Takeshima M, Komatsu H, Kubota C, Ochi S, Takaesu Y, Usami M, Nagasawa T, Makinodan M, Nakamura T, Kido M, Ueda I, Yamagata H, Onitsuka T, Asami T, Hishimoto A, Ogasawara K, Katsumoto E, Miura K, Matsumoto J, Ohi K, Yamada H, Watanabe K, Inada K, Nishimura K, Hashimoto R. Characteristics of the treatments for each severity of major depressive disorder: A real-world multi-site study. Asian J Psychiatr 2022; 74:103174. [PMID: 35661492 DOI: 10.1016/j.ajp.2022.103174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE In the treatment guidelines for major depressive disorder (MDD), the recommended treatment differs based on the severity. However, the type of treatment provided based on the severity of MDD in real-world clinical practice has not been investigated. In this study, we clarified the actual situation of MDD treatment in clinical practice and compared the treatment based on the severity of MDD. METHODS We used data from 1484 patients with MDD at discharge from October 2016 to March 2020. RESULTS The number of psychotropic prescriptions tended to be lower in those diagnosed with MDD in the severe group compared to in the non-severe group. There were significant differences among the three groups (mild, moderate/severe, and psychotic) in the percentage of patients who were not prescribed antipsychotics (p = 1.9 ×10-6), a combination of antipsychotics and antidepressants (p = 5.0 ×10-4), and the implementation rate of modified electroconvulsive therapy (m-ECT) (p = 3.4 ×10-9). The percentage of patients with a severe diagnosis who underwent m-ECT was higher, which corresponded to the severity. CONCLUSION Our findings showed that the use of psychotropics decreased when the severity of MDD was diagnosed, and the rate of a combination of antipsychotics and antidepressants and the implementation rate of m-ECT increased with the severity. However, this study suggests that there is still an evidence-practice gap in the treatment of MDD in Japan, and guidelines are only partially adhered to in the treatment of depression.
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Affiliation(s)
- Hiroyuki Muraoka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hiroko Kashiwagi
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kiyokazu Atake
- Nippon Telegraph and Telephone West Corporation Kyushu Health Administration Center, Fukuoka, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | | | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Chika Kubota
- National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Graduate School of Medicine, Ehime University, Ehime, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Tatsuya Nagasawa
- Department of NeuroPsychiatry Kanazawa Medical University, Ishikawa, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Nara, Japan
| | - Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, Nagano, Japan
| | - Mikio Kido
- Toyama City Hospital, Toyama, Japan; Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Ikki Ueda
- Miyagi Psychiatric Center, Miyagi, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan
| | | | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Suita Japan
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14
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Smith WR, Sisti DA. Rapprochement and Reform: Overcoming Factionalism in Policy Making for Serious Mental Illness. Psychiatr Serv 2022; 73:539-546. [PMID: 35042398 PMCID: PMC9713899 DOI: 10.1176/appi.ps.202100450] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article traces the history of factionalism in policy making and advocacy for persons with serious mental illness from deinstitutionalization to the present. The authors draw on deliberative democratic theory to illustrate how factionalist advocacy causes advocates and policy makers to fail in their duties to represent and develop policy in support of people with serious mental illness. The authors discuss how this factionalism has bred distrust and undermined efforts to address the needs of people with serious mental illness. They propose the formation of a Public Mental Health Policy Commission, guided by principles of deliberative democracy, to overcome factionalism and to improve policy making to meet the needs of people with serious mental illness. The commission must include a diverse array of stakeholders, especially individuals with lived experience of serious mental illness.
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Affiliation(s)
- William R Smith
- Department of Psychiatry (Smith) and Department of Medical Ethics and Health Policy (Sisti), University of Pennsylvania, Philadelphia
| | - Dominic A Sisti
- Department of Psychiatry (Smith) and Department of Medical Ethics and Health Policy (Sisti), University of Pennsylvania, Philadelphia
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15
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Jagadheesan K, Lakra V. Capacity, consent and electroconvulsive therapy: What is the next step forward? Aust N Z J Psychiatry 2022; 56:575. [PMID: 34320848 DOI: 10.1177/00048674211036347] [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: 11/17/2022]
Affiliation(s)
- Karuppiah Jagadheesan
- Broadmeadows Inpatient Psychiatry Unit, North West Area Mental Health Service, Broadmeadows Coburg, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Vinay Lakra
- Broadmeadows Inpatient Psychiatry Unit, North West Area Mental Health Service, Broadmeadows Coburg, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
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16
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Verdijk JPAJ, Pottkämper JCM, Verwijk E, van Wingen GA, van Putten MJAM, Hofmeijer J, van Waarde JA. Study of effect of nimodipine and acetaminophen on postictal symptoms in depressed patients after electroconvulsive therapy (SYNAPSE). Trials 2022; 23:324. [PMID: 35436940 PMCID: PMC9014277 DOI: 10.1186/s13063-022-06206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Postictal phenomena as delirium, headache, nausea, myalgia, and anterograde and retrograde amnesia are common manifestations after seizures induced by electroconvulsive therapy (ECT). Comparable postictal phenomena also contribute to the burden of patients with epilepsy. The pathophysiology of postictal phenomena is poorly understood and effective treatments are not available. Recently, seizure-induced cyclooxygenase (COX)-mediated postictal vasoconstriction, accompanied by cerebral hypoperfusion and hypoxia, has been identified as a candidate mechanism in experimentally induced seizures in rats. Vasodilatory treatment with acetaminophen or calcium antagonists reduced postictal hypoxia and postictal symptoms. The aim of this clinical trial is to study the effects of acetaminophen and nimodipine on postictal phenomena after ECT-induced seizures in patients suffering major depressive disorder. We hypothesize that (1) acetaminophen and nimodipine will reduce postictal electroencephalographic (EEG) phenomena, (2) acetaminophen and nimodipine will reduce magnetic resonance imaging (MRI) measures of postictal cerebral hypoperfusion, (3) acetaminophen and nimodipine will reduce clinical postictal phenomena, and (4) postictal phenomena will correlate with measures of postictal hypoperfusion. Methods We propose a prospective, three-condition cross-over design trial with randomized condition allocation, open-label treatment, and blinded end-point evaluation (PROBE design). Thirty-three patients (age > 17 years) suffering from a depressive episode treated with ECT will be included. Randomly and alternately, single doses of nimodipine (60 mg), acetaminophen (1000 mg), or water will be given two hours prior to each ECT session with a maximum of twelve sessions per patient. The primary outcome measure is ‘postictal EEG recovery time’, expressed and quantified as an adapted version of the temporal brain symmetry index, yielding a time constant for the duration of the postictal state on EEG. Secondary outcome measures include postictal cerebral perfusion, measured by arterial spin labelling MRI, and the postictal clinical ‘time to orientation’. Discussion With this clinical trial, we will systematically study postictal EEG, MRI and clinical phenomena after ECT-induced seizures and will test the effects of vasodilatory treatment intending to reduce postictal symptoms. If an effect is established, this will provide a novel treatment of postictal symptoms in ECT patients. Ultimately, these findings may be generalized to patients with epilepsy. Trial registration Inclusion in SYNAPSE started in December 2019. Prospective trial registration number is NCT04028596 on the international clinical trial register on July 22, 2019.
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17
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Tamman AJF, Anand A, Mathew SJ. A comparison of the safety, feasibility, and tolerability of ECT and ketamine for treatment-resistant depression. Expert Opin Drug Saf 2022; 21:745-759. [PMID: 35253555 DOI: 10.1080/14740338.2022.2049754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Treatment-resistant depression (TRD) is a problematic and prevalent public health and societal concern. Although electroconvulsive therapy (ECT) is the gold standard TRD intervention, the treatment evokes apprehension due to public perceptions, feasibility, and tolerability. Despite significant medical advancements, few medications have been approved by the U.S. Food and Drug Administration for TRD. In 2019, intranasal esketamine, the S-isomer of racemic ketamine, was approved for TRD, garnering significant excitement about the potential for the drug to act as an alternative treatment to ECT. AREAS COVERED The goal of this narrative review is to compare the safety, efficacy, and tolerability of ketamine and ECT; clarify whether ketamine is a reasonable alternative to ECT; and to facilitate improved treatment assignment for TRD. Empirical quantitative and qualitative studies and national and international guidelines these treatments are reviewed. EXPERT OPINION : The field awaits the results of two ongoing large comparative effectiveness trials of ECT and IV ketamine for TRD, which should help guide clinicians and patients as to the relative risk and benefit of these interventions. Over the next five years we anticipate further innovations in neuromodulation and in drug development which broadly aim to develop more tolerable versions of ECT and ketamine, respectively.
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Affiliation(s)
- Amanda J F Tamman
- Department of Psychology, St. John's University, Queens, NY, USA.,Mood and Anxiety Disorders Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amit Anand
- Department of Psychiatry, Mass General Brigham, Harvard Medical School, Boston, MA, USA
| | - Sanjay J Mathew
- Michael E. Debakey VA Medical Center, Houston, TX, USA.,Mood and Anxiety Disorders Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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18
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Coman A. Recipients' experience with information provision for electroconvulsive therapy (ECT). BMC Psychiatry 2022; 22:86. [PMID: 35120485 PMCID: PMC8815125 DOI: 10.1186/s12888-022-03720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite improvements, studies continue to report unsatisfactory provision of information before, during and after electroconvulsive treatment (ECT). AIMS The study explores participants' experiences with information provision about ECT. METHODS In-depth interviews with 21 participants (21- 65 year-old) were conducted. Thematic analysis resulted in identification of four themes: pre-treatment knowledge, experience of informed consent, the need for information depth and life after ECT. The study includes user involvement. RESULTS Although some participants were satisfied with information provision, the majority experienced an education deficit throughout the treatment period. Their consent was based mostly on oral information, insufficient and unvaried information on official health websites and media. Further, patients reported a lack of follow-up services that can attend to (neuro) psychological concerns. CONCLUSIONS Better access to updated factual and narrative information should support patient education and autonomy. Active use of diary writing, better follow-up and more varied representations of experience with ECT in media and health information sites are necessary to educate, improve consent processes and reduce stigma.
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Affiliation(s)
- A. Coman
- grid.5510.10000 0004 1936 8921Centre for medical ethics, Institute for health and society, University of Oslo, P.O. Box 1130, Blindern, 03168 Oslo, Norway
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19
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Abstract
AIMS AND METHOD Electroconvulsive therapy (ECT) often causes fear in the general public because of media representation and negative reported side-effects. This study evaluates a new video focusing on experiences of ECT and how this can aid communicating medical information to the public. Knowledge and attitudes toward ECT after watching the video were compared with a group that received no information and a group that read the current NHS leaflet on ECT. The role of empathy was also considered as a covariate. RESULTS The video was the only condition found to positively affect knowledge and attitudes toward ECT. The video was especially beneficial to those that possessed low perspective-taking trait empathy. CLINICAL IMPLICATIONS These findings demonstrate the video improved knowledge and attitudes toward ECT compared with current material or no information. We suggest that the addition of personal experiences to public information adds perspective, improving overall attitudes toward health treatments.
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Affiliation(s)
- Oakley Cheung
- Department of Psychology, University of Portsmouth,UK
| | - Marc Baker
- Department of Psychology, University of Portsmouth,UK
| | - Paul Tabraham
- Portsmouth and South East Hampshire Division, Southern Health NHS Foundation Trust, UK
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20
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Sidhom E, Omar MH. The Nomenclature of Electroconvulsive Therapy. J ECT 2021; 37:128-132. [PMID: 33337650 DOI: 10.1097/yct.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) is an established but stigmatized psychiatric treatment. The term ECT reflects the treatment's modality and action. Several authors proposed different names for ECT to deal with stigma; however, available literature that promoted different names did not address the risk/benefit ratio or offer evidence-based approach to the efficacy of this approach. We aim to examine proposed names for their specificity, accuracy, understandability, and popularity. In addition, we aim to find evidence-based methods to combat the ECT-related stigma. We reviewed the literature relating to the proposed names using snowballing technique for literature search. Known ECT alternative names were used for search, and whenever another name appears, it was added to our search list. We conducted Medline, PsycINFO, Google Scholar, and PubMed search to check for popularity and cross examine whether proposed terms refer back to ECT. We searched for ECT and stigma, to find evidence for methods to tackle ECT-related stigma. Once, the search stopped yielding newer ideas, we stopped the search at a point of saturation, where no more ideas where generated. Our name search yielded 14 terms. Nine names avoided "electricity" and "convulsion," because of perceived associated stigma. Presence of different terminology can affect the clarity of patient-doctor communication, with no evidence of added benefit. Alternative names may affect doctor-doctor communication about this treatment. We concluded that it is safer to retain the term ECT for the sake of consistency and clarity of communication. Education and experience are evidence-based effective methods of tackling ECT-related stigma.
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Affiliation(s)
- Emad Sidhom
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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21
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McGlynn E, Nabaei V, Ren E, Galeote‐Checa G, Das R, Curia G, Heidari H. The Future of Neuroscience: Flexible and Wireless Implantable Neural Electronics. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2002693. [PMID: 34026431 PMCID: PMC8132070 DOI: 10.1002/advs.202002693] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/15/2021] [Indexed: 05/04/2023]
Abstract
Neurological diseases are a prevalent cause of global mortality and are of growing concern when considering an ageing global population. Traditional treatments are accompanied by serious side effects including repeated treatment sessions, invasive surgeries, or infections. For example, in the case of deep brain stimulation, large, stiff, and battery powered neural probes recruit thousands of neurons with each pulse, and can invoke a vigorous immune response. This paper presents challenges in engineering and neuroscience in developing miniaturized and biointegrated alternatives, in the form of microelectrode probes. Progress in design and topology of neural implants has shifted the goal post toward highly specific recording and stimulation, targeting small groups of neurons and reducing the foreign body response with biomimetic design principles. Implantable device design recommendations, fabrication techniques, and clinical evaluation of the impact flexible, integrated probes will have on the treatment of neurological disorders are provided in this report. The choice of biocompatible material dictates fabrication techniques as novel methods reduce the complexity of manufacture. Wireless power, the final hurdle to truly implantable neural interfaces, is discussed. These aspects are the driving force behind continued research: significant breakthroughs in any one of these areas will revolutionize the treatment of neurological disorders.
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Affiliation(s)
- Eve McGlynn
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Vahid Nabaei
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Elisa Ren
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Gabriel Galeote‐Checa
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Rupam Das
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
| | - Giulia Curia
- Laboratory of Experimental Electroencephalography and NeurophysiologyDepartment of BiomedicalMetabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModena41125Italy
| | - Hadi Heidari
- Microelectronics LabJames Watt School of EngineeringUniversity of GlasgowGlasgowG12 8QQUnited Kingdom
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22
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Griffiths C, Walker K, Reid I, da Silva KM, O'Neill-Kerr A. A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’ project. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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23
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Ulbrich L, Kröger C. Value of Electroconvulsive Therapy in the General Public: A Willingness to Pay Study in Germany. J ECT 2021; 37:51-57. [PMID: 33009216 DOI: 10.1097/yct.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to estimate the value a population-representative sample places on electroconvulsive therapy (ECT) through willingness to pay (WTP) and to assess the effects of individual characteristics on WTP for ECT. METHODS A German population-representative sample of 518 was presented with a hypothetical health loss scenario of depression and was asked to indicate WTP for ECT. Probit and quantile regression were used to estimate the effects of individual characteristics on the probability of stating a positive WTP and on the amount of money respondents were willing to pay. RESULTS Two thirds of respondents stated that they had no knowledge about ECT. Most (56.5%) respondents indicated zero WTP for health gains through ECT treatment. Mean WTP was €5201 ($5612); median WTP was €1000 ($1079). Respondents' monthly household income had a significant effect on the probability of stating a positive WTP. Assessing WTP above zero, income showed a significant positive effect, whereas a higher score of depressive complaints showed a significant negative effect on the amount respondents were willing to pay. CONCLUSION Knowledge about ECT treatment is particularly low in the German public.
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Affiliation(s)
- Laura Ulbrich
- From the Department of Psychology, University of Hildesheim, Hildesheim, Germany
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24
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Cabrera LY, Nowak GR, McCright AM, Achtyes E, Bluhm R. A qualitative study of key stakeholders' perceived risks and benefits of psychiatric electroceutical interventions. HEALTH, RISK & SOCIETY 2021; 23:217-235. [PMID: 35574212 PMCID: PMC9103575 DOI: 10.1080/13698575.2021.1979194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Amid a renewed interest in alternatives to psychotherapy and medication to treat depression, there is limited data as to how different stakeholders perceive of the risks and benefits of psychiatric electroceutical interventions (PEIs), including electroconvulsive therapy (ECT) and deep brain stimulation (DBS). To address this gap, we conducted 48 semi-structured interviews, including 16 psychiatrists, 16 persons diagnosed with depression, and 16 members of the general public. To provide a basis of comparison, we asked participants to also compare each modality to front-line therapies for depression and to neurosurgical procedures used for non-psychiatric conditions. Across all stakeholder groups, perceived memory loss was the most frequently mentioned potential risk with ECT. The most discussed benefits across all stakeholder groups were efficacy and quick response. Psychiatrists most often referenced effectiveness when discussing ECT, while patients and the public did so when discussing DBS. Taken as a whole, these data highlight stakeholders' contrasting perspectives on the risks and benefits of electroceuticals.
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Affiliation(s)
- Laura Y Cabrera
- Center for Neural Engineering, Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, United States
- Rock Ethics Institute, Pennsylvania State University, University Park, PA, United States
| | - Gerald R Nowak
- Department of Sociology, Michigan State University, East Lansing, MI, United States
| | - Aaron M McCright
- Department of Sociology, Michigan State University, East Lansing, MI, United States
| | - Eric Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, East Grand Rapids, MI, United States
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, United States
| | - Robyn Bluhm
- Lyman Briggs College and Department of Philosophy, Michigan State University, East Lansing, MI, United States
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25
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Tsai J, Huang M, Rosenheck RA, Wilkinson S. A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States. Psychiatr Serv 2020; 71:562-569. [PMID: 32151214 DOI: 10.1176/appi.ps.201900448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment. METHODS This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation. RESULTS Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT. CONCLUSIONS These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.
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Affiliation(s)
- Jack Tsai
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
| | - Minda Huang
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
| | - Robert A Rosenheck
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
| | - Samuel Wilkinson
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang)
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26
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Bersani G, Pacitti F, Iannitelli A. 'Delusional' consent in somatic treatment: the emblematic case of electroconvulsive therapy. JOURNAL OF MEDICAL ETHICS 2020; 46:392-396. [PMID: 32054778 DOI: 10.1136/medethics-2019-105540] [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: 04/26/2019] [Revised: 12/17/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient's motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient's inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the 'error' committed for which the depressed patient blames himself and the social repression of the maniacal patient's affirmation of his inflated self-esteem.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Francesca Pacitti
- Department of Clinical Sciences and Applied Biotechnology, University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
| | - Angela Iannitelli
- Department of Clinical Sciences and Applied Biotechnology, University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
- Psychoanalytical Centre of Rome (CPdR), Rome, Italy
- International Psychoanalytical Association (IPA), London, UK
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27
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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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28
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MacMaster FP, Mitchell N, Bichel A, Bercov M, Thompson G, Suen V, Strilchuk A, Rittenbach K. Crossing Death Valley: Bringing Neurotechnology to Psychiatric Clinics in Alberta, Canada. Front Psychiatry 2020; 11:135. [PMID: 32210853 PMCID: PMC7067696 DOI: 10.3389/fpsyt.2020.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/14/2020] [Indexed: 11/28/2022] Open
Abstract
Depression is a major public health problem, with a lifetime and 12-month prevalence estimated at 18 and 6% of adults. Depression is costly in terms of treatment and lost productivity and is the main burden of mental illness across the globe. Existing pharmacological and psychological treatments for depression result in clinically meaningful improvements in <60% of patients. An emerging treatment approach is non-invasive brain stimulation of depression-related brain targets through transcranial magnetic stimulation (TMS). In this perspective, we detail our efforts on bringing TMS to clinical populations in Alberta by utilizing a novel organizational structure that bridges the gap between academia and the health care system. The Addictions and Mental Health Strategic Clinical Network worked with stakeholders to (1) examine the evidence, (2) develop clinical tools for patient selection and protocol application, (3) create overall implementation and evaluation plans to aid in further scale and spread, and even (4) fund the purchase and deployment of devices. Through this work, five publicly supported clinics now exist in Alberta.
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Affiliation(s)
- Frank P MacMaster
- Department of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Nick Mitchell
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada.,Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Allison Bichel
- Strategic Clinical Network for Addictions and Mental Health and Maternal, Newborn, Child & Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Marni Bercov
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Gayle Thompson
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Victoria Suen
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Allison Strilchuk
- Department of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Katherine Rittenbach
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada.,Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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