Electro-convulsive Therapy (ECT)
ECT is a process by which an electric current is passed between two sclap electrodes to create seizures.
The patient will be given an anasthetic and muscle relaxents to prevent fractures.
A 70-150 volt shock is administered for 0.04-1 second 3 times a week for up to 4 weeks.
This treatment was developed as there was reports that schizophrenia was rare in patients with epilspsy and so this led to the belief that seizures could reduce the symptoms of schizophrenia.
Cerletti and Bini (1938) developed ECT based on this theory.
Risks of ECT
One risk is the use of general anasthetic. The mortality rate for ECT is quite low (about 5 per 100,000) a level comparable with deaths from anaesthesia alone.
Also physical risks like broken bones. However patients are given a nerve blocking agent to paralyse the muscles.
Bennet (2003)- patients found the procedure terrifying and despite being denied by the Royal College of Psychiatrists (1997) it can also affect a persons memory and intelligence.
A punishment for behaviour
We are not clear on how ECT works.
Benton (1981)- suggested that patients see ECT as a punishment for their behaviour and so via operant conditioning the behaviour is extinguished.
He also suggested that memory loss allows the restructuring of the patients view of life. However unilateral ECT causes memory loss and is also effective.
Lilienfield (1995)- suggested that the neurotransmitters noradrenalin and endorphins are particularily stimulated during ECT, which might explain why it works.
Effectiveness of ECT
To see the effectiveness we could compare ECT to a control group who recieve a placebo.
Tharyan and Adams (2005)- carried out a review of 26 studies and found that when ECT was compared with placebo ECT, more people improved in the read ECT condition.
ECT ignores the role of psychological factors in schizophrenia as it only treats the symtoms.
It also ignores the social and family situation of the patient.
Ethical issues of ECT
We don't know how ECT works so should we really be using it on patients?
Could somone with schizophrenia fully understand and consent to it's use?
ECT has been accused of being used as a method of control.
However, it's use on schizophrenia has been reduced over the last few decades and is now more commonly used to treat depression.
Cognitive Behavioural Therapy (CBT)
An alternative treatment is the psychological treatment of CBT.
The aim of CBT is to challenge maladaptive negative thoughts and replace them with more constructive thinking that will lead to healthy behaviour.
People with schizophrenia are often unaware that they have problems with their thinking and so a therapist will help to make the maladaptive thoughts conscious.
CBT draws on the cognitive and behavioural fields of psychology and so alters a patients way of thinking and learning.
Found beneifits in terms of reduction of positive symtoms and a 25-50% reduction in recovery time with patients given a combination of antipsychotic medication and CBT suggesting greater effects when the two are combined.
Problems of CBT
Due to CBT being conducted alongside antipsychotic drugs we have problems in seeing how effective ECT is (Kulpers 1997)
CBT may also not be suitable for everyone because Kirschen (2006) found that many patients would not engage in the therapy, particularily the older ones.
In regards to using CBT in patients who hear voices...
Frith (1992)- these voices are actually the persons inner speech being misinterpreted and so CBT helps the patient recognise the voices as their own.
Effectiveness of CBT
Bentall et al (1994)- emphasis is on controlling the thought process rather than uderstanding the unconscious thoughts and feelings behind them.This is a limiting factor in CBT as focus is on symtoms rather than a cure (treatment aetiology fallacy).
Like ECT, CBT ignores the role of family and society in both the cause and the maintenance of schizophrenia, it also ignores biological and physiological causes.
Bentall et al- ECT is most effective for patients experiencing their first episode of schiophrenia as it offers an explanation for the existance of hallucination and delusions which can also help reduce anxiety.
CBT usually has to take place weekly and can last for months and so is costly and time consuming when compared to ECT.