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Electroshock: healing mental illness
- Author:
- FINK Max
- Publisher:
- Oxford University Press
- Publication year:
- 1999
- Pagination:
- 157p.,bibliog.
- Place of publication:
- Oxford
Psychiatrists unfamiliar with electroconvulsive treatment may be embarrassed to discover that concern about its risk is greatly exaggerated and that relapse after electroconvulsive treatment indicates a need for maintenance treatment, not a lack of efficacy. Even authorities on drug treatment are puzzled by the broad spectrum of efficacy of electroconvulsive treatment. For example, all antidepressants can cause mania, but only electroconvulsive treatment can treat it, and no antidepressant drug has been shown to be as effective as electroconvulsive treatment for treating schizophrenia. In bipolar disorder, electroconvulsive treatment is often effective when mood stabilizers fail. In treating catatonic states for which benzodiazepines are the best drug treatment, electroconvulsive treatment succeeds when these drugs fail. These findings do not fit with any data from the neurosciences on receptor mechanisms or second and third messengers. After briefly defining electroconvulsive treatment and outlining its uses, the author discusses the patient's experience. He then describes the risks and technical features of the treatment and the contraindications to it. There are chapters on each of the principal indications for electroconvulsive treatment: depression, mania, thought disorders, and movement disorders, which include catatonic states and parkinsonian rigidity. There is some speculation about the mechanism of action (which is unknown), a brief account of the fascinating origins of electroconvulsive treatment, and considerable discussion of how electroconvulsive treatment became controversial. Each of the clinical chapters contains detailed case reports, and some chapters also contain autobiographical accounts from the popular literature. These profiles reiterate the benefits of the treatment, the often tragic consequences of withholding it or using it inappropriately without consideration of the need for maintenance treatment, and the minimal medical risks and cognitive side effects with current practice. The discussion of informed consent for use in minors and incompetent patients is exemplary. Despite intensive pharmaceutical research, it now appears that the benefits of the new drugs for depression and schizophrenia are mostly decreased side effects and improved compliance; there is little increased efficacy in refractory conditions, which underscores the need for a trial of electroconvulsive treatment. Although new agents for bipolar disorder are more promising, the need for electroconvulsive treatment to treat refractory conditions remains.
An empirical model of therapeutic process for psychiatric emergency room clients with dual disorders
- Authors:
- LONECK Barry, et al
- Journal article citation:
- Social Work Research, 26(3), September 2002, pp.132-144.
- Publisher:
- Oxford University Press
Many individuals with dual disorders of mental illness and substance abuse enter the mental health system through psychiatric emergency rooms (PER's) but may resist treatment and not follow through with referrals to services. This article examines the impact of therapeutic process on referral outcome. Outcome was successful if clients attended all referral appointments. The authors found that therapist warmth and friendliness had a positive association with working alliance, which, in turn, was associated with successful referral. Paradoxically, there was a negative relationship between warmth and friendliness and success. Analysis demonstrated that, for a given level of warmth and friendliness, there must be a correspondingly higher level of working alliance to be associated with success.
Sex offenders in high-security care in Scotland
- Authors:
- BAKER Melanie, WHITE Tom
- Journal article citation:
- Journal of Forensic Psychiatry, 13(2), September 2002, pp.285-295.
- Publisher:
- Routledge
This article examines the characteristics of 53 sex offenders detained in maximum security at the State Hospital, Carstairs, in Scotland. Patients were categorized by diagnosis and four main groups were found: mental handicap, mental illness, mental illness with co-morbid personality disorder and personality disorder alone. As a whole, the patients had experienced multiple areas of deprivation and many had been subject to sexual abuse themselves. Our findings are consonant with other work in this area in noting the importance of deviant fantasy and positive psychotic symptoms. Detailed assessment of mentally disordered sex offenders is recommended, with consequent treatment including pharmacotherapy and a modified cognitive behavioural approach.