Quote from documentry "Shock" about ECT

[surftheiop]

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So today in psych we watch a "documentry" called "shock" which pretty much sets out to overcome the stigma associated with ECT by explaining why/how the stigma arose (movies, no anethesia, kids getting it against their will, etc.) and also to explain the procedure in its modern context.

Along with a bunch of interviews from people it has helped. Then there was a section about the side effects/memory loss.

Anyhow there was a qoute to the effect of :

"ECT is the single most effective psychiatric treatment in existence for those suffering from major depression".

While there is a lot of negative ECT propaganda out there this movie seemed to be Pro-ECT propaganda so i was curious how accurate the qoute was?

 

[Faebinder]

So today in psych we watch a "documentry" called "shock" which pretty much sets out to overcome the stigma associated with ECT by explaining why/how the stigma arose (movies, no anethesia, kids getting it against their will, etc.) and also to explain the procedure in its modern context.

Along with a bunch of interviews from people it has helped. Then there was a section about the side effects/memory loss.

Anyhow there was a qoute to the effect of :

"ECT is the single most effective psychiatric treatment in existence for those suffering from major depression".

While there is a lot of negative ECT propaganda out there this movie seemed to be Pro-ECT propaganda so i was curious how accurate the qoute was?

Well you could spend 6 months of your life in the hospital or get an ECT and possibly forget a couple of months. Which is better?

 

[masterofmonkeys]

haha I don't know if I'd say that ECT is the best option for ANYONE suffering from major depression, I think it's carved itself out a very useful niche in treatment-resistant and severe depression.

I don't think there will ever come a day when you refer a high-functioning individual who's 5/9 on SIGECAPS for ECT.

 

[Doc Samson]

So today in psych we watch a "documentry" called "shock" which pretty much sets out to overcome the stigma associated with ECT by explaining why/how the stigma arose (movies, no anethesia, kids getting it against their will, etc.) and also to explain the procedure in its modern context.

Along with a bunch of interviews from people it has helped. Then there was a section about the side effects/memory loss.

Anyhow there was a qoute to the effect of :

"ECT is the single most effective psychiatric treatment in existence for those suffering from major depression".

While there is a lot of negative ECT propaganda out there this movie seemed to be Pro-ECT propaganda so i was curious how accurate the qoute was?

The quote is true not only for depression, but a variety of other treatment unresponsive psychiatric illnesses - and ECT is the single definitive treatment for catatonia.

 

[masterofmonkeys]

The quote is true not only for depression, but a variety of other treatment unresponsive psychiatric illnesses - and ECT is the single definitive treatment for catatonia.

Quite possibly for illnesses in which the ketamine coma has been found useful as well (PTSD and chronic pain come to mind).

 

[chameleonknight]

The quote is true not only for depression, but a variety of other treatment unresponsive psychiatric illnesses - and ECT is the single definitive treatment for catatonia.

? I thought benzos were fairly effective for catatonia?

 

[whopper]

Benzos do help treat catatonia. ECT is better.

 

[Doc Samson]

? I thought benzos were fairly effective for catatonia?

In my experience (and bear in mind that I deal almost 100% with medically related catatonia rather than schizophrenia) benzos are a temporizing measure (and a useful diagnostic test) until I can get the patient to ECT. Off hand I can think of only 1 or 2 cases of catatonia that completely resolved with benzos - and both of them had psychiatric rather than medical underlay.

 

[surftheiop]

Thanks for the replies, they were helpful.

I had another question about ECT and psychiatrists specifically. It makes sense to me that a psychiatrist would prescribe that someone get ECT but I have also heard people mentioning that psychiatrists can sign up to do ECT's at hospital to make extra money.

When administering ECT what does the psychiatrist actually do? The movie we watched had like a 10 minute section where they showed in ECT and the only person involved with the procedure in the room who obviously stood out as an MD to me was the anethesiologist. And also someone who was reading the EEG's but isnt that more a neurologist's thing?

 

[kugel]

ECT is the safest, fastest and most effective treatment for severe depression. It is a crime that it is withheld from so many patients who deserve a trial of ECT. In CA, there are so many useless hoops to jump through that almost no one who needs it can get it.

There is very little to "do" during ECT treatment. It is a thoroughly boring, underwhelming experience - that can/does save lives.

 

[silas2642]

Thanks for the replies, they were helpful.

I had another question about ECT and psychiatrists specifically. It makes sense to me that a psychiatrist would prescribe that someone get ECT but I have also heard people mentioning that psychiatrists can sign up to do ECT's at hospital to make extra money.

When administering ECT what does the psychiatrist actually do? The movie we watched had like a 10 minute section where they showed in ECT and the only person involved with the procedure in the room who obviously stood out as an MD to me was the anethesiologist. And also someone who was reading the EEG's but isnt that more a neurologist's thing?

Yeah, how much is there to training in ECT? I thought most of what you guys did was press a button during the actual procedure?

 

[OldPsychDoc]

In addition to evaluating the patient and determining the appropriateness of ECT for their condition (we get quite a few referrals of pts with Axis 2 issues where either the doc or the patient is looking for some kind of "quick fix"), we oversee the pre-ECT workup--head CT, EKG, labs, taper the anticonvulsants and benzos (yeah, it's kinda hard to get a therapeutic seizure when someone's taking 4 mg klonopin a day!), to say nothing of patient education, consenting the procedure, etc. In ECT itself, we determine the electrode placement, prep the contact surfaces, coordinate with anesthesia re: VSs, dosing, etc, manage the timing of med administrations (not good to paralyze an awake patient!), decide when to administer the seizure, monitor the motor and EEG seizure activity (yes we read the EEG strip--we don't need to call a neuro consult!🙄), decide whether the treatment is adequate (aiming for a minimum of 30 sec EEG seizure activity), possibly administer a second or third seizure, supervise the patient's initial recovery, monitor and treat side effects (nausea, pain, agitation) in coordination with anesthesia, and document, document, document.

Inasmuch as it involves a "particular method for performing a task, a series of small tasks or step taken to accomplish an end", this does qualify as a "medical procedure", and it is billed for as such. No one will get rich doing ECT, but an RVU is an RVU...

 

[surftheiop]

In addition to evaluating the patient and determining the appropriateness of ECT for their condition (we get quite a few referrals of pts with Axis 2 issues where either the doc or the patient is looking for some kind of "quick fix"), we oversee the pre-ECT workup--head CT, EKG, labs, taper the anticonvulsants and benzos (yeah, it's kinda hard to get a therapeutic seizure when someone's taking 4 mg klonopin a day!), to say nothing of patient education, consenting the procedure, etc. In ECT itself, we determine the electrode placement, prep the contact surfaces, coordinate with anesthesia re: VSs, dosing, etc, manage the timing of med administrations (not good to paralyze an awake patient!), decide when to administer the seizure, monitor the motor and EEG seizure activity (yes we read the EEG strip--we don't need to call a neuro consult!🙄), decide whether the treatment is adequate (aiming for a minimum of 30 sec EEG seizure activity), possibly administer a second or third seizure, supervise the patient's initial recovery, monitor and treat side effects (nausea, pain, agitation) in coordination with anesthesia, and document, document, document.

Inasmuch as it involves a "particular method for performing a task, a series of small tasks or step taken to accomplish an end", this does qualify as a "medical procedure", and it is billed for as such. No one will get rich doing ECT, but an RVU is an RVU...

thanks, good description 🙂