1. Biological treatments for depression ECT

2. The Historical picture http://www.youtube.com/watch?v=QyN8OQz NWh4 http://www.youtube.com/watch?v=QyN8OQz NWh4 The modern picture http://www.youtube.com/watch?v=9L2-B- aluCE http://www.youtube.com/watch?v=9L2-B- aluCE

3. Cerlelli + Bini 1958 First used ECT to treat schizophrenia It was widely used for this purpose in the 40’s in the USA It was however soon found to be more effective for severe depression It is still used to treat the negative symptoms of schizophrenia It involves a 70-150V shock lasting 0.04-1 seconds and gives therapeutic effect to areas of the brain.

4. From 1950 onwards… 11,340 people had ECT in 1999 28,000 in 1995 2/3 were women 41% were over 65 15% were sectioned in hospital and therefore the treatment was not voluntary. The treatment has rarely been used in Europe and Japan.

5. Ethics and side effects MIND- says ECT undermines the trust people have in mental health professionals as it can be enforced and is invasive. Szasz 1971 says it makes the patient no longer a person. In less modern times there was a distinct short term risk as no anaesthesia was used (this has now been remedied!) Can also cause memory loss and retrograde amnesia as well as impaired ability to get ‘new’ memories. The main side effects of ECT are memory loss (usually minor and short term) but can get worse over a longer course of treatment – Lisonby 2000. Benton 1981 found these such side effects are usually temporary but it is hard to prove conclusively how much the side effects are purely down to the ECT due to other factors and variables.

6. Ethics of Consent Consent – There is a question as to whether someone with depression can consent. Consent is not needed if someone has been sectioned, over 2000 people are given non consensual ECT a year. Of those who did consent Rose 2005 found that approximately 50% of patients did not fully understand what ECT was all about.

7. Bilateral v Unilateral In modern times there as been a move to unilateral treatment wherein the probes are used only on the prominent side of the brain. This has shown to reduce side effects. Mortality rate is with this methods less (about 3.6-9%) which is similar to that of general anaesthesias. If you take into account the amount of people with severe depression who commit suicide this is not that bad.

8. BUT Johnstone 2005 found only a 1/3 of clinics are meeting the legal guidelines (bad as it is now commonly used for other things also…) Perhaps then it may only be good for those in dire need or those not responding to other treatment?

9. How effective is Ect? It in general it is believed that the bilateral approach is more effective but it is now avoided due to the increased side effects. Sachten 1999 found little evidence for the placebo effect in this treatment which would suggest it does work… As of 1995 it is still a valid treatment and has on going use but it is diminishing slightly… Breggin 1997 found no evidence from controlled studies of ECT that it lasts longer than 4 weeks. Although with this four weeks a person could have effective drug therapies so may be this is not a problem…. Eranti 2007 showed ECT is effective in the short term but long term symptoms are likely to come back.

10. Example… ECT is often portrayed in films and the portrayal is rarely good! In the ‘olden’ days it probably was quite scary and horrific as you are about to see but in modern times perhaps these portrayals don t help the ‘image’ of ECT as a treatment? It can be elective or enforced and as it can be enforced this can be scary as people do not like the thought of any treatment that is not optional! One Flew Over the Cuckoos Nest demonstrates how and why is was often used in patients suspected of suffering from schizophrenia, gives us an idea of how films of that time may have portrayed this treatment and also highlights the problems historically with the diagnosis of mental health.

11. Tasks 1) Outline ECT as a treatment for abnormality (6marks) 3) Draw up a table which summarises the overall effective and appropriateness of the biological treatments.

12. HW Question Outline and Evaluate one biological treatment for schizophrenia (4 +8 marks) Outline = what are the treatments and how do they work? Evaluate = How effective are they at treating schizophrenia and how appropriate are they for patients? Remember to use evidence where appropriate, to evaluate the research and methods of obtaining the research. Always show evidence of extended reading. You must read around these topics and get further evidence / evaluation points.

13. Extra Reading… Have a look at … www.ect.org/ https://www.rcpsych.ac.uk/expertadvice/treatmentswellbeing/ect.aspx http://www.bbc.co.uk/news/health-23414888 http://www.schizophrenia.com/family/ect1.html …and evaluate at least two of the articles in regard to the use of ECT. Consider; -How does ECT work in the treatment of Schizophrenia? -Is the treatment appropriate? -Is the treatment effective ….for Schizophrenia? (10 marks)