6. Attitudes and opinions
Satisfaction with electroconvulsive therapy among patients and their relatives. (2013) Rajagopal R, Chakrabarti S, Grover S. J of ECT;29:283-290.
Patient satisfaction questionnaires in relation to ECT are fraught with difficulty; not least because of the cognitive side-effects that are associated with successful outcome. This group found that 54% of patients were satisfied overall but that participants expressed dissatisfaction in relation to the information they received before ECT and about possible persisting memory problems. Relatives were more likely than patients to express satisfaction.
Electroconvulsive therapy, the placebo effect and informed consent. (2012). Blease C. J Med Ethics;0:1-5 doi:1136/medethics.2012.100955.
The author acknowledges the benefit of ECT but contends that little is known of the underlying mechanism and that practitioners should refer to the possible contribution of the placebo response before gaining consent to treatment.
Patients’ perspectives on electroconvulsive therapy. A re-evaluation of the review by Rose et al on memory loss after electroconvulsive therapy.(2012) Bergsholm P. J of ECT; 28:27-30.
The author challenges the findings of Diane Rose et al stating that they were selective in the studies that formed the basis for their report and that they did not take the patient perspective on the significance of cognitive side-effects into account.
The promises and perils of non-invasive brain stimulation. (2012) Heinrichs JH. International Journal of Law and Psychiatry. Doi:10.1016/j-ijlp.2011.12.006
The author debates moral and ethical issues relating to brain modulation by non-invasive therapies.
This study from the United States of America concluded that across all hospitals the probability of receiving ECT for depressed white inpatients (7.0%) greatly exceeded that for blacks (2.0%). The difference was thought due to underuse within hospitals where treatment is available.
Racial differences in the availability and use of electroconvulsive therapy for recurrent major depression(2011) Case B, Bertollo D, Laska E et al. doi:10.1016/j.jad.2011.11.026
Perceptions and awareness of electroconvulsive therapy among patients and their families. A review of research from developing countries. (2010) Chakrabarti S, Grover S & Rajagopal R. J of ECT 26;317-332.
Information is taken from 16 published studies of developing countries with the conclusion that, although patients and families generally have a positive attitude to ECT, there are many places where preparation is still sadly lacking. The authors note extreme variations in practice and call for more to be done to improve patient satisfaction with the process.
Self evaluation of the cognitive effects of electroconvulsive therapy. (2011) Brakemeier E, Berman R, Prudic et al. J of ECT 27;59-66
Ninety patients were included in this prospective randomised double blind trial comparing the cognitive effects of ECT using different modalities (unilateral versus bilateral) and different pulse widths (brief versus ultra-brief pulse). Results were dependent on the assessment tool used and the authors concluded that a patient global report (Global Self Evaluation of Memory) correlated more accurately with objective tests, treatment modality and pulse width compared to more traditional measures of memory which only correlated with improvement in depression ratings.
Differences between subjective and objective assessments of the utility of electroconvulsive therapy in patients with bipolar and unipolar depression. (2009). Hallam KT, Smith DI, Berk M. J. Affect. Disord. 112, 212-218.
This was a case note review of 787 records. The authors report that there was a significant improvement in clinical global impression and HoNOS scores in both groups but that there was a poorer subjective improvement with ECT in the bipolar compared to the unipolar illness group.
A patients journey: Electroconvulsive therapy. (2009). Webber M. BMJ;338, 169-170 .An article from a husband about his wife's treatment for recurrent depression and successful ECT describing the thoughts, feelings and processes that the couple went through to reach their decisions to continue with maintenance treatment.
Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public. (December 2008) McFarquhar T, Thompson J. J of ECT;24:244-253.
This survey of 70 medical students and 70 members of the public revealed continued fears with respect to ECT based on lack of information on the process and misconceptions gleaned from the media. The aim of educational interventions should be to separate the reality of ECT from the media's portrayal.
Examination of the effect of education about electroconvulsive therapy on nursing practice and patient satisfaction. (December 2008). Arkan B, Ustun B. J of ECT; 24:254-259.
Nor surprisingly education given to nurses was shown to improves practice with the knock on effect of increased patient satisfaction as measured by a global rating scale. The nurse plays a vital role in the care of the patient undergoing ECT.
The cognitive side effects of modern ECT: patient experience or objective measurement? March 2008. Marina Vamos, J of ECT; 24:18-24.
Four themes in this article that uses 8 patients account of therapy encourage us to be person centred and aware of the subjective in describing possible side-effects at ECT. These themes are: the need for clear information, the importance of validation of experience, the impact of daily disruption and the issue of self-esteem.
A life regained. June 2008. Stephen Dinwiddie, J of ECT. 24:107-108
An editorial questioning why there is so much controversy about ECT given the data on effectiveness and safety. Until such time as newer more focussed treatments replace ECT the author suggests that articles on this therapy should be less judgemental.
The meaning of electroconvulsive therapy: a patients perspective. June 2008. Melissa Hensley, J of ECT; 24:112-113.
A description of one patients change in attitude to ECT; from coping with the stigma, feelings of depersonalisation and sense of defeat to feelings of empowerment in making an active choice to continue with maintenance treatment.
The influence of name on the acceptability of ECT: the importance of political correctness. Andrade C & Thyagarajan S. June 2007. J of ECT,23:75-77.
The authors set out to determine how attitudes to ECT are influenced by what ECT is called. They interviewed 125 lay people and preferences were as follows: electrostimulatory therapy 53%; electroshock therapy 38%; electroconvulsive therapy 9%. The authors suggest changing the name to emphasize its stimulatory effects and downplay parallels with epilepsy. A form of words to explain the treatment is offered.
The effects of an education and training program on attitudes to electroconvulsive therapy. Oldewening K et al. June 2007. J of ECT;23:82-88.
This study, involving 94 health care students, found that attitudes to ECT improved following a hospital based education-training programme.
Patients who inappropriately demand electroconvulsive therapy. Rasmussen K & Lineberry T. June 2007. J of ECT;23:109-113.
The authors report 5 case studies of patients whom they consider to have a primary or secondary gain motivating continued dependence on ECT. They offer guidance on alternative management strategies.
A questionnaire study of patients experience of electroconvulsive therapy. Myers D. September 2007. J of ECT;23:169-174.
148 (51%) responses were received following a questionnaire sent to those having ECT at a UK hospital between 1995 and 2002. The conviction that side-effects persisted was thought to be related to current depression and inversely to age but not to the number of ECTs stimulations given. Treatment given without informed consent was associated with a relatively unfavourable view. The author emphasises the importance of listening to the patients's viewpoint.
Consent to ECT:patients experiences in an Irish ECT clinic. Rush G, McCarron S, Lucey J. January 2008. Psychiatric Bulletin;32,15-17.
This postal survey (57% response rate from a total 89 patients) reports a high level of satisfaction with the consent process at ECT. This was attributed to a low rate of coercion associated with support and adequate verbal and written information given pre treatment.
Nurses knowledge of and attitude to electroconvulsive therapy. Wood H, Chambers M, White S. December 2007. J of ECT;23:251-254
This questionnaire study of the attitudes of 211 nurses found that there was a highly significant relationship between knowledge and positive attitude to ECT. The authors suggest that nurses should gain experience early in their careers.
Patients and their relatives attitudes toward electroconvulsive therapy in bipolar disorder. Virit O et al. December 2007. J of ECT;23:255-259.
The attitudes of 70 bipolar patients and their relatives were explored by this group from Turkey. Treatment was given three times a week using bilateral electrode placement and sine-wave electricity. The majority of respondents felt that they had not received adequate information but despite this were satisfied with the outcome. The most commonly reported side-effect was memory loss.
Knowledge of and attitudes towards electroconvulsive therapy of medical students in the United Kingdom, Egypt and Iraq: a transcultural perspective. Abbas M et al.December 2007. J of ECT 23;260-264.
Another study of attitudes to ECT confirming that improved working knowledge and experience results in a more positive attitude.
Patients views on the quality of care when receiving electroconvulsive therapy. Kershaw K, Rayner L, Chaplin R. Psychiatric Bulletin (2007),31,414-417.
A questionnaire on quality of care was completed by 389 patients who had received ECT at accredited clinics in England and Wales between 2004 and 2006. Results showed a 65% or more satisfaction rating for member clinics. Least positive scores related to the fabric of the facilities and being introduced to clinic staff prior to treatment.
Perspectives of patients and relatives about electroconvulsive therapy: A qualitative study from Vellore, India. Rajkumar A, Saravanan B, Jacob K. December 2006. J of ECT;22:253-258.
Confirmation of the complex issues surrounding the giving and retaining of information and the quality of the consent process from these authors who interviewed 52 patients and their relatives before and after ECT. There were significant differences in perception between patients and relatives and between voluntary and detained patients. More than half of recipients were not aware of the details of treatment but were not unhappy about receiving ECT. There was no significant difference between clinicians and relatives perceptions of benefits and side-effects.
Patients attitudes to electroconvulsive therapy. Rush G, McCarron S, Lucey J. June 2007. Psychiatric Bulletin, 31,212-214.
A questionnaire was posted to 89 consecutive patients who had received ECT treatment. There was a 57% response. 88% said they would consider having ECT again and 71% reported at least a modest improvement in symptoms. 60% reported continuing memory impairment at an average 17 weeks post treatment. The standard treatment given was with a brief pulse machine, bilateral electrode placement and estimating dose according to sex and gender.
A family member's experience with ECT. Anon. Jof ECT 2005;21(4):199.
An editorial describing a typical scenario involving treatment of a minor where the parents had differing views about ECT treatment.
Patient satisfaction after electroconvulsive therapy. Sienaert et al. J of ECT 2005;21(4):227-231
36 patients over two years completed a survey based on the Patient Satisfaction Questionnaire, Mini-Mental State Examination, Squire Subjective Memory Questionnaire, Beck Depression Inventory and Positive and Negative Affect Schedule. ECT was given via either bifrontal or unilateral electrode placement. Considerable memory problems were reported but the authors concluded that satisfaction with ECT was based on factors other than outcome, side-effects, demographics or clinical picture.
What predicts patients expressed likelihood of choosing electroconvulsive therapy as a future treatment option? Rosenquist P et al. J of ECT 2006;22(1):33-37.
This prospective study of 77 patients concluded that just over half were as likely to choose ECT again compared to those classed as unlikely. Choosing ECT again was more likely in those severely depressed and impaired beforehand and who had then responded best to treatment. There was no association with quality of life scores or deficits in cognitive function.
Challenges to British Practice of Electroconvulsive Therapy. Fink M. J of ECT 2006; 22(1):30-31.
The author outlines the history of use of ECT in several countries including the UK, USA and Thailand. He challenges the views of the National Institute for Clinical Excellence (NICE) and calls on the Royal College of Psychiatrists to address the critics of ECT in the UK.
Family member presence during electroconvulsive therapy: Patient rights versus medical culture. March 2005. Evans G & Staudenmeier J. Letter in J of ECT Vol 21.
A description of a total of 101 ECT sessions to 6 patients where a family member was present. The authors describe this to be a helpful practice and generally positive experience with family members playing an active part in certain aspects of the procedure eg measuring seizure length, recording memory loss post ECT.
Electroconvulsive therapy Attitudes and misconceptions. June 2005. Dowman J, Patel A, Rajput K. J of ECT, 21(2);84-87.
A review of published literature since 1975, in which the authors conclude that the stigma which remains around ECT acts as a barrier to public acceptance. They call for doctors to counteract negative publicity given to ECT.
Subjective experience of electroconvulsive therapy. Benbow S & Crentsil J. August 2004. Psychiatric Bulletin. 28,289-291.
Two questionnaires were used to rate side-effects and attitudes to ECT in 70 people receiving treatment at the same clinic. Side-effects were commonly reported but predominately rated as mild or moderate. Memory problems were noted in 72% of patients (10% severe, 62% moderate or mild) Less than one fifth of the 60% respondents to the second questionnaire rated ECT as a worse experience than going to the dentist.
Racial disparity in the use of ECT for affective disorders. Breakey W & Dunn G. September 2004. Am J Psychiatry, 161:1635-1641.
This survey of 17,914 admissions to an academic unit between 1993 and 2002 showed that, contrary to popular belief, African Americans with affective disorders were less likely than Caucasians to be treated with ECT. The disparity could not be explained by demographic or socio-economic variables.
Discrepancy between opinion and attitude on the practice of ECT by psychiatrists specialising in old age in the Netherlands. VdWurff F et al.
Results from this postal questionnaire showed that only a small minority (<5%) thought that ECT was the treatment of choice in a depressive disorder with psychotic features, severe suicide risk or physical exhaustion. The authors conclude that this negative attitude among professionals may contribute to the underuse of ECT in the Netherlands.
ECT in the Management of Major Depression: Implications of Recent Research. Andrade C, Nelson AI, Fink M. The World Journal of Biological Psychiatry; July 2003. 4(3): 139.
The authors produce a paraphrased update on their evaluation of recent evidence on the place of ECT; especially effective for older, psychotic and suicidal patients.
Summary of the Practice Parameter for the use of Electroconvulsive Therapy with Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. January 2004. 43(1):119-122.
Support is given for the use of ECT in adolescents who have not responded to pharmacological treatments. Clinical guidelines for practitioners include consent issues and a choice of treatment modality to minimise cognitive side-effects.
Patients Perspectives on Electroconvulsive Therapy: Systematic Review. Rose D et al; BMJ.June 2003. 326(7403):1363.
This descriptive systematic review set out to ascertain patients' views on ECT including the possible benefits and experience of side-effects. The authors challenged the assumption that the 80% improvement rate quoted for ECT meant that patients were satisfied especially given that over one third reported persistent memory loss.
Decisional Capacity of Severely Depressed Patients Requiring Electroconvulsive Therapy. Lapid M et al. Journal of ECT June 2003, 19(2):67-72.
This study of forty people with severe depression concluded that most had decisional capacity to give informed consent to ECT. Education and repeating information further improved decisional capacity to a certain extent.
How Fixed are Child Psychiatrists Views about ECT in the Young? Walter G & Rey J. Journal of ECT June 2003, 19(2):88-92.
This was a follow up postal survey of the views on ECT of child psychiatrists in Australia and New Zealand. Only 54% (n=129) of the original 1996 sample responded in 2000 but responses showed an increased knowledge and more willingness to approve the use of ECT in adolescents.
Electroconvulsive therapy - state of the art. Eranti S & McLoughlin D. Brit J Psych. January 2003; 182, 8-9.
This is an editorial debating the future of the ECT clinic in the light of declining use and reported variations in practice, standards and opportunities for training. The authors mention two possibilities: the formation of a managed clinical network (as in Scotland) or the development of regional specialist centres where expertise can be concentrated.
Patients and their Relatives Knowledge of, Experience With, Attitude Toward, and Satisfaction With Electroconvulsive Therapy in Hong Kong, China. Tang W, Ungvari G, Chan G. Journal of ECT December 2002; 18(4):207-212.
This study of patients and relatives attitudes concluded that majority of patients had little knowledge of ECT yet the majority were satisfied with the treatment and maintained a positive attitude.
Walter G et al. March (2002), Medical Student Knowledge and Attitudes Regarding ECT Prior to and After Viewing Scenes from Movies. Journal of ECT 18(1):43-46.
The level of knowledge about ECT in the 94 students participating in this study was low prior to viewing selected film video clips. After viewing, support for ECT decreased by one third thus prompting the authors to call for adequate training to correct attitudes developed by popular media.
Walter G, Fisher K and Harte A. March (2002). ECT in Poetry. Journal of ECT 18(1):47-53.
A collection of poems which provide personal accounts of ECT from the point of view of patient, carer and clinician.
McDonald A. and Walter G. (2001), The portrayal of ECT in American Movies. Journal of ECT December 2001. 17(4):264-274.
The authors reviewed 22 films from 1948-2000 and concluded that ECT on film has become a progressively more negative and cruel intervention with no pretence to rational examination of the treatment.
Wheeldon T.J. Robertson C. Eagles JM. Reid I.C.(1999), The views and outcomes of consenting and non-consenting patients receiving ECT. Psychological Medicine. 29(1):221-3.
Cheshire K.E. and Freeman C.P.L. (1986 ), Attitude studies in electroconvulsive therapy. , Convulsive Therapy, 2, (1), pp 31-42.
Freeman C.P.L., Weeks D., Kendell R.E. (1980 ECT: patients who complain. ), Brit. J Psych.137: 17-25
