Electroconvulsive therapy ECT and psychosurgery

Electroconvulsive therapy (ECT) was introduced by Cerletti in Italy in 1938. It involves production of a fit by passing an electric current through the brain. ECT today is carried out under a short general anaesthetic, and a muscle relaxant is given to reduce the intensity of the fit. Modern ECT machines deliver brief square-wave (not sine-wave) pulses of electricity and allow the 'dose' to be individually adjusted for the patient.

However, ECT has recently tended to arouse controversy. Some pressure groups have demanded a ban on its use. Most psychiatrists, however, while acknowledging and to some extent sharing these reservations, nevertheless consider it a highly effective treatment which they sometimes need to prescribe -albeit reluctantly - in certain severe mental illnesses. However, today, it seems to be needed much less frequently. I am responsible for a highly morbid and deprived catchment area, yet I have needed to prescribe it only twice in the last 3 years. Colleagues in elderly psychiatry prescribe it more frequently.

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