• Electroconvulsive therapy in the Republic of Ireland, 1982.

      Latey, R. H.; Fahy, T. J.; Regional Hospital Galway. University Department of Psychiatry.; Royal College of Psychiatrists. Irish Division. (Galway University Press, 1982)
      Electroconvulsive Therapy (ECT) is the induction of seizure activity in the brain by the passage of a small electric current between two electrodes placed on the scalp. The patient is invariably asleep under the influence of a rapidly acting anaesthetic agent. The epileptic convulsion or fit (which is an indication of satisfactory treatment effect) is modified to a series of muscular twitching by a muscle relaxant administered intravenously by the anaesthetist once the patient is asleep. The treatment procedure takes about five minutes with about an hour of sleep needed for complete recovery afterwards. The commonest indication for ECT is severe depressive illness or other serious mental disturbance where other treatments have failed or are unsuitable. A series of individual treatments. at intervals of one or more days, is commonly needed before relief of symptoms occurs. The treatment is widely acknowledged to be safe and has been in use for over forty years. With the introduction of effective antipsychotic and antidepressant drugs in the 1950s, ECT has been used less frequently and more selectively than in the past. However, there is little likelihood that ECT will be displaced by drugs or other treatments of comparable safety in the foreseeable future. Several recent studies of exceptional scientific rigour have helped to dispel residual doubts about the efficacy of ECT, although the details of the moile of action of the treatment are still not fully understood. . In recent years, ECT has attracted criticism from civil rights groups in the United States and more recently in the United Kingdom. Allegations were made of too frequent use of ECT, harmful consequences of the treatment and/or misuse of ECT to control anti-social behaviour tn detained patients. Public anxiety was not lessened by the impact ofthe popular film "One Flew Over the Cuckoo's Nest" which depicted ECT, unmodified by anaesthetics or muscle relaxants, as a barbaric and cruel treatment for the control of undesirable behaviour. Pressure from civil rights groups in Ihe U.S.A. finally led to a series of legal decisions which had the effect of prescribing the treatment or so restricting its use in certain States as to make it unavailable to patients. Anticipating similar developments on this side of the Atlantic, the Royal College of Psychiatrists commissioned a major survey by John Pippard and Les Ellam in 1981 of Electroconvulsive Treatment in Great Britain:Thls was the first such survey to include field visits to ECT clinics. These authors showed that ECT was used selectively in the United Kingdom but the authors found much to criticise in the way of obsolete equipment, poor facilities for patients, abdication of consultant responsibility (inexpert junior psychiatrists often administering the treatment) and sometimes scant regard for the privacy and feelings of patients. . The present survey was undertaken on behalf of the Irish Division of the Royal College of Psychiatrists. A major objective was to replicate (and possibly validate) the British findings and in the process to audit professional opinion and practice and to determine rates of ECT prescribing in this country. The methods used were broadly similar to those of the British survey. Rating scales andqueSlionnaires, in particular, were identical in the two studies. Thus, opinions of Irish psychiatrists were elicited by postal questionnaire, field visits were made to all ECT centres and clinics and a large sample of patients was documented prospectively over a three-month period by their psychiatrists. Statistics of ECT prescribing were collected and analysed in relation to national patterns of hospitalisation for mental illness. Finally, evidence was sought of any change in practice which might have taken place as an effect of the research.