Question

Explain the following in detail about Electroconvulsive Therapy:

1. Controversy

2. Issues including how might issues surrounding the chosen technology be addressed/solved?

3. Challenges

4. Regulatory Implications

*Provide statically significant data

Answer 1

. Controversy.......

ECT usually used for a severe treatment failure depression or mania or in a patient with catatonia (lack of movement,speech,) and associated schizophrenia, severe psychosis etc.Occasionally dementia patients with uncontrollable aggressive behaviour are given ECT.

Now there are controversy regarding its efficacy and also regarding ethics aspect

Although ECT is usually safe, but as with other medical therapy it has also its risks like tachycardia and increase blood pressure.Serious cardiac problems may not be unusual with pre-existing cardiac ailments. As with immediate side effects a transient memory loss ,confusion may occur.Even after symptoms improve, continuation of antidepressive medication should be there to prevent a recurrence.

Again it has been noticed that disorder involving some increasing suicidal tendencies can be reduced with ECT .

But  the patient requiring ECT is not in a mental frame to give informed consent for ECT though ECT can reduce such desire. So this may rise controversy too in not being able to be involved in the decision making process of his /her own treatment.

Solving Issues of technology..of ECT.....

The traditional sine wave ECT dosing is now superseded by the repeated brief pulses (0.5 to 2 milliseconds) associated with greater clinical efficiency and fewer side effects .This is because it gives the stimulus on brain regions which regulate mood but minimal stimulation of brain regions which regulate cognitive function.

Again the dose that is  minimum volt of electrical charge is important in inducing Seizure rather than the absolute intensity of the stimulus.We should get maximum clinical benefit with minimal brain tissue affected by electrical volts.This can be done with selective placement of the electrode like bitemporal /right unilateral etc.

Use of muscle relaxants and anesthesia, also reduced the adverse effects of ECT

Challenges.....Already discussed . It includes side effects and ethics both

Regulatory Implications....There are no national USA law for ECT. The State regulatory boards are the one which has varied regulations in different states