Tag Archives: Mania

Electro-Convulsive Therapy

Definition:
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.

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Electroconvulsive therapy (ECT), formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown. Today, ECT is most often recommended for use as a treatment for severe depression which has not responded to other treatment, and is also used in the treatment of mania and catatonia. It was first introduced in the 1938 and gained widespread use as a form of treatment in the 1940s and 1950s.

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Informed consent is a standard of modern electroconvulsive therapy. According to the Surgeon General, involuntary treatment is uncommon in the United States and is typically only used in cases of great extremity, and only when all other treatment options have been exhausted and the use of ECT is believed to be a potentially life saving treatment. However, caution must be exercised in interpreting this assertion as, in an American context, there does not appear to have been any attempt to survey at national level the usage of ECT as either an elective or involuntary procedure in almost twenty years. In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent

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Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy is usually continued, and some patients receive continuation/maintenance ECT. In the United Kingdom and Ireland, drug therapy is continued during ECT.

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The treatment involves placing electrodes on the temples, on one or both sides of the patient’s head, and delivering a small electrical current across the brain, with the patient sedated or under anaesthetic. The aim is to produce a seizure lasting up to a minute, after which the brain activity should return to normal. Patients may have one or more treatment a week, and perhaps more than a dozen treatments in total.

Although ECT has been used since the 1930s, there is still no generally accepted theory to explain how it works. One of the most popular ideas is that it causes an alteration in how the brain responds to chemical signals or neurotransmitters.

Why & when it is done?
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania.

ECT is used to treat:
*Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.

*Treatment-resistant depression, long-term depression that doesn’t improve with medications or other treatments.

*Schizophrenia, particularly when accompanied by psychosis, a desire to commit suicide or hurt someone else, or refusal to eat.

*Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision making, impulsive or risky behavior, substance abuse and psychosis.

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*Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and some other psychiatric disorders. In some cases, catatonia is caused by a medical illness.

Electroconvulsive therapy is sometimes used as a last-resort treatment for:

#Treatment-resistant obsessive compulsive disorder, severe obsessive compulsive disorder that doesn’t improve with medications or other treatments

#Parkinson’s disease, epilepsy, and certain other conditions that cause movement problems or seizures

*Tourette syndrome that doesn’t improve with medications or other treatments

ECT may be a good treatment option when medications aren’t tolerated or other forms of therapy haven’t worked. In some cases ECT is used:

#During pregnancy, when medications can’t be taken because they might harm the developing fetus

#In older adults who can’t tolerate drug side effects

#In people who prefer ECT treatments over taking medications

#When ECT has been successful in the past

Risk factor:
Patients are given short-acting anaesthetics, muscle relaxants and breathe pure oxygen during the short procedure in order to minimise the risks. However, although ECT is much safer than it was, there are still side effects to the treatment. The most common are headache, stiffness, confusion and temporary memory loss on awaking from the treatment – some of these can be reduced by placing electrodes only on one side of the head. Memory loss can be permanent in a few cases, and the spasms associated with the seizure can cause fractured vertebrae and tooth damage. However, the recommended use of muscle relaxant nowadays makes the latter a very rare occurrence. Patients can also experience numbness in the fingers and toes.

The death rate from ECT used to be quoted as one for every 1,000 patients, but with smaller amounts of electric current used in modern treatments, accompanied by more safety techniques, this has been reduced to as little as four or five in 100,000 patients.

Recomendations:
A common argument against ECT is that it destroys brain cells, with experiments conducted on animals in the 1940s often cited as evidence. However, modern studies have yet to reproduce these findings in the human brain.

Some activists, however, still campaign against the widespread use of ECT in psychiatry, quoting those cases which have resulted in long-term damage or even death, whether because of the built-in chance of problems, or through errors by doctors.

Experts say that given the correct staff training, and when used for the right clinical conditions, ECT can ‘dramatically’ benefit the patient. An audit of ECT in Scotland between February 1996 and August 1999 said concerns about unacceptable side effects, effectiveness of the treatment and disproportionate use on elderly people were ‘largely without foundation’.

It said that in nearly three quarters of cases people with depressive illness showed ‘a definite improvement’ after ECT. Women were more likely to receive the treatment than men, but the auditors said this was because they were twice as likely to suffer from depression. Only 12 per cent of patients who got ECT were aged over 75. However, the Royal College of Psychiatrists has admitted that in the past the treatment has been administered by untrained, unsupervised junior doctors. However, modern guidelines have changed this and ECTAS (ECT Accreditation Services) exist to check that such treatment is being given safely and efficiently.

Guidelines on ECT from NICE (2003) recommend that it’s used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment. options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with:

•Severe depressive illness
•Catatonia
•Prolonged or severe manic episode

NICE also says that ‘valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. The decision to use ECT should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion. This discussion should be enabled by the provision of full and appropriate information about the general risks associated with ECT and about the risks and potential benefits specific to that individual. Consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. There should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/or carers to facilitate informed discussion is strongly encouraged.’

 

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Video:Electroconvulsive therapy

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Harold A. Sackeim
Insulin shock therapy
History of electroconvulsive therapy in the United Kingdom
Psychiatric survivors movement
Consumer/Survivor/Ex-Patient Movement
List of people who have undergone electroconvulsive therapy

 

Resources:
http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129
http://www.bbc.co.uk/health/physical_health/conditions/electro_convulsive_therapy.shtml
http://en.wikipedia.org/wiki/Electroconvulsive_therapy

http://www.minddisorders.com/Del-Fi/Electroconvulsive-therapy.html

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Irritability ‘Key to Bipolar Disorder’

Parents, please note — want to know where your child is suffering from bipolar disorder? It’s simple for a study says that irritability should be considered when diagnosing for the condition.
………………irritable children
Researchers at Bradley Hospital in Providence have found that some kids with bipolar disorder experience manic episodes without extreme elation — one of the hallmarks of the disorder — and are diagnosed based on irritable mood.

“Diagnosing kids with bipolar disorder is challenging. One of the chief controversies is whether irritability should be included among the criteria for this diagnosis because it can also overlap with a number of other psychiatric disorders, such as attention deficit hyperactivity disorder.

“Our findings confirm that while irritable-only mania is uncommon, it does exist — particularly in younger children — and should be considered in a bipolar diagnosis,” Jeffrey Hunt, who led the study, said in a statement.

For their study, the researchers quantified frequency and severity of manic symptoms — including irritability and elation — in 361 children, all between the ages of 7 and 17, already diagnosed with bipolar disorder.

The researchers found 10% of children were irritable-only and about 15% were elated-only. Nearly three-quarters experienced both elation and irritability, the findings revealed.

The study has been published in the latest edition of the ‘Journal of the American Academy of Child and Adolescent Psychiatry‘.

Source:
BBC NEWS:28Th. June. ’09

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Bipolar Affective Disorder

About 1 in 100 people in the US has bipolar affective disorder, also known as manic depression. in this disorder, episodes of elation and abnormally high activity levels tend to alternate with episodes of low mood and abnormally low energy levels (depression). More than half of all people with bipolar affective disorder have repeated episodes. trigger factor for manic and depressive episodes are not generally known, although they are sometimes brought on in response to a major life-event, such as a marital breakup or bereavement. Bipolar affective disorder usually develops in the early 20s and can run in families, but exactly how it is inherited is not known.

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Symptoms?
Symptoms of mania and depression tend to alternate, each episodes of symptoms lasting an unpredictable length of time. between periods of mania and depression, mood and behavior are usually normal. however, a panic phase may occasionally be followed immediately by depression. sometimes, either depression or mania predominates to the extent that there is little evidence of a pattern of changing moods. Occasionally, symptoms of mania and depression are present during the same period.

The symptoms may include:

· Elated, expansive, or sometimes irritable mood.
· Inflated self-esteem, which may lead to delusions of great wealth, accomplishment, creativity, and power.
· Increased energy levels and decreased need for sleep.
·Distraction and poor concentration.
· Loss of social inhibitions.
· Unrestrained sexual behavior.
· Spending excessive sums of money on luxuries and vacations.

Speech may be difficult to follow because the person tends to speak rapidly and change topic frequently. At times, he or she may be aggressive or violent and may neglect diet and personal hygiene.

During an episode of depression, the main symptoms include:

· Feeling generally low.
· Loss of interest and enjoyment.
· Diminished energy level.
· Reduced self-esteem.
· Loss of hope for the future.

While severely depressed, an affected person may not care whether he or she lives or dies. About 1 in 10 people with bipolar disorder eventually attempts suicide.

In more severe cases of bipolar disorder, delusions of power during manic episodes may be made worse by hallucinations. When manic, the person may hear voices that are not there praising his or her qualities. In his or her depressive phase, these imaginary voices may describe a person’s inadequacies and failures. in such cases, the disorder may resemble schizophrenia.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

What might be done?
During a manic phase, people usually lack insight into their condition and may not know that they are ill. Often a relative or friend observes erratic behavior in a person close to him or her and seeks professional advice. A diagnosis of bipolar affective disorder is based on the full range of the person’s symptoms, and treatment will depend on whether the person is in a manic or a depressive phase. For the depressive phase, antidepressants are prescribed, but their affects have to be monitored to ensure that they do not precipitate a manic phase. during the first days or weeks of a manic phase, symptoms may be controlled by antipsychotic drugs.

Some people may need to be admitted to the secure environment of a hospital for assessment and treatment during a manic phase or a severe depressive phase. They may feel creative and energetic when manic and may be reluctant to accept long-term medication because it makes them feel “flat”.

Most people make a good recovery from manic-depressive episodes, but recurrences are common. for this reason, initial treatments for depression and mania may be gradually replaced with lithium, a drug that has to be taken continuously to prevent relapse. If lithium is not fully effective, other types of drugs, including certain anticonvulsant drugs, may be given. In severe cases in which the drugs have no effect, electroconvulsive therapy may be used to relieve symptoms by including a brief seizure in the brain under general anesthesia.

Once symptoms are under control, the person will need regular follow-ups to check for signs of mood changes. A form of psychotherapy can help the person come to terms with the disorder and reduce stress factors in his or her life that may contribute to it.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies

Resource:

http://www.athealth.com/Consumer/disorders/Bipolar_1.html

http://www.charak.com/DiseasePage.asp?thx=1&id=31

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