Gazdag Gábor, Ungvari Gabor S
First Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary.
University of Notre Dame, Fremantle, WA 6009, Australia.
World J Psychiatry. 2019 Jan 4;9(1):1-6. doi: 10.5498/wjp.v9.i1.1.
Electroconvulsive therapy (ECT), which is among the oldest and most controversial treatments in the field of psychiatry, has its 80 birthday this year. In this brief historical overview, the discovery of the therapeutic effects of convulsive therapy by Laszló Meduna, and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described. Meduna's original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT. The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications, including catatonia, and pre- and postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving. Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed. The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys. This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT, which constitutes a violation of psychiatric patients' right to an effective treatment.
电休克疗法(ECT)是精神病学领域最古老且最具争议的治疗方法之一,今年迎来了它的80岁生日。在这篇简短的历史概述中,描述了拉斯洛·梅杜纳发现惊厥疗法的治疗效果,以及促使乌戈·切莱蒂和卢西奥·比尼用电作为诱发癫痫发作手段的情况。梅杜纳关于癫痫与精神分裂症拮抗作用的原始理论已被关于ECT作用机制的假说所取代。还讨论了ECT在现代精神病学中的地位,特别关注其最重要的临床适应症,包括紧张症,以及对ECT有反应且ECT甚至可能挽救生命的产前、产后情感和精神状态。还回顾了ECT的不良反应以及与最近开发的脑刺激方法的比较。媒体对ECT的负面描述及其早期的滥用可能导致了态度调查中反复表明的对其负面的专业和公众认知。这种负面态度在发达国家ECT使用的减少以及ECT可及性的降低中起到了重要作用,而这侵犯了精神病患者获得有效治疗的权利。