Suicidal patient

One of the most common reasons given by the psychiatrists for administering ECT is that it prevents suicide. Depressed patients have a higher death rate than the general population, from both suicide and non-suicide causes, and this rate is reduced by ECT. In a study on the effects of ECT on suicides rates, it was found suicide to be lower in ECT treated patients that the patients treated by psychotherapy alone. ECT can save lives in case of acute risk of suicide. No other form of treatment produces immediately visible positive results in patients with bi-polar disorder.

Within two weeks, a severely depressed and suicidal patient would become calm or even euphoric. The people who have been treated with ECT are the only ones who really know the side effects of that they are experiencing, and it is perhaps time for professional to dedicate more time to hearing these stories. [4-5] Ultimately, the need to resolve the dichotomy of opinion regarding the efficacy of ECT , whether through collaborative work between the two competing sides, through research into patients perspectives or preferably, a combination of the two, is paramount.

[6] To assume that ECT works well in the treatment of depression with minimal side effects could be devastating if found not to be true, but equally, to call for its demise owing to an unsubstantiated belief in its destructive effects could be deleterious as it may prevent depressed patients from receiving effective- possibly life saving -psychiatric treatment. Conclusion Although electroconvulsive therapy (ECT) is effective in bipolar depression (1), mania (2), and bipolar mixed state (3–5), its use in the long-term treatment of bipolar disorder is controversial.

Despite methodological flaws, studies in which bipolar patients were included strongly suggest that continuation ECT is very effective. ECT must be used to achieve quick and short-term improvement of extreme indications once all other methods of treatment alternatives have failed to work, or when the condition of the patient is thought to be critical. On the whole, the different researches present the substantiation that real ECT where an electric current is applied is more effective than placebo ECT in the short term.

The data offers proof that the stimulus constraints have a significant effect on efficacy; at the end of a procedure of treatment, two-sided ECT is reported to be more effective than uni-lateral ECT. [7] Increasing the electrical stimulus higher than the person’s seizure threshold is found to enhance the efficacy of uni-lateral ECT at the cost of increased cognitive impairment. It is recommended that the use of ECT should be done only in certain restricted circumstances.

In summary, it can be said that in selected patients, particularly those who relapse under prophylactic pharmacotherapy, are medication resistant in the index episode and respond well to acute ECT series, at least in combination with supporting medication, may be an efficient and safe alternative to a pharmacological continuation or refractory ECT alone.

References

1. Sherman, C. (2000). Adjust dose, schedule to smooth ECT in elderly. Clinical Psychiatry News, 28, 24 2. Breeding, J. (2001). Electroshock and informed consent.

Journal of Humanistic Psychology, 40, 65-79. 3. Krystal, A. D. , Dean, M. D. , Weiner, R. D. , & Tramontozzi, L. A. , III. (2000). ECT stimulus intensity: Are present ECT devices too limited? American Journal of Psychiatry, 157, 963-967. 4. Flint, A. J. , & Rifat, S. L. (2002). Refractory treatment for recurrent depression in late life. A four-year outcome study. American Journal of Geriatrics Psychiatry 8, 112-116.

5. Cohen, D. , Taieb, O. , Flament, M. , Benoit, N. , Chevret, S. , Corcos, M. , Fossati, P. , Jeammet, P., Allilaire, J. F. , & Basquin, M. (2000). Absence of cognitive impairment at long-term follow-up in adolescents treated with ECT for severe mood disorder. American Journal of Psychiatry, 157, 460-462. 6. Bailine, S. H. , Rifkin, A. , Kayne, E. , & Selzer, J. (2000). Comparison of bi-frontal and bitemporal ECT for major depression. The American Journal of Psychiatry, 157, 121-123. 7. National Institute for Clinical Excellence: Guidance on the use of electroconvulsive therapy. (2003) Technology Appraisal 59.

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