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Mental illness
Published in Govert den Hartogh, What Kind of Death, 2023
The underlying principle of this suggestion is correct: every evidence-based treatment option that has a substantial chance of success within a reasonable time frame and that does not involve burdens to the patient that are disproportional to that chance should be tried out.29 Otherwise we cannot be sure enough that there is insufficient hope for improvement. The question is whether we should implement that principle by ticking off a standardized list. The effects of some treatment options, e.g., electroconvulsive therapy (ECT), other brain stimulation therapies with less risk of creating cognitive impairments, or some kinds of medication, may be so clear and pervasive that we should insist on trying them out in all cases for which they are indicated. In the case of other treatments, however, the effectiveness of a treatment may be disputable in particular circumstances, for example as a result of social problems or because of a history of non-responsiveness to related treatments. Comorbidity adds new dimensions to a kind of suffering that is already multidimensional. If any alternative treatment promises to decrease the level of suffering in one dimension, what about the other dimensions?
Prognosis
Published in Simon Lovestone, Robert Howard, Depression in Elderly People, 2020
Simon Lovestone, Robert Howard
The outcome of depression in late life, then, is not dissimilar to the outcome of depression in younger people. The majority of patients will recover and will remain well one year later. Of those that relapse, a large proportion will have spent much of the intervening period well and active. Not surprisingly a relatively poor outcome is associated with a more severe initial episode and with chronic ill health. Treatment undoubtedly does affect prognosis – both recovery from the initial episode and maintaining subsequent remissions. Adequate initial treatment is essential and for more severe depressive episodes this may necessitate the use of electroconvulsive therapy (ECT). Indeed some of the differences in outcome in the studies on prognosis of depression in the elderly probably relate to differing use of ECT, with those centres utilising ECT demonstrating a better prognosis for their patients.
Special considerations: Electroconvulsive therapy
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Dhritiman Chakrabarti, Deepti Srinivas
Electroconvulsive therapy (ECT) is a therapeutic modality that uses iatrogenically induced seizures for biological therapy of medically resistant and acute cases of depression, psychosis, and bipolar disorder. The number of patients receiving ECT relative to those on medication for psychiatric disorders is proportionately higher in the geriatric population, mainly due to unresponsiveness to medication, responsiveness to ECT, and also due to intolerance of medication-associated adverse effects. This chapter discusses the relevance and anesthetic considerations of ECT in the geriatric population.
Recovery of patients with severe depression in inpatient rural psychiatry: a descriptive clinical study
Published in Nordic Journal of Psychiatry, 2020
Snaebjorn Omar Gudjonsson, Eydis Kristin Sveinbjarnardottir, Ragnheidur Harpa Arnardottir
This study was conducted at a 10-bed inpatient acute psychiatric unit at Akureyri Hospital, Iceland, which serves a rural population of around 50,000 inhabitants. The focus at the unit is acute care with an emphasis on collaborative interdisciplinary teamwork. The treatment theoretical framework is based on the Model of Care by Glick et al. [27], which emphasises evidence-based quality protocols during admission and three phases of treatment: assessment, implementation, and resolution phase. Treatment includes pharmacology, psychotherapy, and other traditional psychological support therapies, and in fewer instances electroconvulsive therapy (ECT). Psychoeducation, activity motivation, physical activity and support are given daily during hospitalisation. DASS-42 is routinely used at admission and discharge. Family support interventions had not been specially implemented at the unit at the time of the study and HRQoL was not a part of the routine assessment.
Retinal Nerve Fiber Layer Thickness Alterations after Electroconvulsive Therapy in Patients with Mental Illness
Published in Seminars in Ophthalmology, 2018
Didar Ucar, Nazım Yıldız, Mustafa Hepokur, Fatih Baltu, Elvin Guliyev, Murat Emul, Ahmet Murat Sarıcı
Electroconvulsive therapy (ECT) is an alternative, efficient, and safe treatment modality, especially in certain treatment-resistant neuropsychiatric disorders. In one comprehensive review, the ongoing neurotrophic effects of ECT in clinical studies and electroconvulsive shock (ECS) in preclinical studies were emphasized in the hippocampus, prefrontal cortex, amygdala, and hypothalamus.7 Although there are prospective magnetic resonance imaging (MRI) studies investigating the effects of ECT on the gray matter in the literature, we could not find any studies searching for alterations in the gray matter after ECT sessions by measuring the RNFL thickness using OCT. We hypothesized that there might be some alterations in the RNFL thicknesses between the pre- and post-ECT values in patients with mental illnesses. Therefore, for the first time, we investigated the ECT-induced alterations in the RNFL in patients who underwent ECT and compared them with the values obtained from healthy controls.
Do Psychiatrists Hear Their Patients' Voices? The Importance of Qualitative Research on Brain-Related Technologies
Published in AJOB Neuroscience, 2018
The lack of attentiveness to patients’ subjective experience, in the context of the clinical use of brain-related technologies, may be problematic from clinical and ethical perspectives. For example, researchers assume that electroencephalogram (EEG) studies have no potential of causing any physical harm. However, this perception, which is probably correct from an “outward” objective biological perspective with regard to normal subjects, may be mistaken for some psychiatric patients, due to “inward” subjective reasons. The data pertaining to electroconvulsive therapy (ECT)-related anxiety (Obbels et al. 2017) may suggest that undergoing a procedure that includes a direct attachment to a patient's head may provoke realistic and unrealistic fears. This may be especially disturbing with regard to subjects who suffer from psychotic disorders. It is not unrealistic to assume that for some of these patients, the utilization of an unfamiliar (especially in the case of an invasive) brain-related technology may give rise to a paranoid attitude toward the medical staff conducting the study. Theoretically, this concern is more disturbing with regard to patients with delusional content relating to thought insertion or thought broadcasting. In turn, one can expect that the patient's adherence to therapy will be reduced. In this scenario, the brain-related intervention will indirectly result in a negative effect on the patient's well-being. Indeed, subjective experiences have been found to be a contributing factor to nonadherence to antipsychotics (Moritz et al. 2014; Taira et al. 2006).