Fink: Electroconvulsive Therapy 2nd edition

Electroconvulsive therapy (ECT) is an effective and safe treatment for those with severe mental illness. Yet, many consider it so dangerous that they fear it as much as they fear the disease. It is often labeled “the most controversial treatment in psychiatry.” The controversy is not about its efficacy or its safety, which have been proved, but about the idea that the treatment actually alters the brain, changing a person’s personality and character. This mistaken perception has many roots —in the pain and complications of ECT’s early use; in the confusion with the brain- altering and ineffective treatments of insulin coma and lobotomy, which were introduced at the same time but have long been discarded; and in fierce philosophical and economic competition among psychotherapists. 

Electroconvulsive therapy has undergone fundamental changes since its introduction 75 years ago. It is no longer the bone-breaking, memory stealing, fearsome treatment pictured in films. Anesthesia, controlled oxygenation, and muscle relaxation make the procedure so safe that the risks are less than those accompanying the use of several psychotropic drugs. Indeed, for the elderly, the systemically ill, and pregnant women, ECT is a safer treatment for mental illnesses than alternatives. 

Psychotropic drugs and psychosocial therapies are the primary treatments that are offered the psychiatric ill, but are often inadequate. They may fail to relieve the disorder, or fail to relieve it quickly enough, or they may cause difficult or even dangerous side effects. In such cases, ECT is certainly preferable. 

When a physician recommends ECT (also known as electroshock or convulsive therapy), family members and patients ask: 
  • Is this old treatment still used? 
  • Is it safe? 
  • Is there a risk of brain damage? 
  • Will there be memory loss? 
Usually a patient has been severely depressed for many weeks, has not improved with the medicines that have helped for a while, and is getting worse. Often the doctor has no other medications to suggest. 

More questions arise: 
  • What are the chances that the therapy will work? 
  • Why didn’t the doctor suggest this treatment in the first place? 
  • And occasionally, how does it work?
This book answers such questions.
A decade ago, the first edition of this book was written to answer these same questions. Why do we need a new edition? Treatment procedures have improved, risks have been drastically reduced, and we have learned more about the workings of the brain. We are better able to select patients for good outcomes. At one time, fixed numbers of treatments were prescribed, but we now know that some form of ongoing therapy must be continued to keep patients well. Many doctors and patients now, more than ever, readily recognize the value of ECT in reducing the drive to suicide and in relieving many serious psychiatric illnesses. 

This book is written for those faced with decisions about the use of ECT and is meant to complement the DVDs that are available to educate patients about what they can expect. This book is also meant to help students, medical practitioners, and mental health workers to intelligently identify and prepare patients for treatment. My hope is that it will answer questions that arise frequently about ECT; it is meant to be a guide, answering questions about the who, what, why, when, and how of the treatment. 

The medical community’s experience with ECT is extensive and sometimes contradictory. Like all medical specialties, ECT is not always practiced the same way in every facility, so some of the information in this book may differ from what other physicians recommend. Though clinicians and researchers do not always agree about various aspects of the therapy, the suggestions in this book are consistent with present standards for effective treatment, culled from one doctor’s experience of over half a century in studying the mechanism of ECT and its clinical applications. Readers who are interested in learning more about the research conducted on ECT can consult the publications cited in the end notes and listed in the Bibliography. Those works support the recommendations given here.

  • Chapter 1 What Is Electroconvulsive Therapy?
  • Chapter 2 The Patient’s Experience
  • Chapter 3 The Treatment Technique
  • Chapter 4 Side Effects and Memory Issues
  • Chapter 5 Depressive Mood Disorders
  • Chapter 6 Manic Mood Disorders
  • Chapter 7 Movement Disorders
  • Chapter 8 Other Uses: Psychosis, Pregnancy, and Status Epilepticus
  • Chapter 9 Pediatric ECT
  • Chapter 10 How Does ECT Work?
  • Chapter 11 How Did Convulsive Therapy Originate?
  • Chapter 12 Is Brain Stimulation an Alternative to ECT?
  • Chapter 13 Is ECT Practice Ethical? 115
  • Appendices
  • Notes
  • Bibliography
  • Index

Book Details
  • Paperback: 176 pages
  • Publisher: Oxford University Press, USA; 2 edition (December 1, 2008)
  • Language: English
  • ISBN-10: 0195365747
  • ISBN-13: 978-0195365740
  • Product Dimensions: 8 x 5.4 x 0.7 inches
List Price: $17.95

Medical Lecture Note Copyright © 2011