[Electroconvulsive therapy and defibrillation in the paper. An analysis of the media]

[Medical students' attitude towards electroconvulsive therapy: Impact of patient-oriented training]

BACKGROUND

As a particular aspect of psychiatric clinical training many students instinctively harbor reservations towards the field of electroconvulsive treatment (ECT). In this context the question arises how controversial issues, such as ECT can be addressed during the placement. The clinical training is predestined to provide basic knowledge concerning ECT for future doctors. As multipliers and potential referrers they then can work to prevent severe mental illness from becoming chronic.

MATERIALS AND METHODS

Prior to the clinical psychiatric teaching course 158 medical students of the RWTH Aachen University were randomly assigned to three groups. The first actively took part in an ECT therapy session (ECT group), the second was shown an educational video (video group) and the third served as a control group. A questionnaire was filled in before and after the training concerning the knowledge and the attitudes towards ECT.

RESULTS

In the course of the clinical training the attitudes of the students towards ECT became more positive for all items. The willingness to agree to ECT in the case of patients, family members and friends and themselves increased in the ECT group and the video group but not in the control group. Only the ECT group proved to be superior to the control group in the direct comparisons. In both interventions the knowledge about ECT increased more in comparison to the control group despite the very limited interventions.

CONCLUSION

Reservations to touch on the controversial issue of ECT during the clinical training do not seem to be justified. Even a single hands-on or video experience can have a relevant impact on knowledge and attitude towards ECT in medical students. This opportunity should be used more intensively.

Public attitudes towards electroconvulsive therapy in the Chuvash Republic

BACKGROUND

Public attitudes towards a given medical procedure can have a significant influence on the employment of that method. Electroconvulsive therapy (ECT) is a medical procedure that has received an exceptionally ambiguous public reception since its inception.

AIM

To survey the level of information about and attitudes towards ECT in a general population sample of the Chuvash Republic of the Russian Federation.

METHODS

A randomly selected cohort of 5,373 people was contacted by telephone. The respondents were asked three closed and three open questions.

RESULTS

The response rate was 74.7%. Only 35.2% of those interviewed said they knew anything about ECT. Health professionals and younger respondents were better informed. The two main sources of information about ECT were foreign films and the mass media. The main indication of ECT was thought to be schizophrenia. The majority (63.3%) of the respondents had negative opinions and emotions about ECT.

CONCLUSION

Limited information about and generally negative attitudes towards ECT were found in the general population of the Chuvash Republic. Gender, age, education level, employment in the health industry, and information source were found to be the determining factors in the knowledge of and attitudes towards ECT.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

Subjective evaluation of the therapeutic and cognitive effects of electroconvulsive therapy

BACKGROUND

Methods used to evaluate subjective effects of electroconvulsive therapy (ECT) have relied on self-report about discrete aspects of memory. Although objective deficits are demonstrable, patients generally report improved memory after ECT. Patients have not been asked to evaluate the global impact of ECT on mood or memory. This study was undertaken to compare patients' evaluations of ECT outcomes using direct questioning about global impact compared with standard methods.

METHODS

A prospective, naturalistic study was conducted in seven hospitals. Patients completed clinical and neurocognitive assessments before ECT, including the Cognitive Failures Questionnaire (CFQ), the Autobiographical Memory Interview-Short Form, and a novel interview assessing expectations about the impact of ECT on mood and memory (Global Self-Evaluation-Mood [GSE-Md], GSE-memory [GSE-My]). Follow-ups were conducted one and 24 weeks after ECT, and the GSE-Md and GSE-My evaluated perceived global impact at these time points.

RESULTS

Patients reported marked improvement after ECT on the CFQ, a traditional instrument assessing specific cognitive complaints. CFQ and depression severity scores were strongly correlated. On the GSE-My, patients reported a deleterious memory effect both one and 24 weeks after ECT. GSE-My, but not CFQ, scores were associated with treatment technique and long-term retrograde amnesia.

CONCLUSIONS

Characterization of patients' experience of cognitive side effects after ECT differs markedly depending on assessment method. Direct questioning about global impact revealed more negative views and associations with objective indices of cognitive impairment. This represents the first report of concordance between subjective and objective measures of the effects of ECT on memory.

Anästhesiologische Aspekte bei Elektrokrampftherapie

Electroconvulsive therapy (ECT) is used in the therapy of severe psychiatric disorders. The treatment, in which a generalized epileptic seizure is provoked by electrical stimulation of the brain, is performed under anaesthesia and muscle relaxation. Considering careful previous clinical examination and anaesthesiological and internal contraindications, ECT is a safe form of treatment. The following review is intended to familiarize with ECT and to provide advice for the anaesthesiological management.