Electroconvulsive Therapy in a Rural Teaching General Hospital in India

Shukla, G D

doi:10.1192/bjp.139.6.569

Cited by 17 publications

(9 citation statements)

References 5 publications

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“…The methodological failings were not limited to failure to compare to a SECT group. In a British Journal of Psychiatry study, claiming that the proportions showing some improvement were 100% for depression and 98% for schizophrenia, the description of how improvement was measured was: "A record was kept of progress" (Shukla, 1981). A survey for the British Royal College of Psychiatrists simply gathered psychiatrists' opinions about improvement (Pippard & Ellam, 1981).…”

Section: Does Ect Work?mentioning

confidence: 99%

The effectiveness of electroconvulsive therapy: A literature review

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Bentall²

2010

Epidemiol Psychiatr Sci

105

113

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SUMMARYAim – To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.Declaration of Interest: Neither author has any financial conflicts of interest in relation to this paper.

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Section: Does Ect Work?mentioning

confidence: 99%

The effectiveness of electroconvulsive therapy: A literature review

Read

Bentall²

2010

Epidemiol Psychiatr Sci

105

113

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“…17,25,35 Havens 17 reports that, in his randomized prospective study referenced earlier, more than half of the patients who underwent unmodified ECT showed recovery-room restlessness, whereas only 5% to 9% of those receiving modified ECT experienced the same. 17,25,35 Havens 17 reports that, in his randomized prospective study referenced earlier, more than half of the patients who underwent unmodified ECT showed recovery-room restlessness, whereas only 5% to 9% of those receiving modified ECT experienced the same.…”

Section: Post-ect Confusion and Agitationmentioning

confidence: 99%

“…However, other potential contributing factors such as electrode placement 36 and pretreatment clinical features 37 were not reported in this study. A review by Shukla, 35 an Indian ECT practitioner, describes severe post-ECT confusion and excitement occurring much more often after unmodified treatment, although data are not provided. Three patients in the Havens study receiving unmodified treatment experienced ''organic-psychotic'' symptoms during the course of ECT consisting of disorientation, psychomotor excitation, delusions, and hallucinations, whereas none in the modified group experienced these symptoms.…”

Section: Post-ect Confusion and Agitationmentioning

confidence: 99%

Decreasing Adverse Outcomes of Unmodified Electroconvulsive Therapy

Gallegos¹,

Vaidya²,

D’Agati³

et al. 2012

The Journal of ECT

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Electroconvulsive therapy (ECT) is far and away the most effective treatment for depression and quite effective for a range of other psychiatric conditions that are unresponsive to medication. Electroconvulsive therapy in the developed world has been administered with anesthesia, muscle relaxants, and ventilation since the mid-1950s following 20 years of unmodified treatment. However, in much of the developing world, ECT continues to be administered unmodified because of lack of resources. We review the efficacy of unmodified compared with modified treatment. We also review the potential drawbacks of unmodified treatment including fear and anxiety, worse postictal confusion, fracture risk, and the negative effects of unmodified treatment on how ECT is perceived in the general community. Finally, we consider potential solutions in developing countries to minimize adverse outcomes of unmodified treatment by pretreating patients either with low-dose benzodiazepines or sedating, but not anesthetizing, dosages of anesthetic agents. Randomized controlled trials are necessary before either of these options could be considered an acceptable alternative to completely unmodified treatment when modified treatment is unavailable.

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“…The situation in non‐Western countries is difficult to assess because of the lack of statistics. However, the information available indicates that, in developing countries like India and Nigeria, the percentage of psychiatric patients receiving ECT has, for several years, been even higher than those in Western countries (Odejide, 1980; Ihezue and Ebigbo, 1981; Shukla, 1981; Saju and Jacob, 1993), that while ECT use was on the decline in the West it was on the increase in India (Vahia et al. , 1974), and that this trend is probably also continuing (see, for example, Saju and Jacob, 1993).…”

Section: The Side‐effects and Theory Of Ectmentioning

confidence: 99%

Electroconvulsive Therapy and the Fear of Deviance

Giles¹

2002

J Theory Soc Behav

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After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior.

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Electroconvulsive Therapy in a Rural Teaching General Hospital in India

Cited by 17 publications

References 5 publications

The effectiveness of electroconvulsive therapy: A literature review

The effectiveness of electroconvulsive therapy: A literature review

Decreasing Adverse Outcomes of Unmodified Electroconvulsive Therapy

Electroconvulsive Therapy and the Fear of Deviance

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