Cerletti had noted a shock to the head produced convulsions in dogs. It was believed early on that inducing convulsions aided in helping those with severe schizophrenia but later found to be most useful with affective disorders such as depression. Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his assistant Lucio Bini at Sapienza University of Rome developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1938, experimented for the first time on a person affected by delusions. The ECT procedure was first conducted in 1938 by Italian neuro-psychiatrist Ugo Cerletti and rapidly replaced less safe and effective forms of biological treatments in use at the time. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide. In 1937, the first international meeting on schizophrenia and convulsive therapy was held in Switzerland by the Swiss psychiatrist Max Müller. Meduna is thought to be the father of convulsive therapy. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol). Ĭonvulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. In the second half of the 19th century, such efforts were frequent enough in British asylums as to make it notable. Duchenne, the mid-19th century "Father of Electrotherapy", said its use was integral to a neurological practice. Benjamin Franklin wrote that an electrostatic machine cured "a woman of hysterical fits." By 1801, James Lind as well as Giovanni Aldini had used galvanism to treat patients with various mental disorders. Treatment and cure of hysterical blindness was documented eleven years later. As to its earliest antecedents one doctor claims 1744 as the dawn of electricity's therapeutic use, as documented in the first issue of Electricity and Medicine. In 1785, the therapeutic use of seizure induction was documented in the London Medical and Surgical Journal. History and neuroscientific basis įurther information: History of electroconvulsive therapy in the United Kingdom and History of electroconvulsive therapy in the United StatesĪs early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. High-dose unilateral ECT has some cognitive advantages compared to moderate-dose bilateral ECT while showing no difference in antidepressant efficacy. Placement can be bilateral, where the electric current is passed from one side of the brain to the other, or unilateral, in which the current is solely passed across one hemisphere of the brain. These treatment parameters can pose significant differences in both adverse side effects and symptom remission in the treated patient. ECT can differ in its application in three ways: electrode placement, treatment frequency, and the electrical waveform of the stimulus. ECT is administered under anesthesia with a muscle relaxant. The usual course of ECT involves multiple administrations, typically given two or three times per week until the patient no longer has symptoms. ĮCT is often used as an intervention for major depressive disorder, mania, and catatonia. Among treatments for severely depressed pregnant women, ECT is one of the least harmful to the fetus. : 259 Immediately following treatment, the most common adverse effects are confusion and transient memory loss. Īside from effects on the brain, the general physical risks of ECT are similar to those of brief general anesthesia. However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT). Electroconvulsive therapy ( ECT) is a psychiatric treatment where a generalized seizure (without muscular convulsions) is electrically induced to manage refractory mental disorders.
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