ECT works by using electricity
to induce an epileptic-like
seizure in the patient
we know this as chimps
became less aggressive
when their frontal lobe
was removed
ethical issues with using chimps
first developed by Cerletti and Bini (1938)
under the belief that by inducing a seizure
in a schizophrenic patient, they should
reduce/eliminate the symptoms
Side effects
the general anaesthetic
carries its own risk
makes the
mortality rate for
ECT look quite low
physical harm could come from the effects of an
epileptic seizure; reported that patients have suffered
broken bones and bruising due to restraints
however, without it, more harm could've been caused
disruption to memory; patient is
often confused and disorientated
for about 40 minutes after the
treatment; could be distressing
however, recall gradually returns
Royal College of Psychiatrists (1997) - ECT
does not have any long term effects on
memory / intelligence
however, critics have said that ECT
also caused mental / emotional
dysfunction, as well as memory loss
How does ECT work?
although it's not clear how it
works, Benton (1981) identified
3 possible explanations:
patients come to see
ECT as a punishment
for their behaviour
the memory loss caused
allows the restructuring of
the patient's view of life
however, unilateral ECT
causes less memory
loss and is effective
the shock produces a range of
changes in the brain. Lilienfield
(1995) - neurotransmitters are
particularly stimulated
however, in some cases the
effects of ECT are permanent;
would be temporary if due to
neurotransmitters
Effectiveness
an American Psychiatric Association (APA) review in
2001 listed 19 studies that had compared ECT with
'simulated ECT' (patients are given general
anaestesia but no ECT - a form of placebo)
the review concluded that ECT produced
results that were no different from or
worse than anti-psychotic medication
however, some evidence that ECT
combined with anti-psychotic medication
may be more effective than either alone
(Tharyan and Adams, 2005)
Cognitive Behavioural Therapy (CBT)
aim - challenge maladaptive thoughts
and replace them with constructive
thinking leading to healthy behaviour
therapist will try to make these
maladaptive thoughts conscious,
and the patient will see that there
is no basis for these thoughts
CBT techniques
understanding where
symptoms originate
can be crucial for
some patients
EG. patient hears
voices and believes they
are demons; they are
naturally afraid
offering a range of
psychological
explanations for the
existence of hallucinations
can help reduce anxiety
patients are encouraged to evaluate the content of
their delusions/hallucinations and to consider ways in
which they can test the validity of their faulty beliefs
the therapist may draw diagrams to
show patients the links between their
thinking, behaviour and emotion
Drury (1996) found benefits in
terms of a reduction of
symptoms and a 25-50%
reduction in recovery time with
patients given a combination of
anti-psychotic medication and
CBT; medication allows
access to the benefits of CBT
CBT cannot completely
eliminate the symptoms
Kulpers (1997) - CBT
seems to be effective
however, Kingdon &
Kirschen (2006) found that
CBT wasn't for everyone, as
it will not benefit people
who don't fully engage
patients are taught strategies to protect
them against the wishes of the voices; EG.
relaxation, choosing to pay attention to the
voices at particular times of day
however, focussing on
voices can be damaging as
you're not fixing it; listening to
the voices can enforce them
however, Romme & Escher (2000) -
focussing on the voices reduces the
likelihood of harm to others or yourself
CBT ignores the role of family and
society in both the cause and the
maintenance of schizophrenia