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Example research essay topic: Electro Convulsive Therapy American Journal Of Psychiatry - 1,253 words

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Since its introduction to the world in the mid 1930 s, electro convulsive shock therapy, or ECT, has been one of the most effective and least understood treatments in psychiatry. The technique itself has changed in many ways since its conception and is now considered a safe and effective treatment of patients with major depressive disorder, manic episodes, schizophrenia, and other serious mental disturbances. However, the neurobiological changes critical to the therapeutic success of ECT have not yet been fully understood. Such a knowledge gap has led to an inaccurate portrayal of ECT in the media and misconceptions about ECT being held by many patients, lay people, and even health care professionals. Convulsive therapy was introduced in 1934 in Europe by Ladislaus von Media as a treatment for catatonic schizophrenia. He induced seizures by the injection of camphor in oil but soon replaced camphor with methanol because of its solubility and rapid onset of action.

Also in 1934, Cerletti and Bini pioneered the use of electricity to induce seizures. Electrical-induced convulsions were more safe, reliable, and inexpensive than the camphor-induced convulsion (Willoughby 12). According to the Journal of the American Medical Association, the number of ECT procedures performed in the United States exceeds coronary bypass, appendectomy, or hernia repair (Nobler 305). While the most common application of ECT is for psychological disorders, the uses of ECT range from major depression and schizophrenia to cancer and Parkinsons disease (305). Although its mechanism of action is not understood, studies by the American Journal of Psychiatry showed a decrease in the level of glucose metabolism in the cerebral cortex of the brain following ECT. The decreased neuronal activity is consistent with potential anticonvulsant and antidepressant effects (305).

In order for a patient to undergo ECT, the patient must give informed consent (Irvin 578). The patient and family members are informed of the risks and potential side effects including: anoxia during the seizure, memory loss, death rate of one per 10, 000 treatments, and ventricular arrhythmias (578). During the procedure, ECT electrodes are placed on the head either bilaterally or unilaterally. The patient is given a muscle relaxant and a short-acting general anesthetic for sedation. An electrical current is applied to induce a grand mal seizure. The seizure must last at least 25 seconds to be effective.

It is believed that the seizure initiates a series of events that correct abnormalities of the brain (579). ECT is the only somatic treatment in psychiatry that is typically discontinued following response, yet patients untreated following ECT have high rates of relapse (Sackeim 1299). For this reason pharmacological agents are used concurrently to avoid relapses. The problem is that medications are not effective until four to six weeks after initiation (1299).

Some patients receive outpatient ECT as maintenance to avoid relapses. These sessions may continue for six weeks or six months. The patient may receive treatments in a variety of locations including hospitals or ambulatory clinics (Irvin 576). Martha Manning, a psychotherapist who wrote a book about her own bout with depression, is convince that ECT saved her life.

In severe depression, everything goes to gray and takes and effort... Youre a non reactor. You could win the lottery and you think, So! Martha underwent several treatments of ECT and will continue to be on medication for the rest or her life (Hubbard 65). Top researchers in their field have argued about its safety and efficacy. While psychiatrist David Barton of the Royal Melbourne Hospital, Australia states ECT remains one of the most effective treatments available in psychiatry (Harrigan 401), Peter Begin claims, Its barbaric Ive seen hundreds of patients with brain damage from it (Hubbard 65).

A consumer group in England criticized the Surgeon Generals claims that electro convulsive therapy is regarded as a safe and effective treatment. has advantages over pharmacotherapy (Comment 382). The National Mental Health Consumers Self-Help Clearinghouse called the Surgeon Generals statement a blanket endorsement, citing overlooked evidence of the dangers and effectiveness of ECT (382). In an interview by the American Journal of Psychiatry when Dr. Robert Butler was asked if he viewed ECT as a last resort therapy, he responded: If someone is suicidal, no longer eating, or losing weight quickly and in danger of some medical crisis, ECT would be my treatment of choice, not my treatment of last resort. It might save their life.

An antidepressant take 6 to 8 weeks, often longer, to take effect, assuming the first medicine you try works. If someone is suicidal or medically unstable, this may be too late (Mulsant 561). The effectiveness of the ECT correlates with the degree of cognitive impairment. The more stimuli given, the more effective the treatment, but also the more ill effects experienced. There is also much controversy about ECT dosing methods. David Barton explains that there are three dosing methods: The stimulus method, each patients seizure threshold sets subsequent doses.

Another method is the fixed dose method, where every patient is given the same dose set by the clinic. Finally there is the age method, in which the clinics standard dose is adjusted for agee. g. , a 40 -year-old receives 40 % of the standard dose (Harrigan 401). According to the American Journal of Psychiatry, less than 8 % of all U.

S. psychiatrists provide this treatment. A study was completed taking data compiled from 1988 - 1989 to characterize what psychiatrist would perform ECT. The results of this study were as follows: Psychiatrists who provided ECT were more likely to be male, to have graduated from a medical school outside the United States, and to have been trained in the 1960 s or 1980 s rather than the 1970 s. They were more likely to provide medications than psychotherapy, to practice at private rather than state and county hospitals, to treat patients with affective and organic disorders, and to practice in a county containing an academic medical school (Hermann 889). According to the AORN Journal, electro convulsive therapy offers patients safe outpatient treatment alternative.

With increased outpatient services, decreased health care resources, and the strong influence of third-party payers, outpatient ECT has tremendous financial potential (Irvin 573). I personally believe this alternative healing method does have its benefits. My great grandmother was taken to the Mayo Clinic in Rochester, Minnesota in the late 1930 s. She was diagnosed with involutional melancholia (referred to as severe depression today). She had presented symptoms of severe depression with suicidal tendencies, believed to be partially caused by two previous miscarriages. She was treated with electro convulsive therapy.

She dreaded the treatments, but according to her daughter, this woman changed from a withdrawn, extremely nervous and depressed individual into a happier, more relaxed, well-adjusted but less ambitious person. It is understandable how the public can hold such negative views of this treatment. In the early development of ECT, the abuses were terrifying, but technological advances have transformed this once dangerous practice into a treatment that, although not without risk, may improve some people's quality of life and in some case, even save lives. The risks involved with electro convulsive therapy, such as memory loss, may be more frightening than risks associated with pharmacological treatments; however, when quick improvement must be made, or when other alternatives have failed, electro convulsive therapy should be considered. The history of this treatment should not condemn it to the annals of failed medical practices, but the current advances in this treatment should earn electro convulsive therapy the status of a viable treatment option for certain patients.


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Research essay sample on Electro Convulsive Therapy American Journal Of Psychiatry

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