Hypnosis: A Viable Alternative Treatment

hypnotherapy

Contrary to popular notion, hypnosis is not an obscure practice customarily carried out only by charlatans or mediums.  Hypnosis is a legitimate therapeutic tool utilised by some in the medical community.  In the field of psychiatry, hypnosis is known as hypnotherapy, a very helpful aid in the practice of psychotherapy.

The Hypnotic Spell

Hypnosis or hypnotherapy employs guided relaxation and sustained concentration on something to bring about a trance.  A trance is a state in which a person is so highly aware or focused on something specific that external stimuli is blocked out or ignored.  A hypnotised person is so engrossed on his point of focus that he does not register anything going on around him for the time being.

For the skilled psychiatrist, hypnotherapy can be a very effective adjunctive treatment.  Hypnosis can be a useful behaviour modification tool and as such can prove to be invaluable to the field of psychotherapy which seeks to change behaviours and mindsets in treating many mental disorders.  Under the state of a hypnotic trance, patients can perceive and explore painful memories, thoughts, and feelings that may be present in their subconscious minds but hidden from their conscious ones.

What Hypnosis is Used For

Sigmund Freud, the father of psychoanalysis (a type of psychotherapy) criticised hypnotherapy and consequently only reinforced the negative perception hypnotism was getting over fifty years ago.  However, after WWII, hypnotism gained favourable ground and is now an internationally acknowledged valid medical method to treat not only psychiatric conditions but also such physical
diseases as AIDS, asthma, eczema, and irritable bowel syndrome.

In psychiatry, hypnotism is basically used for:

  • Removing symptoms of mental illnesses such as anxiety and depression
  • Decreasing stress
  • Treating psychological traumas
  • Treat phobias
  • Alleviate chronic pain such as arthritic pain
  • Manage psychosomatic symptoms such as high blood pressure brought about by anxiety
  • Control destructive behavioural impulses such as those typified by anorexia, gambling, and sexual addiction

Two Types of Hypnosis

As a therapeutic aid, hypnotism may be used as two different strategies:

  1. Analysis Therapy

Hypnosis is used to relax the patient and bring him to a point where he and the therapist may pinpoint the root cause of the mental problem.  The cause is usually a painful memory hidden by the brain in its subconscious area.  Once the original trauma has been uncovered, it can now be addressed with behavioural therapy, counselling, and other psychotherapy treatments.

  1. Suggestion Therapy

Destructive behaviour such as smoking, drinking, or hair pulling can be minimised or eliminated by the suggestive power of hypnotherapy.  Hypnosis opens patients up to suggestions to change bad habits, alter their perceptions, and even adapt to sensations.  As such, hypnosis has also proven to be very useful for pain management.

Does Hypnosis Work?

Yes it does, especially if the person undergoing hypnosis is highly suggestible.  Research points to those who can become very engrossed in a daily task or activity (i.e. reading or painting) may be more hypnotically inclined than most.

Hypnosis is gradually brought on a willing individual through the verbal guidance of a hypnotherapist.  The hypnotised person is neither asleep nor unconscious but is acutely aware and hyper responsive at a subconscious level.  His subconscious mind is more open to suggestions and therefore has improved propensity to change unwanted behaviour when brought back to his normal mental state.

Hypnosis however is not an immediate cure.  Several sessions may need to take place before some progress may be seen.  Moreover, subjects must be willing patients to undergo this type of therapy for this to work because hypnosis cannot make one do what he does not want to do.

Is Hypnotherapy Safe?

Generally, hypnosis is safe but it must be performed by qualified hypnotist-physicians.  Contrary to general belief, hypnosis cannot change your ethics or moral values.  A person cannot be forced to do something he doesn’t want to do or change the way he thinks.  The value of hypnotherapy lies with making wanted behavioural changes much easier.

As with almost anything, however, hypnotherapy can be abused.  There is such a thing as regression-based hypnosis which takes the patient backwards through his life in order to recover repressed memories.  This can be dangerous because the hypnotist can accidentally suggest memories that never occurred.  Because hypnotism puts the person under a highly suggestive mode, little add-ons to already traumatic memories may lead to additional mental health problems.  Patients with a history of psychosis must talk to their physicians first before putting themselves under hypnotherapy.  Hypnosis can increase the risk of a psychotic episode happening.

Arts Therapy

art therapy session

Arts therapies are constructive non-verbal approaches that allow mental health patients to adequately express themselves through the creative process.  Painting, composing music, and writing a poem are different artistic ways through which patients may communicate feelings when verbal expression just seems too inadequate or just not preferable at the moment.

Arts therapy is also known as expressive therapy or creative arts therapy.  The emphasis of this therapy is on the creative process rather than on the resulting work of art.  This is why people with no artistic background can still benefit from arts therapy because the final artwork is not judged by its aesthetic value.  Instead, the therapist helps the patient find his voice about his personal issues by letting him go through the creative process, one which gradually helps him understand himself better.

How Is Arts Therapy Conducted?

After completing your project, your therapist will help you think about your creation and about how it relates to your feelings and experiences.  For some people though, the mere exercise of creating art somehow is enough therapy in itself.  The artistic activity allows them to discover many things about themselves and helps them process these revelations as well.

Art therapy may be conducted in a group session or on a one-on-one basis.  This type of therapy lends itself well to many forms of mental illnesses.  It is often used in conjunction with other kinds of therapy like talking therapies.

Art therapy has proven to be a successful form of treatment because it has helped many learn to deal with, and in some cases even bounce back, from their mental health issues.

Who is Best Suited for Arts Therapy?

Arts therapy is recommended as treatment for many behavioural, emotional, and mental problems.  They have proven to be particularly helpful with patients experiencing:

  • detachment from their feelings
  • resistance to talking therapies because relating their experiences may be too painful at the moment

People with these mental problems may benefit from art therapy:

  • Schizophrenia
  • Schizoaffective disorder
  • ADHD (Attention Deficit Hyperactivity Disorder)
  • Eating disorders (i.e. bulimia, anorexia)
  • PTSD (Post Traumatic Stress Disorder)
  • Depression
  • Anxiety
  • Stress-related issues
  • Traumatic brain injury
  • Developmental disabilities
  • Social challenges

Types of Arts Therapy

Art Therapy has varied modalities:

Music Therapy

Communication with one’s therapist or group members is through playing, listening, or singing a musical piece.  It may involve playing instruments such as the drums, maracas, chimes, bells, and wood blocks.

During a music therapy session, the therapist listens to the music you create or present and tries to understand the emotions you are trying to convey.  In response, they play their own music which is geared toward making positive changes in the way you feel.  Music is the medium the therapist uses to help you explore your feelings and think about the way you relate to people and your environment.

Dance Therapy

When body movements are a more comfortable mode of expression for a patient, then dance therapy is recommended.  Dancing can help a patient express emotions he may find difficult to talk about.

Dance therapy is also beneficial for those who:

  • are feel disconnected from their emotions and from things in daily life
  • have been sexually or physically abused as the experiences show in the way a person holds and moves his or her body
  • have a difficult time with physical contact
  • have physical symptoms from their mental illness.  Ex. Depression manifests as pain
  • have negative perception of their body and therefore have eating disorders such as anorexia or bulimia

Dramatherapy

Dramatherapy involves participating or creating skits or plays in which one needs to act out, use body movements, facial expressions, role play, or mime to express what one feels or wants to convey.  For those who are not particular about acting, dramatherapy also offers behind-the-scenes roles such as lighting, directing, costume or scenery creation, or even being the audience.

Art Therapy

Art therapy involves using art materials and other physical objects to help the patient connect with the world around them.  Clay, paint, pebbles, and crayons are just a small portion of art materials a patient may use to express himself through artwork.  A camera may also be used to take photos as glimpses to your past emotions and memories.

Finding an Arts Therapist

Arts Therapy is regulated and therefore has certain regulations about how this type of therapy must be conducted.  Make sure that your art therapist is registered with the Health and Care Professions Council (HCPC).

art therapy

Neurosurgery for Mental Disorder (NMD)

brain-surgery-treatmentNeurosurgery for Mental Disorder (NMD) is the modern name for psychosurgery.  NMD is a very controversial medical field that has not yet undoubtedly proven its merits.  The whole medical process is a collaboration between psychiatrists and neurosurgeons in which the goal is to remove or destroy a small piece of the brain to mitigate severe depression or acute obsessive-compulsive disorder (OCD).

Important Facts about NMD

NMD is a very high risk procedure and recommended only if all therapies, including psychiatric drugs and electroconvulsive therapy (ECT), have been totally unsuccessful.  Because of the high risk of adverse effects, a few doctors usually recommend this treatment as a very last resort.  Patients with this recommendation need to give their consent before NMD can be performed on them.

Other key factors to be knowledgeable of before considering NMD:

  • NMD is not a cure.  The surgery is done just to decrease the symptoms of the acute mood disorder or OCD but the patient still has to go through psychotherapy and other psychiatric treatments.
  • NMD cannot be reversed.  The surgery is permanent and therefore whatever side effects there may be can become permanent as well.
  • NMD is an extremely rare surgical procedure.  Only 4 people in the U.K. received this treatment in the years 2013-2014.
  • There are two alternative treatments to NMD:  deep brain stimulation (DBS) and vagus nerve stimulation (VNS).  While NMD involves taking out a small part of the brain, DBS stimulates parts of the brain with implanted electrodes.  DBS has proven to work with severe depression and OCD however in some cases, symptoms come back when the stimuli is removed.  VNS involves surgery where a device is planted into your chest.  The device’s electrodes are connected to the vagus nerve located at the neck where it sends timed pulses through the nervous system.
  • NMD is not done to change or modify a person’s behaviour.  If there are any changes, these are usually side effects, not a procedural aim.
  • In the U.K., NMD is not recommended for anorexia, personality disorders, and schizophrenia.
  • NMD is not a lobotomy, a type of neurosurgery done in the past to treat schizophrenia.  Lobotomy had been a controversial procedure and is not, or perhaps very rarely, done today.  Although a small percentage benefited from the procedure, most patients were left mentally dull, vacant, and incapacitated.

The NMD Procedure

The purpose of NMD is to break the connections between the nerves in small parts of the limbic system which is thought to be creating the mental issues.  The frontal lobes of the brain hold the limbic system which is responsible for emotional responses and some involuntary physical responses such as blood pressure regulation and heart rate changes.

The operation involves drilling a small hole through your skull to allow a fine probe controlled by special imaging software to be guided to a specific area of the frontal lobe.  Once in the right spot, an electrical current is pulsed through the probe to destroy a miniscule area of brain tissue.  After this, the probe is then removed and the skull cuts are either stitched or glued.

Effects to Mental Capacity and Personality

Since cases are very few, there is no conclusive evidence of the effectiveness or ineffectiveness of NMD.  To glean data from just the few, these are the findings of its post operative effects.

No evidence has surfaced to claim that NMD causes any loss in mental or thinking ability.  In fact, the operation itself may have dampened or relieved patients of symptoms so that it allows them now to think more clearly and have better concentration.

There are, however, very few patients that have undergone personality changes from the operation.

Side Effects of NMD

NMD can cause:

  • Apathy or disinterest.  Some patients who went through surgery for severe depression were reported to be indifferent to their issues which used to upset them before the operation.
  • Weight gain
  • Headaches which can be severe and last for several days

High Risks of NMD

Because NMD touches the brain, it carries high risks common to most brain surgeries:

  • Confusion
  • Epileptic seizures
  • Damage to blood vessels which may cause stroke
  • Feeling of pressure in the frontal area.  This pressure is caused by fluid build-up by the brain tissues as part of the healing process.  Confusion may also result from this fluid build-up and the condition can last for a month after surgery.

The Law on Patient Consent to NMD

The law on patient consent differ between the England-Wales territory and Scotland.  The Mental Health Act allows NMD for patients in England and Wales if all conditions are true:

  • The patient consents to NMD treatment.
  • A Second Opinion Appointed Doctor (SOAD) and two other appointees by the Care Quality Commission in England or the Healthcare Inspectorate Wales certify that (1) the SOAD approves of the treatment; (2) the patient has the capacity to consent; (3) the patient does consent.

It is very important to note that in England and Wales, patient consent is an absolute requirement for treatment, even if the patient does not have the capacity to give his consent.  In other words, if the patient lacks the capacity to consent, he cannot receive NMD treatment within England and Wales.

Scotland, however, has a different ruling.  NMD can be applied if all conditions are true:

  • An appointed medical practitioner by the Mental Welfare Commission has given his approval of NMD’s benefits for the patient.
  • A further two lay appointees by the Commission certifies whether the patient has the capacity of giving his consent or not.
  • If the patient is capable of consenting, then he is asked for his formal consent.  If the patient is incapable of consenting, he should not be objecting to the treatment.

Under Scottish law, as long as the patient does not object to the surgery, the patient can be given the NMD treatment even if he lacks the capacity to give his permission or consent.

Stopping or Coming Off Medication: Can I or Can’t I?

Psychiatric medications are prescribed to help people cope with emotions they cannot do so on their own.  These drugs may be a good or bad thing, depending on how one’s body reacts to them and what side effects these engender.  Although prescription medications have helped people who really need them, these sometimes exact their price from other areas of our health.  Some drugs could cause weight gain, a drop in libido, or loss of focus, among many other major and minor ramifications.  It is for these reasons that people decide to stop or gradually lessen their intake of medication.

Coming off or stopping medication altogether is not as easy or consequence-free as one may think.  It is not a simple “stop the drug; stop the side effects” scenario.  In fact, there are risks, some dangerous, to suddenly coming off the drug as well as being on it.  Much like being “between the devil and the deep blue sea,” the decision to discontinue taking medications that one has been taking for quite some time needs thorough thinking and awareness of the disadvantages.

stop-your-meds

Why People May Want to Stop Taking their Medications

People often mistake psychiatric drugs as cures when these simply hold the fort, so to speak.  Although they are a big help, psychiatric medications function as symptom reducers, not exactly recovery tools.  Over time, people can become dependent on these medications and have difficulty managing without them.  In other situations, the drugs don’t effectively block the symptoms but seem to enhance their degree.  For others, the side effects can be debilitating such as sleep deprivation, forgetfulness, excessive weight gain, feelings of detachment, and many more.

Some people would simply want to live a drug-free life.  While a no-drugs personal policy is ideal, it is not always workable or even safe.  In cases where the mental illness has become critical to the safety of the person and others around him, prescribed medication can be obligatory under the Mental Health Act.

Why Coming Off or Stopping Medications is a Risky Business

If you have been taking your prescription for three months and over, it is unwise to suddenly stop taking them.  Coming off psychiatric drugs may introduce withdrawal symptoms which may put you back to where you started in the first place.  While people who have been taking the drug for a very short time may sometimes safely stop cold turkey, this is not the case with people who have been following their prescriptions for months or years.

Because the brain has adapted to the presence of a drug, stopping its intake could cause severe withdrawal consequences.  One cannot simply say they will weather the withdrawal storm or hope to steel their minds to the physical and emotional aftermath.  In some cases, even gradual reduction of intake can lead to repercussions, ranging from moderate to severe, such as suicidal or violent behaviour.  This is why even gradual coming off a psychiatric drug must be a supervised situation.

The decision to come off or stop taking your medication altogether must be done after knowing your risks.  Your psychiatrist or general practitioner is the best person to consult on the matter as he is more knowledgeable of the drug.

Coming Off Gradually

The brain and body needs time to adjust to the reduction of intake.  Sudden dosage decreases may throw your body off-kilter and make you very sick from withdrawal symptoms.  Your mental illness, for which your drug was originally prescribed for, may also surface and pile on more symptoms.  Sometimes, it may be difficult to weed out whether the symptoms come from coming off or from the mental illness itself.

If you have been taking a drug for over six months, then expect a six-month or more timetable to get yourself completely weaned off the prescription.  If you have been taking the drug for ten years, then the reduction should be very slowly, spanning a period of years before being free of the medication.

Some people have prescriptions of two or more psychiatric drugs.  Coming off has to be done one drug at a time.  Since drugs affect how other drugs in your prescription work, your psychiatrist or GP must suggest which drug to reduce first and what other dosages need to be adjusted because of the change.

Alternative Support for Coming Off Drugs

Aside from your doctor, you may turn to these alternatives to help you deal with withdrawal symptoms for coming off your medications.

Talking Therapies

Medications can suppress emotions and creativity; so, coming off drugs can trigger these emotional issues.  Cognitive Behavioural Therapy (CBT), psychotherapy, and other forms of counselling may be very helpful in dealing with emotional upheavals.

Alternative Therapies

As further support to dealing with withdrawal symptoms, your doctor may recommend alternative therapies such as exercise, acupuncture, yoga, meditation, and aromatherapy.

Art Therapies

Art, music, dance, and writing can become invaluable and enjoyable ways of expressing one’s emotions.  The art therapist’s job is to encourage you to express yourself in whatever medium you feel comfortable doing.  You do not need to possess a painting talent, for instance, to engage in painting sessions because the main goal here is not to create good art work but use art therapy as a venue to deal with difficult feelings or memories.

You may use what you created to talk to your therapist about your work’s relation to your feelings.  For some people, art therapy in itself is a healing process that helped them deal with or even recover from their mental illness.

 

The decision to stop or gradually come off medications is something one must consider very carefully by weighing both one’s risks and benefits from the move.  Never stop taking or reducing your intake on your own.  With a decision like this, seeking your doctor’s medical advice becomes doubly imperative.

About Community Care and Aftercare

 

U.K.’s Community Care Program

Community Care or Domiciled Care is the British government’s health policy for home treatment of the mentally and physically disabled.  The system does away with the practice of institutionalization in which patients were placed under the care of an institution.  Before the 80s, mentally ill people were given over to the care of mental institutions.

Presently, community care refers to various health care services available to the public.  These services are available through clinics, home therapy, day care centres, social work support, and counselling, among others.  The system by which specific types of care or treatment is delivered to a patient is called care planning which is usually arranged by the Community Mental Health Teams (CMHTs).

community care

Establishment of U.K.’s Community Care Policy

Institutionalisation of the mentally and physically disabled was a British medical practice for decades.  In the 1960s and 1970s however, the practice gained widespread criticism after the media focused on allegations of malpractice and mismanagement of care under these huge institutions.  Criticism reached its peak when a nurse exposed the brutality and inhumane treatment of mental patients in Ely Hospital in Cardiff.  Other scandalous stories surfaced, prompting official investigations into institutions.

Under then Prime Minister Margaret Thatcher, Community Care policy was established in the 1980’s.  The aim was to maintain and provide care for people in their own homes rather than being put away in large institutions.  The move was also a more budget-friendly alternative for the government.

Community Care for Mentally Ill Patients

Community care for mentally ill individuals has two types of caring systems:  health care and social care.

Health care is concerned with support for managing both physical and mental ailments.  This includes medications; talking therapies (Cognitive Behaviour Therapy, psychotherapy, and other types of counselling); support from a psychiatrist, a community mental health team (CMHT) or a community psychiatric nurse; crisis services; and preventative care to help people be aware of mental health problems.

Social care involves patient assistance in managing their everyday tasks which may be compromised by mental illness.  Examples for social care services may be help in obtaining transportation for attending therapies and group supports; financial management of personal finances; cleaning, cooking, and general housework; and managing relations with family and friends, among many other services.

Depending on individual needs, a patient may opt to receive only mental health care or just social care or both.  Ideally, community-based care should be able to give the opportunity for mentally ill individuals to integrate as much normalcy in their lives as they can.

How to Access Community Care

The most common point for accessing community-based care is through a general practitioner (GP) who will assess the patient’s needs and may refer him to other services.  For instance, if the GP feels a mental health problem is complex, he may refer the individual to a community mental health team (CMHT) which may provide the network of support he needs.  A CMHT is a group of various mental health providers such as psychiatrists, nurses, social workers, etc. who all work in tandem to deliver the necessary care.

If a person’s mental health situation warrants more support, the CMHT may put the patient under the Care Programme Approach (CPA).  The CPA is a system by which a patient is entrusted to a care coordinator responsible for managing both mental health care and social care assessments and services.  The patient is given a Care Plan which details the specific support and provider the patient needs.  The Care Plan should also include a crisis plan as a guide to patients hitting a low point during their care (ex. contemplation of self-harm or suicide).  This crisis plan details what to do, whom to contact, where to go, etc.

care chart

 

Aftercare

Mental health aftercare is a free service the government mandates under Section 117 of the Mental Health Act of 1983.  Free aftercare service is further government support given to mental patients under these circumstances:

  • Obligated by law to be detained in a hospital as per Section 3 of the Mental Health Act.
  • Sentenced to detention in a mental/psychiatric hospital by a criminal court
  • Transferred to a psychiatric hospital

Aftercare involves outpatient treatment, access to a psychiatric nurse, counselling or therapy, employment support, assistance with personal financial management, use of day care centres, and the like.

If one has been deemed eligible for aftercare, an evaluation of his needs should be outlined and provided before the patient is released from the hospital.  The patient will receive a plan detailing specific services he will need and expect from the aftercare program.

Tardive Dyskinesia (TD)

Pills macro

There always exists a caveat with medications.  It is for this reason that doctors and patients must discuss the risks of side effects involving drug treatments.  One side effect of long-term use of antipsychotic drugs may be tardive dyskinesia.

What is Tardive Dyskinesia?

The term tardive is an adjective that refers to late appearances or delayed onset of something such as a disease or symptom.  Dyskinesia denotes abnormal movements.  Tardive dyskinesia then means a neurological disorder characterized by involuntary and repetitive movements of the face, lips, cheeks, tongue, torso, and limbs.  Examples of these movements are uncontrollable chewing motions and tongue darting.  These symptoms are often a belated onset of side effects of long-term neuroleptic drug intake.

TD was first discovered in the 1950s when chlorpromazine and other psychotic drugs were introduced.  A large percentage of patients with tardive dyskinesia at present are schizophrenics or have a neuropsychiatric disorder, conditions which expose them to long-term use of neuroleptics and anticholinergics or to substance abuse of other drugs or agents.

Symptoms of Tardive Dyskinesia

Common symptoms of TD are chronic and involuntary:

  • Lip puckering                                                                                                       tardive dyskinesia
  • Lip smacking
  • Tongue thrusting
  • Grimacing
  • Pursing of lips
  • Blinking
  • Jaws swinging
  • Chewing
  • Movements of legs, sometimes to the point where the spasms can interfere with locomotion
  • Movements of the limbs, torso, fingers, hands, or toes

Sometimes a TD patient may have difficulty breathing and may make grunting sounds.

It is important to diagnose TD for what it is, a neurological disorder, not a mental illness.  The danger of misdiagnosing tardive dyskinesia as symptoms of a mental illness may lead to prescriptions of neuroleptic drugs which may further exacerbate the condition toward a severe and debilitating case.

Drugs that May Cause Tardive Dyskinesia

Listed below are medications that have been linked to TD.  Note that a few are not antipsychotic drugs:

  • Flunarizine
  • Metoclopramide
  • Fluphenazine
  • Prochlorperazine
  • Chlorpromazine
  • Haloperidol
  • Trifluoperazine
  • Flunarizine — medication for migraine, dizziness, and vertigo
  • Reglan (metoclopramide)  — used to treat heartburn, nausea, and gastric disorders

High Risk Groups for TD

Patients on neuroleptic drugs for several months or years are at high risk for developing TD.  In some, however, TD can manifest in as short as six weeks.

Women, especially those with diabetes mellitus, organic brain injuries, or with negative schizophrenic symptoms, are more prone to developing TD.  The elderly are also at higher risk for this disorder than young patients.  In addition, people with a history of alcoholism and drug addiction are also at risk for developing tardive dyskinesia.

Patients who have undergone electroconvulsive therapy (ECT) may also be included the high risk group for TD.

Treatment of TD

Tardive dyskinesia has not been thoroughly studied and as such no adequate cure is on offer for this condition.  Prognosis looks hopeful for TD patients who have been diagnosed correctly very early at the onset so that the medication that may be causing the disorder is stopped or gradually reduced.  Stopping the offending drug, however, is a not a guarantee for TD symptoms to go away.  Despite being off the medication, a few patients may still exhibit the symptoms which may become permanent and may even take a turn for the worse.

Botulinin toxin or botox, for short, has helped reduce the degree of movements in severe cases.  Benzodiazepines such as Clonazepam have also proven some effectivity in treating TD, although these are limited by the body’s natural increasing tolerance of the drug.

It should also be of interest to know that Vitamin B6 has shown effectivity against TD symptoms in two randomised double-blind trials published in the American Journal of Psychiatry in 2001.

Mental health doctors have also turned to Tetrabenazine to tread TD.  This drug reduces the levels of dopamine and blocks dopamine receptors.  It does, however, come with its own arsenal of side effects such as drowsiness, Parkinsonism (characterized by body tremors), anxiety, depression, insomnia, and restless leg syndrome.

For the most part, tardive dyskinesia unfortunately has no real cure so prevention is still the best way around it.

Electroconvulsive Therapy (ECT)

 

What is Electroconvulsive Therapy?

Electroconvulsive Therapy or ECT is a form of medical therapy for people with severe mental illness who do not respond to counselling, medication, or other forms of treatment.  The therapy involves sending carefully controlled electric impulses to the brain to stimulate a brief epileptic fit with the goal of relieving extreme depression, mania, or catatonia.  The electric stimuli seem to provoke changes in brain chemistry which help alleviate the patient’s mental symptoms.

When ECT is administered, the patient is given a muscle relaxant and put to sleep with anaesthesia.  Electrodes are placed on the head after which a finely channelled electric current is sent to stimulate the brain.  These impulses trigger slight seizure-like movements in the sleeping patient.  The session is painless and lasts only several minutes after which the patient awakes with no memory of the treatment or the events leading up to it.  He may also wake up disoriented but this will last only for a while.

Improvements in patients are noticed usually after the first three sessions and major improvements are palpable after six.  These improvements could manifest as better sleeping patterns, less lethargy, or better appetites.

Is Electroconvulsive Therapy Dangerous?

ECT today is a generally safe method as it involves no pain or bad shocks.  There is a side effect though which involves memory impairment lasting about several weeks after the treatment.  Although memory is usually resolved in the short-term, there are rare cases in which patients do lose personal and skill memories and have difficulty processing new information.

In cases of extreme depression, the benefits however may outweigh the risks of a memory disadvantage especially in patients whose need for some symptom alleviation are urgent.  For instance, a mother with severe postnatal depression may require the symptom alleviation ECT may provide, when other therapies have failed to, in order to for her to adequately nurture her infant.

ECT has gotten a bad reputation because of the errors done during its early developmental phase.  ECT’s stigma stemmed from misuse of equipment, inadequate information and staff training, and improper treatment administration.  These errors had proved to be injurious to some patients who were administered with high electric charges without anaesthesia causing memory loss, fractured bones, and other serious injuries.  Electroconvulsive therapy has evolved to today’s relatively safe administration of finely controlled charges, anaesthesia, and strict supervision.

electroconvulsive-therapy-adverse effects

Who are Candidates for ECT?

Patients who merit a prescription for electroconvulsive therapy may be:

  • suicidal because of severe depressive symptoms.  About 80% of these cases report a mood improvement with ECT.
  • unresponsive to drugs or talking therapies
  • in a severe manic episode lasting for a long period of time
  • catatonic
  • those that have a history of responding well to ECT therapy in the past
  • aggressive or extremely agitated because of dementia
  • pregnant and cannot take medications
  • intolerant of the side effects of drugs
  • mothers with severe postnatal depression.  As electroconvulsive therapy works more quickly than counselling or medication, it helps cut down the time that the mother spends away from infant nurture.
  • nutritionally compromised because patient refuses food or sustenance owing to extreme depression
  • severely psychotic or schizophrenic

Is ECT Effective?

There is a huge body of evidence now that ECT is an invaluable treatment tool for those with acute depression and psychosis.  Although electroconvulsive therapy can go a long way in treating patients, this must be followed up with talking therapies and medication to avert recurrence of extreme symptoms.

Types of Electroconvulsive Therapies

There are two types of ECT administration which is differentiated by the location of electrode placement:

  • Right Unilateral Treatment

Right unilateral treatment involves the placement of one electrode at the crown of the head and the other, at the right temple.  The placement produces milder stimuli and therefore has lower risks of side effects concerning memory.  The patient response rate, however, is also slower compared to bilateral ECT, the other type of treatment.  If patients do not respond to right unilateral treatment, they may be switched to the stronger bilateral one.

  • Bilateral Treatment

Bilateral treatment is a full-on type that requires electrodes to be placed on both the left and right temples of the patient’s head.  In this case, the electric stimuli are much stronger, but still controlled, and therefore more effective in resistant patients.  Bilateral ECT however carries more risk of some memory loss.

Bilateral ECT

The patient and doctor should work out which treatment type is best.  This usually involves taking into consideration the patient’s medical and psychiatric history, severity of symptoms, and personal concerns as well.