Bipolar

[Armadillos]

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I have seen a procedure requiring anesthesia.
.

Thats good because it gives you some reference and familiarity with paralytics/induction agents/etc., I think it would be really eye opening for you to see ECT. Its very similar to surgery except your not getting midazolam preop, they aren't going to intubate, it lasts like 4 minutes (and you dont have to stand there like a T-rex trying not to contaminate yourself). Again, I don't want you to think we are ignoring the cognitive risks, just pointing out that there is absolutely nothing violent/barbaric about the ECT procedure itself.

 

[pre med 2014]

I would be surprised if anyone outside of Hollywood or living in the 21st century would be dragged kicking and screaming to a PACU or OR for this procedure. Something about medical ethics and assualt/battery being limiting factors.

and how is that the conversation goes from involuntary ECT never happens and it would be assault/battery to somehow me having to gain an understanding of the 'life-saving' benefits of non-consensual ECT?

I thought everyone was saying it doesn't happen...

 

[Armadillos]

and how is that the conversation goes from involuntary ECT never happens and it would be assault/battery to somehow me having to gain an understanding of the 'life-saving' benefits of non-consensual ECT?

I thought everyone was saying it doesn't happen...

You dont even know what "it" is, start with that

 

[pre med 2014]

You dont even know what "it" is, start with that

applying ~200 volts to the brain with the intent of inducing a seizure while the patient is under general anesthesia??

 

[Armadillos]

applying ~200 volts to the brain with the intent of inducing a seizure while the patient is under general anesthesia??

Seems your learning something from the thread, because no less than a few hours ago you thought ECT was whatever the heck they were doing in that video, so now go back and check out some of the other posts/resources/etc in the light of this new understanding.

 

[notdeadyet]

and how is that the conversation goes from involuntary ECT never happens and it would be assault/battery to somehow me having to gain an understanding of the 'life-saving' benefits of non-consensual ECT?

I thought everyone was saying it doesn't happen...

Pre med, I mean this in the most instructive way possible. When you came on here, you demonstrated that you didn't have an understanding of what ECT actually is. Folks have been trying to help shed light for you, but rather than show an ability to formulate this new information and allow it to change your perspective, you selectively focus and double-down. This is a very, very bad tendency in the practice of medicine and leads to bad outcomes for your patients. I'd think on it some.

As to your post here, I don't think anyone said that non-consensual ECT never happens. I think folks were disagreeing with your description of folks being dragged kicking and screaming into ECT, which someone said would be assault and battery.

They are right. I have never heard of non-consensual ECT being given to folks who had capacity. Non-consensual ECT, which is extremely, extremely rare, is not given against folks consent, it is given to folks who do not have the ability to given consent. This is typically folks who are literally or figuratively catatonic from depression and the psychiatrist (and family... and hospital ethics team...) determine collectively that ECT should be tried to save the patient's life.

So "everyone" wasn't saying that non-consensual ECT doesn't happen. Folks were just trying to help shatter the stereotype you were perpetuating of patients being forced into ECT against their will, kicking and screaming.

Anyway, I'll sign off this thread. If you learn more about ECT and have some actual questions about its practice, feel free to post it.

 

[OldPsychDoc]

They are right. I have never heard of non-consensual ECT being given to folks who had capacity. Non-consensual ECT, which is extremely, extremely rare, is not given against folks consent, it is given to folks who do not have the ability to given consent. This is typically folks who are literally or figuratively catatonic from depression and the psychiatrist (and family... and hospital ethics team...) determine collectively that ECT should be tried to save the patient's life.

^^^and a JUDGE.

 

[notdeadyet]

^^^and a JUDGE.

Very good catch, thank you. This also has to go before a judge with the patient also independently represented by the equivalent of a patients rights advocate.

 

[pre med 2014]

I have never heard of non-consensual ECT being given to folks who had capacity. Non-consensual ECT, which is extremely, extremely rare, is not given against folks consent, it is given to folks who do not have the ability to given consent. This is typically folks who are literally or figuratively catatonic from depression and the psychiatrist (and family... and hospital ethics team...) determine collectively that ECT should be tried to save the patient's life.

The author of Doctors of Deception, a shock survivor, was a college grad from a prestigious college and was very functional within her career in writing and photography. So just to be clear when you describe patients who lack 'capacity' we're not talking about degenerates here.

 

[hamstergang]

So just to be clear when you describe patients who lack 'capacity' we're not talking about degenerates here.

I don't think that anyone but you thought that lacking capacity at the time of treatment made one a degenerate. You really don't seem to have any idea what's going on in this thread despite having such strong opinions about it. It's not a good look.

 

[SuperSoccer19]

The author of Doctors of Deception, a shock survivor, was a college grad from a prestigious college and was very functional within her career in writing and photography. So just to be clear when you describe patients who lack 'capacity' we're not talking about degenerates here.

Capacity, per a NEJM article that I don't have the citation here, implies the following:
1. Must be able to communicate
2. Must understand risk and benefits of a procedure
3. Must Appreciate Risks and Benefits
4. Decision made by patient (assuming 1-3 are met), is consistent with patient's values and understanding 2 and 3.

A patient who is too depressed or psychotic to really understand the concept of ECT or even communicate his/her preference, lacks capacity. This type of person in some jurisdictions might be a candidate for ECT assuming next of kin/judge are making this decision with the assistance of a physican. If someone is so sick he or she cannot eat, is self-mutalating, out of control, etc. and the benefits of a higher risk procedures outweight the risks, he could be eligible for ECT without the patient actually consenting.

Its a similar concept to having a demented/delirious patient with a gangranous leg. The patient is not in always in the right state of mind to understand that an amputation could be lifesaving and refuses this procedure. If the patient understands that amputation is the only option and disagrees, but is in the right state of mind and justify why, then she has capacity to refuse the surgery. I was going to use the example of someone with increased intracranial pressure leading to a need for a CSF shunt, but in this situation implied consent would probably kick in, but based on the above conversations, this would be "involuntarily" drilling a hole in someone's head according to pre-med.

 

[pre med 2014]

I don't think that anyone but you thought that lacking capacity at the time of treatment made one a degenerate. You really don't seem to have any idea what's going on in this thread despite having such strong opinions about it. It's not a good look.

I have in no way displayed an extreme viewpoint. I've even gone so far as to be somewhat ok with truly consensual ECT. If you know the risks, and you want it then to be against that I'd be going against my own libertarian principles.

Although prominent neurologists have been very vocal about the danger of purposefully inducing seizures, I still would say when I am a doctor I should probably not interfere with voluntary ECT. People do a lot of dangerous activities (cliff jumping, motorcycle riding, etc...) and individual should be able to decide for themselves what level of risk they are willing to take. As a doctor I can only give my opinion of the risk, but ultimately the individual has to decide if the risk is worth it.

 

[hamstergang]

I have in no way displayed an extreme viewpoint.

Who said that you did display an extreme viewpoint? I think your viewpoint is uninformed and wrong, but I don't know that I'd call it extreme.

Although prominent neurologists have been very vocal about the danger of purposefully inducing seizures, I still would say when I am a doctor I should probably not interfere with voluntary ECT. People do a lot of dangerous activities (cliff jumping, motorcycle riding, etc...) and individual should be able to decide for themselves what level of risk they are willing to take. As a doctor I can only give my opinion of the risk, but ultimately the individual has to decide if the risk is worth it.

You make it sound like prominent neurologists are saying that ECT is dangerous. It's not, and so you are being misleading on purpose. Your opinion of the risk is currently useless (or dare I say harmful) as it stems more from ignorance than fact. Learn facts, then opine.

 

[pre med 2014]

"You make it sound like prominent neurologists are saying that ECT is dangerous"

Dr. John Friedberg MD was a neurologist who bravely stood up to psychiatric oppression particularly in regards to the use of ECT.

 

[istillbelieve]

Back to ECT and the bipolar patient

If it helps bipolar patients, what are the chances of relapse? I have to go and research this.

 

[istillbelieve]

Double post

 

[Armadillos]

"You make it sound like prominent neurologists are saying that ECT is dangerous"

Dr. John Friedberg MD was a neurologist who bravely stood up to psychiatric oppression particularly in regards to the use of ECT.

I was curious so I did some googling, first thing I saw was a transcript of some testimony to some court/government body

"I do not believe in mental illness."

"I do not believe in hypothetical diseases of the mind"

 

[pre med 2014]

I was curious so I did some googling, first thing I saw was a transcript of some testimony to some court/government body

"I do not believe in mental illness."

"I do not believe in hypothetical diseases of the mind"

I googled him out of curiosity to see some of his testimony. This is an interesting and short read, note in the conclusion he does not oppose ECT under free and clear consent.

EDIT: actually that must be the one you read, I didn't notice the part where he said mental illness is not a disease in there.

http://www.ect.org/news/newyork/friedbergtest.html

 

[Armadillos]

EDIT: actually that must be the one you read, I didn't notice the part where he said mental illness is not a disease in there.

http://www.ect.org/news/newyork/friedbergtest.html

You may interpret his words differently, but both of those things I put in quotes were copied/pasted directly from his testimony

 

[pre med 2014]

You may interpret his words differently, but both of those things I put in quotes were copied/pasted directly from his testimony

The language doesn't matter. A lot of psychiatrists believe bipolar is a disease but still would not administer treatment involuntarily out of respect for human dignity even if they dislike the patient.

Some people truly are more dangerous, the problem is that a staunch bigot is more easily startled than you or I. In turn he will identify more innocent persons who will not commit future crimes. The issue is for every one crime you prevent you are going to incarcerate at least 20 innocent people who will not commit a crime. And if you are full out bigot you may commit 100s of innocents per one future crime you prevent.

 

[pre med 2014]

Ok deleted I don't want to drift this thread off on a philosophical tangent.

I'll end it by saying Friedman doesn't mean mental illness doesn't exist what he means is that an outside judgement of dangerousness is not in itself indicative of a disease pathology.

 

[Armadillos]

The language doesn't matter. A lot of psychiatrists believe bipolar is a disease but still would not administer treatment involuntarily out of respect for human dignity even if they dislike the patient.

Some people truly are more dangerous, the problem is that a staunch bigot is more easily startled than you or I. In turn he will identify more innocent persons who will not commit future crimes. The issue is for every one crime you prevent you are going to incarcerate at least 20 innocent people who will not commit a crime. And if you are full out bigot you may commit 100s of innocents per one future crime you prevent.

What are you even talking about?? Its absurd for you to even conjecture that any (non-criminal) physician would ever consider administering ECT to someone "because they dislike the patient". Also extremely troubling that when searching for analogies related to mental illness you immediately turn to criminality and crime/punishment.

 

[pre med 2014]

What are you even talking about?? Its absurd for you to even conjecture that any (non-criminal) physician would ever consider administering ECT to someone "because they dislike the patient". Also extremely troubling that when searching for analogies related to mental illness you immediately turn to criminality and crime/punishment.

It was stated earlier in this thread ECT is only administered involuntarily to those who are a danger to themselves or others. I.e. They will commit a crime unless properly 'treated'

And by the way, that's all the patient is going to hear. They don't care how you dance around with words, you tell them they need it to be safe, they translate it as without it they are criminals.

 

[Armadillos]

It was stated earlier in this thread ECT is only administered involuntarily to those who are a danger to themselves or others. I.e. They will commit a crime unless properly 'treated'

And by the way, that's all the patient is going to hear. They don't care how you dance around it, you tell them they need it to be safe, they translate it as without it they are criminals.

What are you talking about???
ECT isn't used on people to prevent them from committing crimes, where are you pulling this crap from? If anything, giving ECT would increase the chance someone could commit crimes, its hard to commit a crime when your catatonic or have severe psychomotor ******ation.

 

[splik]

no nowhere in this thread did anyone mention ECT being use for people are a danger to others.

 

[pre med 2014]

Involuntary treatment with ECT can occur in some states, but only with a court order as part of a judicial commitment process. Again, the providers need to demonstrate the patient's danger to themselves and inability to give informed consent, and the necessary indication of ECT for the patient's condition. We are usually successful in obtaining these orders in cases of severe catatonia, for example, in which it is thoroughly evidence-based, effective, and life-saving.

I knew something to this effect was said earlier, but specifically a danger to others was in fact not mentioned. I was just going from memory here.

 

[Armadillos]

I knew something to this effect was said earlier, but specifically a danger to others was in fact not mentioned. I was just going from memory here.

Which shows you have no understanding of what ECT is used for, please try to properly educate yourself before coming in here trying to confront ECT. The only reason Im still responding to you at this point is I know a lot of people without medical training (premeds or otherwise) read these forums and the things your saying perpetuate stereotypes that are damaging to people with mental illness.

 

[dozitgetchahi]

Dude.

Involuntary ECT is most commonly used (today) in the context of catatonia. A person who is catatonic to the extent that they cannot offer consent is actually not an *active* threat to themselves or others - they are completely silent, often rigid, etc. It is not a good place to be. Usually at this point, benzos and other treatments have been tried to no avail. ECT is being utilized in a last resort effort to save their lives. A pretty good analogy is a pt in v-fib...pt is in dire straits, other treatments may have been tried to no avail. We shock them and potentially restore a normal rhythm (I'll note that ECT is actually much more effective in terms of outcomes than electrical cardioversion in the previously mentioned circumstances).

The type of "ECT abuse' you're decrying is a relic of the early- to mid-1900s which (at least in the West) has essentially ceased today. It's not done anymore. So don't worry about it.

And for christ's sake, don't waltz into medical school with this type of extremely narrow-minded, legalistic mindset. I too had some fairly ignorant beliefs about medicine when I started medical school...medical school changed all that. Once you see how the scene looks from the other side, things begin to make a lot more sense. (And this is not to say that there still aren't abuses here and there and strange ideas in the wide world of medicine that really could use revision...just that these are a lot less common than you probably think now).

 

[Fenster]

I'm going to digress from all the digressions in the thread and get back to the topic (sort of).

Stephen Fry is bipolar. I'd love to work with him.

Generalizing all patients with a disorder as being difficult to work with is ridiculous.

 

[istillbelieve]

"Involuntary ECT is most commonly used (today) in the context of catatonia. A person who is catatonic to the extent that they cannot offer consent is actually not an *active* threat to themselves or others - they are completely silent, often rigid, etc. It is not a good place to be. Usually at this point, benzos and other treatments have been tried to no avail. ECT is being utilized in a last resort effort to save their lives. A pretty good analogy is a pt in v-fib...pt is in dire straits, other treatments may have been tried to no avail. We shock them and potentially restore a normal rhythm (I'll note that ECT is actually much more effective in terms of outcomes than electrical cardioversion in the previously mentioned circumstances)."

Totally agree! Also catatonic patients aren't functional enough to commit a crime.

 

[istillbelieve]

Dude.

And for christ's sake, don't waltz into medical school with this type of extremely narrow-minded, legalistic mindset. I too had some fairly ignorant beliefs about medicine when I started medical school...medical school changed all that."

He/she is a medical student.

 

[whopper]

wow, missed a lot of this thread.

I'm not sure how this pans out in most states, but I can tell you how it is in a few. ECT for involuntarily committed patients is politically difficult. It can take months of court hearings and 2nd, 3rd, even 4th opinions before it's done. Reason is that ECT is seen as invasive, it's involuntary, and landmark cases have created a standard of requiring a lot of reviews for more invasive procedures.

This is not always a bad thing. The legal system, in general, has erred on the side of patient care and humanitarian approaches.

Such bureaucracy gets in the way if the provider is good. Someone needing ECT and not getting it for months is poor care. It serves it's purpose if the provider is terrible, because in the review process someone will likely be able to convince a judge that the ECT shouldn't be done.

And unfortunately, the reality of what is going on IMHO is this system is needed because there's enough bad doctors out there to still require several reviews.

 

[Shikima]

Capacity, per a NEJM article that I don't have the citation here, implies the following:
1. Must be able to communicate
2. Must understand risk and benefits of a procedure
3. Must Appreciate Risks and Benefits
4. Decision made by patient (assuming 1-3 are met), is consistent with patient's values and understanding 2 and 3.

A patient who is too depressed or psychotic to really understand the concept of ECT or even communicate his/her preference, lacks capacity. This type of person in some jurisdictions might be a candidate for ECT assuming next of kin/judge are making this decision with the assistance of a physican. If someone is so sick he or she cannot eat, is self-mutalating, out of control, etc. and the benefits of a higher risk procedures outweight the risks, he could be eligible for ECT without the patient actually consenting.

Its a similar concept to having a demented/delirious patient with a gangranous leg. The patient is not in always in the right state of mind to understand that an amputation could be lifesaving and refuses this procedure. If the patient understands that amputation is the only option and disagrees, but is in the right state of mind and justify why, then she has capacity to refuse the surgery. I was going to use the example of someone with increased intracranial pressure leading to a need for a CSF shunt, but in this situation implied consent would probably kick in, but based on the above conversations, this would be "involuntarily" drilling a hole in someone's head according to pre-med.

This was the case last night with me in my private clinic last night. I had her hospitalized for emergent mood stabilization. Once stabilized, will look at ECT options.