Electroshock therapy in psychiatry. Indications, consequences

Today, many have heard of this method of treatment, such as electroshock, or electroconvulsive therapy. This procedure due to the films is notorious. But how is it really in fact, is this kind of therapy really dangerous and so frightening, as they say about it?

What is this procedure?

When electroconvulsive therapy is performed, a current of varying strength is passed through the patient's brain - from 200 to 1600 milliamperes. Its voltage ranges from 70 volts to 400. The duration of exposure does not exceed a few seconds, often limited to fractions of seconds. These impulses provoke convulsions. But it is worth noting that the delivered dose of tension is individual, depending on the patient's susceptibility. A session is considered successful if the seizure itself has a duration of 25 seconds. To conduct this therapy in the region of the temples, electrodes are installed on both sides. Sometimes they are attached to the front and back of the head. Electrical impulses usually start only through one side of the brain. The location of the electrodes will depend on the disease of the person, since with different diagnoses the area of influence on the brain changes.

Before the procedure, a patient can be administered a medicine that temporarily paralyzes the entire muscular system. These measures are necessary to ensure that the patient does not break his bones at the time of passing electricity through the brain. This indicates that electroconvulsive therapy causes a strong shake-up of the whole organism. In addition, the session is necessarily performed under general anesthesia.

But to cause such a shock, specialists use not only electricity. For therapeutic purposes, gas inhalants are used (the composition is inhaled through a mask) and chemical agents (administered subcutaneously with a needle). The effect of these drugs is equal to the electrical effect. Experts say that the treatment is due to the shock state at the time of seizures, and it does not matter what methods they are caused (through a mask, needle or current).

What is the purpose of this therapy?

In 1938, electroshock therapy was proposed as a method of getting rid of schizophrenia. Also, this procedure is aimed at helping patients who suffer from some other mental illness. But after years it became clear that this method of treatment is not effective in the case of schizophrenia, but it does give good results in a depressed state. Some physicians argue that this method of getting rid of such mental disorders is most effective, since approximately 75% of patients have received a cured cure for the symptoms of their illness.

Indications for therapy

There are many conditions in which you are offered to conduct a course of this treatment. But only four types of mental disorders have been prescribed, in which the procedure of electroconvulsive therapy is appointed in an emergency. These include:

• Depression, during which there was revealed an irrepressible desire for suicide and the desire to injure yourself.
• Febrile catatonia.
• Conditions in which the patient stubbornly refuses to take water or food.
• Malignant neuroleptic syndrome.

But there are other indications in which electroconvulsive therapy may be recommended, but in these cases the procedures will be conducted in a planned manner. In addition, this method of treatment is used not only in psychiatry, but also in narcological and neurological areas (for example, in epilepsy, pain syndromes).

Treatment of depression

Electroconvulsive therapy is most commonly used for depression. It is established that this disease occurs due to the hyperactive signal exchange between different parts of the brain. Therefore, the goal of the treating doctor should be to break these ties and restore normal exchange. It is believed that it is convulsions caused by electrical impulses that reduce the number of hyperactive links between brain regions that are responsible for mood, concentration and thinking.

Preparation for therapy

To proceed with this method of treatment, you will need to complete the following steps:

1. Full study of the patient's neurological and somatic state.
2. A general analysis of blood and urine is done. In some cases, a biochemical blood test is performed in more detail.
3. An evaluation of cognitive functions is given.
4. The cardiovascular system is checked and the electrocardiogram is examined.
5. The musculoskeletal functions of the patient are evaluated.

There are also a number of other activities, such as stopping food and some of the medications that the patient took for treatment.

In addition, contrary to the popular belief that electroshock therapy in psychiatry is compulsory, the procedure is started only with the consent of the treating party. The patient must personally take this decision and sign a special form. But sometimes a person's mental state is extremely difficult, and he is not able to give his answer. In this case, a close relative or guardian can agree to the procedure. But in order for the decision to be legal, a consultation of doctors is being held, which give their conclusion.

Frequency of procedures

It is known that electroconvulsive therapy in psychiatry is conducted in a whole course, which includes several sessions. Their frequency varies depending on the country and the clinic where the treatment is performed. Usually, the patient is given two or three sessions per week. The average course duration is four weeks. Some patients improve much earlier, and sometimes only two weeks are enough. Sometimes the improvement does not occur even after 20 times of therapy. But it is noticed, if the first 12 sessions did not move the state from the dead point, then further treatment by this method will be unsuccessful.

Effects

This method of therapy is cardinal, and he, of course, has side effects, which are early and late. In the first case, violations occur immediately after the end of the session or during the session. This involves unnaturally prolonged seizures, which requires immediate interruption of the process by the introduction of special drugs. Tachycardia may also appear during the session. In addition, the reaction may occur on anesthesia or another drug that is used for therapy. It manifests itself in the form of apnea (respiratory arrest).

In addition, the early consequences include headaches after the procedure, which can be eliminated with the help of light painkillers. After the seizure, overexcitement, nausea, a change in pressure, a painful condition, and confusion may gradually appear , which gradually fade away. But they can intensify with each session. The most terrible consequences include a heart attack and death.

Later side effects appear after a time after several procedures. They can grow throughout the course while electroconvulsive therapy is performed. Consequences, as already mentioned, can manifest themselves in the form of a long confusion of consciousness. It can also be partial amnesia or problems with thinking.

Memory breakdown

For a long time there was an opinion that this procedure inevitably damages the brain. Therefore, studies were conducted to find out what memory is erased during electroconvulsive therapy, and what disorders occur in this case. It was found that the disturbances begin to manifest after about the sixth session. In this case, amnesia can have a different character. At times the patient simply did not remember that he was being treated with this method, and in other cases, selective memory loss was noted . For example, a person was not able to remember names or other details. But all these violations occurred only with those patients who, before the start of therapy on MRI, foci of excessive intensity were fixed in the subcortical white matter. Usually after a few weeks the memory of these patients was restored completely, although some still noted that part of the events of their life had been irretrievably erased.

Are there any contraindications

In connection with a number of side effects, the question may arise in which cases electroconvulsive therapy is unacceptable. Strangely enough, doctors do not call absolute contraindications for this method of treatment. Although many doctors try to be cautious, because there are conditions of the patient, in which these procedures can lead to the death of the patient. This includes:

• Postponed myocardial infarction (should be three months).
• Intracranial hypertension.
• Gastrointestinal bleeding.
• Pheochromocytoma.
• Presence of brain tumors (the genus of origin is taken into account).
• With problems associated with intolerance to anesthesia.

But, besides all this, there are conditions in which during the procedure it is necessary to take additional measures to minimize the risk of serious complications.