ECT

[edie1]

Any comments / opinions on this once very controversial topic. Personal experience would be great to hear ie success, patient experience, etc. I hope to work as a psychiatric nurse and I am not sure how to feel about this treatment.

[Callisonanne]

I would also encourage you to talk to your local ECT provider and see if they would allow you to follow a patient through the treatment. When you get to see it you will say "oh....that's all it is."

[JustKeepDriving]

This might come off as a semi rant, but here it goes:

Psychiatry and the mental health field are seriously misjudged by many people. I understand that it has a shady past - but you have to realize that the interventions we have available to us today are still rather new and that the first antipsychotic didn't show up on the scene until the 1950's. In many ways we are still very much a fledgling field of medicine and there is so much that we still do not understand.

Take psychosurgery. People look at it and thing "what a terrible thing to do to someone." While I agree, you also have to understand that at the time when psychosurgery was popular we didn't have the chemical interventions that we do today. Our mental facilities were overcrowded, and we honestly thought we were helping people. It's hard to understand unless you work with the persistently mentally ill. Even today with all the interventions we have available I still get that patient that doesn't respond to any medication. Period.

Think of it like the full code/full care patient that use to be a fully productive member of society and now just lies there vented unable to provide even the most basic care for themselves. As a nurse we feel for these people, we put all our effort and care into them knowing that their life is totally miserable and wondering if they wouldn't just be better off in hospice care.

The persistently mentally ill are like that, only sometimes even worse. We have a patient who is so persistently paranoid that everyday he will smear himself down with feces and attack us, he refuses to eat because he thinks we are poisoning him and he self harms by head banging and says he just wants to die. We have tried everything. Every medication and every intervention.

His life will continue like this... forever.

I've watched him get injured multiple times during attacks on staff and self harming episodes. I've watched my staff - who really do have empathy for him - get put out of work for months because he has seriously injured them.

He is in so much mental turmoil and pain.

I imagine that was what it was like back in the day. You have all these patients that are seriously mentally ill, where you have absolutely no interventions available to you. There were no antipsychotics. When psychosurgery came out it really was a revolutionary procedure. We didn't know that much about the brain or the interrelationship between neuroanatomy and behavior - but it was at least something that seemed to work.

Like many things in medicine - early pregnancy inductions, T & A's, joint replacements ect. - psychosurgery and ECT became overused and utilized for the wrong reasons. Like they say, the road to hell is paved with good intentions (and some greed).

Surgeons aren't still demonized today because they caused a mass amount of infections back in the day because hand hygiene and sterilization were unknown. Obstetricians use to prescribe DES to women to prevent adverse pregnancy outcomes - they aren't seen as "bad" even though today we know that there is a clear link between exposure to DES in utero and adenocarcinoma in girls and women.

Things in medicine have changed, in both psychiatry and the general medical field. Patients have to consent to procedures, we can't just decide to medicate someone (involuntary medication is a difficult process that requires judicial oversight), and patients have the right to refuse treatment.

We still do psychosurgery today. It's not going through the eye socket anymore but using electrocautery on portions of the brain - generally utilized for individuals with debilitating OCD that does not respond to any other intervention.

ECT is still used and I've seen great results. You know that schizophrenic patient? His conservator consented to ECT and for the first time since he arrived at the hospital 10 years ago he was able to leave his room, socialize with peers and attend a yoga class. It was remarkable.

ECT is like hitting a "reset" button on the brain. We don't know exactly how it works and it has better efficacy for some vs. others. The results can be remarkable.

Sadly, the state overturned the conservators consent and stated that our patient could no longer attend ECT treatments. He has since decompensated and has returned to being that terrified old man. We were all terribly sad for him.

I'm going to get off my soapbox now because at this point I've written way more than I planned to but seriously, I feel like psychiatry - the physicians, nurses, patients ect - are judged way more harshly than other medical fields. We fight to overcome a stigma and in some cases have gone so far in the other direction due to our hands being tied by our history that we are limited in our options and what we can do for our patients.

[JonathanClouse]

Well finally got a green light to wear some protection. It can be pretty embarrassing waking up from the procedure to find that you accidentally crapped or peed all over yourself, your gown, and the gurney....despite hitting the restroom pre-procedure!