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Quatermass II is a British science-fiction serial, originally broadcast by BBC Television in 1955. It is the second in the Quatermass series by writer Nigel Kneale, and the first of those serials to survive in its entirety in the BBC archives. It is also the earliest surviving complete British science-fiction television production. The serial sees Professor Bernard Quatermass of the British Experimental Rocket Group being asked to examine strange meteorite showers. His investigations lead to his uncovering a conspiracy involving alien infiltration at the highest levels of the British Government. As some of Quatermass's closest colleagues fall victim to the alien influence, he is forced to use his own unsafe rocket prototype, which recently caused a nuclear disaster at an Australian testing range, to prevent the aliens from taking over mankind. Although sometimes compared unfavourably to the first and third Quatermass serials, Quatermass II was praised for its allegorical concerns of the damaging effects of industrialisation and the corruption of governments by big business. It is described on the British Film Institute's "Screenonline" website as "compulsive viewing." (Full article...) Recently featured: Battle of the Nile – Sega v. Accolade – Bart King

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Mona Lisa (La Joconde) is a half-length portrait of a woman by Leonardo da Vinci which was probably completed between 1503 and 1506, with further refinement continuing until 1517. Though the painting is thought to be of Lisa del Giocondo, a lack of definitive evidence has long fueled alternative theories as to the sitter's identity, including that it may represent Leonardo's mother Caterina in a distant memory. It has been held in the Louvre in Paris since 1797 and is acclaimed as "the best known, the most visited, the most written about, the most sung about, the most parodied work of art in the world." Painting: Leonardo da Vinci

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Bioelectromagnetics Bioelectromagnetics, also known as bioelectromagnetism, is the study of the interaction between electromagnetic fields and biological entities. Areas of study include electrical or electromagnetic fields produced by living cells, tissues or organisms; for example, the cell membrane potential and the electric currents that flow in nerves and muscles, as a result of action potentials. Others include animal navigation utilizing the geomagnetic field; potential effects of man-made sources of electromagnetic fields like mobile phones; and developing new therapies to treat various conditions. The term can also refer to the ability of living cells, tissues, and organisms to produce electrical fields and the response of cells to electromagnetic fields.

Biological phenomena Short-lived electrical events called action potentials occur in several types of animal cells which are called excitable cells, a category of cell include neurons, muscle cells, and endocrine cells, as well as in some plant cells. These action potentials are used to facilitate inter-cellular communication and activate intracellular processes. The physiological phenomena of action potentials are possible because voltage-gated ion channels allow the resting potential caused by electrochemical gradient on either side of a cell membrane to resolve.

Bioelectromagnetism is studied primarily through the techniques of electrophysiology. In the late eighteenth century, the Italian physician and physicist Luigi Galvani first recorded the phenomenon while dissecting a frog at a table where he had been conducting experiments with static electricity. Galvani coined the term animal electricity to describe the phenomenon, while contemporaries labeled it galvanism. Galvani and contemporaries regarded muscle activation as resulting from an electrical fluid or substance in the nerves. Some usually aquatic animals have acute bioelectric sensors providing a sense known as electroreception while migratory birds navigate in part by orienteering with respect to the Earth's magnetic field. In an extreme application of electromagnetism the electric eel is able to generate a large electric field outside its body used for hunting and self defense through a dedicated electric organ.

Thermal effects Most of the molecules in the human body interact weakly with electromagnetic fields in the radiofrequency or extremely low frequency bands.[citation needed] One such interaction is absorption of energy from the fields, which can cause tissue to heat up; more intense fields will produce greater heating. This can lead to biological effects ranging from muscle relaxation (as produced by a diathermy device) to burns.Many nations and regulatory bodies like the International Commission on Non-Ionizing Radiation Protection have established safety guidelines to limit EMF exposure to a non-thermal level. This can be defined as either heating only to the point where the excess heat can be dissipated, or as a fixed increase in temperature not detectable with current instruments like 0.1°C. [citation needed] However, biological effects have been shown to be present for these non-thermal exposures;[citation needed] Various mechanisms have been proposed to explain these,1 and there may be several mechanisms underlying the differing phenomena observed. Biological effects of weak electromagnetic fields are the subject of study in magnetobiology.[citation needed]

Behavioral effects Many behavioral effects at different intensities have been reported from exposure to magnetic fields, particularly with pulsed magnetic fields. The specific pulseform used appears to be an important factor for the behavioural effect seen; for example, a pulsed magnetic field originally designed for spectroscopic MRI was found to alleviate symptoms in bipolar patients, while another MRI pulse had no effect. A whole-body exposure to a pulsed magnetic field was found to alter standing balance and pain perception in other studies.

1Binhi, 2002

TMS and related effects A strong changing magnetic field can induce electrical currents in conductive tissue such as the brain. Since the magnetic field penetrates tissue, it can be generated outside of the head to induce currents within, causing transcranial magnetic stimulation (TMS). These currents depolarize neurons in a selected part of the brain, leading to changes in the patterns of neural activity. In repeated pulse TMS therapy or rTMS, the presence of incompatible EEG electrodes can result in electrode heating and, in severe cases, skin burns. A number of scientists and clinicians are attempting to use TMS to replace electroconvulsive therapy (ECT) to treat disorders such as severe depression. Instead of one strong electric shock through the head as in ECT, a large number of relatively weak pulses are delivered in TMS therapy, typically at the rate of about 10 pulses per second. If very strong pulses at a rapid rate are delivered to the brain, the induced currents can cause convulsions much like in the original electroconvulsive therapy. Sometimes, this is done deliberately in order to treat depression, such as in ECT.

Health effects of artificial electromagnetic fields and current use in medical therapy While health effects from extremely low frequency (ELF) electric and magnetic fields (0 to 300 Hz) generated by power lines, and radio/microwave frequencies (RF) (10 MHz - 300 GHz) emitted by radio antennas and wireless networks have been well studied, the intermediate range (IR) used increasingly in modern telecommunications (300 Hz to 10 MHz) has been studied far less. Direct effects of electromagnetism on human health have been difficult to prove, and documented life threatening interferences from electromagnetic fields are limited to medical devices such as pacemakers and other electronic implants.2 However, a number of studies have been conducted with artificial magnetic fields and electric fields to investigate for example their effects on cell metabolism, apoptosis and tumor growth.3 Electromagnetic radiation in the intermediate frequency range has found a place in modern medical practice for the treatment of bone healing and for nerve stimulation and regeneration; it is now also approved as a novel cancer therapy in form of Tumor Treating Fields, which are alternating electric fields in the frequency range of 100–300 kHz. Since some of these methods involve magnetic fields that invoke electric currents in biological tissues and others only involve electric fields, they are strictly speaking electrotherapies albeit their application modi with modern electronic equipment have placed them in the category of bioelectromagnetic interactions. 2Electromagnetic fields & public health: Intermediate Frequencies (IF). Information sheet February 2005. World Health Organization. Retrieved Aug 2013. 3Wartenberg, M., Wirtz, N., Grob, A., Niedermeier, W., Hescheler, J., Peters, S. C. and Sauer, H. (2008), "Direct current electrical fields induce apoptosis in oral mucosa cancer cells by NADPH oxidase-derived reactive oxygen species". Bioelectromagnetics, 29: 47–54. doi: 10.1002/bem.20361

References Organizations •The Bioelectromagnetics Society (BEMS) •European BioElectomagnetics Association (EBEA) •Society for Physical Regulation in Biology and Medicine (SPRBM) (formerly the Bioelectrical Repair and Growth Society, BRAGS) •International Society for Bioelectromagnetism (ISBEM) •The Bioelectromagnetics Lab at University College Cork, Ireland •Institute of Bioelectromagnetism •Vanderbilt University, Living State Physics Group, archived page •Ragnar Granit Institute. •Institute of Photonics and Electronics AS CR, Department of Bioelectrodynamics.

Books •Becker, Robert O.; Andrew A. Marino, Electromagnetism and Life, State University of New York Press, Albany, 1982. ISBN 0-87395-561-7. •Becker, Robert O.; The Body Electric: Electromagnetism and the Foundation of Life, William Morrow & Co, 1985. ISBN 0-688-00123-8. •Becker, Robert O.; Cross Currents: The Promise of Electromedicine, the Perils of Electropollution, Tarcher, 1989. ISBN 0-87477-536-1. •Binhi, V.N., Magnetobiology: Underlying Physical Problems. San Diego: Academic Press, 2002. ISBN 0-12-100071-0. •Brodeur Paul; Currents of Death, Simon & Schuster, 2000. ISBN 0-7432-1308-4. •Carpenter, David O.; Sinerik Ayrapetyan, Biological Effects of Electric and Magnetic Fields, Volume 1 : Sources and Mechanisms, Academic Press, 1994. ISBN 0-12-160261-3. •Carpenter, David O.; Sinerik Ayrapetyan, Biological Effects of Electric and Magnetic Fields : Beneficial and Harmful Effects (Vol 2), Academic Press, 1994. ISBN 0-12-160261-3. •Chiabrera A. (Editor), Interactions Between Electromagnetic Fields and Cells, Springer, 1985. ISBN 0-306-42083-X. •Habash, Riadh W. Y.; Electromagnetic Fields and Radiation: Human Bioeffects and Safety, Marcel Dekker, 2001. ISBN 0-8247-0677-3.

•Horton William F.; Saul Goldberg, Power Frequency Magnetic Fields and Public Health, CRC Press, 1995. ISBN 0-8493-9420-1. •Mae-Wan, Ho; et al., Bioelectrodynamics and Biocommunication, World Scientific, 1994. ISBN 981-02-1665-3. •Malmivuo, Jaakko; Robert Plonsey, Bioelectromagnetism: Principles and Applications of Bioelectric and Biomagnetic Fields, Oxford University Press, 1995. ISBN 0-19-505823-2. •O'Connor, Mary E. (Editor), et al., Emerging Electromagnetic Medicine, Springer, 1990. ISBN 0-387-97224-2.

Journals •Bioelectromagnetics, Wiley, 1985–present, (ISSN 0197-8462) •Bioelectrochemistry, Elsevier, 1974–present, (ISSN 1567-5394) •International Journal of Bioelectromagnetism, ISBEM, 1999–present, (ISSN 1456-7865) •BioMagnetic Research and Technology archive (no longer publishing) •Biophysics, English version of the Russian "Biofizika" (ISSN 0006-3509) •Radiatsionnaya Bioliogiya Radioecologia ("Radiation Biology and Radioecology", in Russian) (ISSN:0869-8031)

External links •A brief history of Bioelectromagnetism, by Jaakko and Plonsey. •Direct and Inverse Bioelectric Field Problems •Human body meshes for MATLAB, Ansoft/ANSYS HFSS, Octave (surface meshes from real subjects, meshes for Visible Human Project)

Magnetobiology Magnetobiology is the study of biological effects of mainly weak static and lowfrequency magnetic fields, which do not cause heating of tissues. Magnetobiological effects have unique features that obviously distinguish them from thermal effects; often they are observed for alternating magnetic fields just in separate frequency and amplitude intervals. Also, they are dependent of simultaneously present static magnetic or electric fields and their polarization. Magnetobiology is a subset of bioelectromagnetics. Bioelectromagnetism and biomagnetism are the study of the production of electromagnetic and magnetic fields by biological organisms. The sensing of magnetic fields by organisms is known as magnetoreception.

Biological effects of weak low frequency magnetic fields, less than about 0.1 millitesla (or 1 Gauss) and 100 Hz correspondingly, constitutes a physics problem. The effects look paradoxical, for the energy quantum of these electromagnetic fields is by many orders of value less than the energy scale of an elementary chemical act. On the other hand, the field intensity is not enough to cause any appreciable heating of biological tissues or irritate nerves by the induced electric currents. An example of magnetobiological effects is the magnetic navigation by migrant animals. It is established that some animals are able to detect small variations of the geomagnetic field on the order of tens of nanoteslas to find their seasonal habitats.

Reproducibility The results of magnetobiological experiments are poorly reproducible. 10–20% of publications report failed attempts to observe magnetobiological effects. In the majority of experiments, success depended on a rare happy coincidence of suitable electromagnetic and physiological conditions. Many of the experiments await confirmation by independent studies.

Safety standards Practical significance of magnetobiology is conditioned by the growing level of the background electromagnetic exposure of people. Some electromagnetic fields at chronic exposures may pose a threat to human health. World Health Organization considers enhanced level of electromagnetic exposure at working places as a stress factor. Present electromagnetic safety standards, worked out by many national and international institutions, differ by tens and hundreds of times for certain EMF ranges; this situation reflects the lack of research in the area of magnetobiology and electromagnetobiology. Today, the most of the standards take into account biological effects just from heating by electromagnetic fields, and peripheral nerve stimulation from induced currents.

Medical approach Practitioners of magnet therapy attempt to treat pain or other medical conditions by relatively weak electromagnetic fields. These methods have not yet received clinical evidence in accordance with accepted standards of evidence-based medicine. Some institutions recognize the practice as a pseudoscientific one. Other institutions, such as NASA, use magnet technology for biological regenerative effects of bone in mammals.

Possible causes of the effects In magnetobiology, theory is lagging far behind experiment. The nature of biological effects of weak electromagnetic fields remains unclear as yet, despite numerous experimental data. The following suggested causes of magnetobiological phenomena are frequently discussed: 1. Crystallization of iron-bearing magnetic nanoparticles in tissues of the organism, 2. Dependence of some biochemical free-radical reactions on the magnetic field magnitude, 3. Possible existence of long-lived rotational states of some molecules inside protein structures, 4. Magnetically induced changes in physical/chemical properties of liquid water. Explanation of the physical nature of biological effects of weak magnetic fields is a fundamental scientific problem.

Profile scientific journals •Bioelectromagnetics •Electromagnetic Biology and Medicine •Biomedical Radioelectronics •Biophysics

Further reading •Presman A.S. Electromagnetic Fields and Life, Plenum, New York, 1970. •Kirschvink J.L., Jones D.S., MacFadden B.J. (Eds.) Magnetite Biomineralization and Magnetoreception in Organisms. A New Biomagnetism, Plenum, New York, 1985. •Binhi V.N. Magnetobiology: Underlying Physical Problems. — Academic Press, San Diego, 2002. — 473 p. — ISBN 0-12-100071-0 •Binhi V.N., Savin A.V. Effects of weak magnetic fields on biological systems: Physical aspects. Physics – Uspekhi, V.46(3), Pp.259–291, 2003.

Biophysics Biophysics is an interdisciplinary science using methods of, and theories from, physics to study biological systems.4 Biophysics spans all levels of biological organization, from the molecular scale to whole organisms and ecosystems. Biophysical research shares significant overlap with biochemistry, nanotechnology, bioengineering, agrophysics, and systems biology. It has been suggested as a bridge between biology and physics.

Overview Molecular biophysics typically addresses biological questions similar to those in biochemistry and molecular biology, but more quantitatively. Scientists in this field conduct research concerned with understanding the interactions between the various systems of a cell, including the interactions between DNA, RNA and protein biosynthesis, as well as how these interactions are regulated. A great variety of techniques is used to answer these questions. Fluorescent imaging techniques, as well as electron microscopy, x-ray crystallography, NMR spectroscopy and atomic force microscopy (AFM) are often used to visualize structures of biological significance. Conformational change in structure can be measured using techniques such as dual polarisation interferometry and circular dichroism. Direct manipulation of molecules using optical tweezers or AFM can also be used to monitor biological events where forces and distances are at the nanoscale. Molecular biophysicists often consider complex biological events as systems of interacting units which can be understood through statistical mechanics, thermodynamics and chemical kinetics. By drawing knowledge and experimental techniques from a wide variety of disciplines, biophysicists are often able to directly observe, model or even manipulate the structures and interactions of individual molecules or complexes of molecules. In addition to traditional (i.e. molecular and cellular) biophysical topics like structural biology or enzyme kinetics, modern biophysics encompasses an extraordinarily broad range of research, from bioelectronics to quantum biology involving both experimental and theoretical tools. It is becoming increasingly common for biophysicists to apply the models and experimental techniques derived from physics, as well as mathematics and statistics (see biomathematics), to larger systems such as tissues, organs (e.g. see cardiophysics), populations and ecosystems. Biophysics is now used extensively in the study of electrical conduction in single neurons, as well as neural circuit analysis in both tissue and whole brain.

4Careers in Biophysics brochure, Biophysical Society

Focus as a subfield Generally, biophysics does not have university-level departments of its own, but has presence as groups across departments within the fields of molecular biology, biochemistry, chemistry, computer science, mathematics, medicine, pharmacology, physiology, physics, and neuroscience. What follows is a list of examples of how each department applies its efforts toward the study of biophysics. This list is hardly all inclusive. Nor does each subject of study belong exclusively to any particular department. Each academic institution makes its own rules and there is much overlap between departments. •Biology and molecular biology - Almost all forms of biophysics efforts are included in some biology department somewhere. To include some: gene regulation, single protein dynamics, bioenergetics, patch clamping, biomechanics. •Structural biology - Ångstrom-resolution structures of proteins, nucleic acids, lipids, carbohydrates, and complexes thereof. •Biochemistry and chemistry - biomolecular structure, siRNA, nucleic acid structure, structure-activity relationships. •Computer science - Neural networks, biomolecular and drug databases. •Computational chemistry - molecular dynamics simulation, molecular docking, quantum chemistry •Bioinformatics - sequence alignment, structural alignment, protein structure prediction •Mathematics - graph/network theory, population modeling, dynamical systems, phylogenetics. •Medicine and neuroscience - tackling neural networks experimentally (brain slicing) as well as theoretically (computer models), membrane permitivity, gene therapy, understanding tumors. •Pharmacology and physiology - channelomics, biomolecular interactions, cellular membranes, polyketides. •Physics - negentropy, stochastic processes, covering dynamics. •Quantum biophysics involves quantum information processing of coherent states, entanglement between coherent protons and transcriptase components, and replication of decohered isomers to yield time-dependent base substitutions. These studies imply applications in quantum computing. •Agronomy and agriculture Many biophysical techniques are unique to this field. Research efforts in biophysics are often initiated by scientists who were traditional physicists, chemists, and biologists by training.

Notes •Perutz MF (1962). Proteins and Nucleic Acids: Structure and Function. Amsterdam: Elsevier. ASIN B000TS8P4G. •Perutz MF (1969). "The haemoglobin molecule". Proceedings of the Royal Society of London. Series B 173 (31): 113–40. Bibcode: 1969RSPSB.173..113P. doi: 10.1098/rspb.1969.0043. PMID 4389425. •Dogonadze RR, Urushadze ZD (1971). "Semi-Classical Method of Calculation of Rates of Chemical Reactions Proceeding in Polar Liquids". J Electroanal Chem 32 (2): 235–245. doi: 10.1016/S0022-0728(71)80189-4. •Volkenshtein M.V., Dogonadze R.R., Madumarov A.K., Urushadze Z.D. and Kharkats Yu.I. Theory of Enzyme Catalysis.- Molekuliarnaya Biologia (Moscow), 6, 1972, pp. 431–439 (In Russian, English summary. Available translations in Italian, Spanish, English, French) •Rodney M. J. Cotterill (2002). Biophysics : An Introduction. Wiley. ISBN 978-0471-48538-4. •Sneppen K, Zocchi G (2005-10-17). Physics in Molecular Biology (1 ed.). Cambridge University Press. ISBN 0-521-84419-3. •Glaser, Roland (2004-11-23). Biophysics: An Introduction (Corrected ed.). Springer. ISBN 3-540-67088-2. •Hobbie RK, Roth BJ (2006). Intermediate Physics for Medicine and Biology (4th ed.). Springer. ISBN 978-0-387-30942-2. •Cooper WG (2009). "Evidence for transcriptase quantum processing implies entanglement and decoherence of superposition proton states". BioSystems 97 (2): 73–89. doi: 10.1016/j.biosystems.2009.04.010. PMID 19427355. •Cooper WG (2009). "Necessity of quantum coherence to account for the spectrum of time-dependent mutations exhibited by bacteriophage T4". Biochem. Genet. 47 (11–12): 892–910. doi: 10.1007/s10528-009-9293-8. PMID 19882244. •Goldfarb, Daniel (2010). Biophysics Demystified. McGraw-Hill. ISBN 0-07163365-0.

External links •Biophysical Society •Journal of Physiology: 2012 virtual issue Biophysics and Beyond •bio-physics-wiki •Link archive of learning resources for students: biophysika.de (60% English, 40% German)

Electrical brain stimulation Electrical brain stimulation (EBS), also referred to as focal brain stimulation (FBS), is a form of electrotherapy and technique used in research and clinical neurobiology to stimulate a neuron or neural network in the brain through the direct or indirect excitation of its cell membrane by using an electric current. It is used for research or for therapeutical purposes.

History Electrical brain stimulation was first used in the first half of the 19th century by pioneering researchers such as Luigi Rolando [citation needed](1773–1831) and Pierre Flourens [citation needed](1794–1867), to study the brain localization of function, following the discovery by Italian physician Luigi Galvani (1737–1798) that nerves and muscles were electrically excitable. The stimulation of the surface of the cerebral cortex by using brain stimulation was used to investigate the motor cortex in animals by researchers such as Eduard Hitzig (1838–1907), Gustav Fritsch (1838–1927), David Ferrier (1842–1928) and Friedrich Goltz (1834– 1902). The human cortex was also stimulated electrically by neurosurgeons and neurologists such as Robert Bartholow (1831–1904) and Fedor Krause (1857– 1937). In the following century, the technique was improved by the invention of the stereotactic method by British neurosurgeon pioneer Victor Horsley (1857– 1916), and by the development of chronic electrode implants by Swiss neurophysiologist Walter Rudolf Hess (1881–1973), José Delgado (1915-2011) and others, by using electrodes manufactured by straight insulated wire that could be inserted deep into the brain of freely-behaving animals, such as cats and monkeys. This approach was used by James Olds (1922–1976) and colleagues to discover brain stimulation reward and the pleasure center. American-Canadian neurosurgeon Wilder Penfield (1891–1976) and colleagues at the Montreal Neurological Institute used extensively electrical stimulation of the brain cortex in awake neurosurgical patients to investigate the motor and sensory homunculus (the representation of the body in the brain cortex according to the distribution of motor and sensory territories).

Process Two-photon excitation microscopy has shown that microstimulation activates neurons sparsely around the electrode even at low currents (as low as 10 μA) up to distances as far as four millimeters away. This happens without particularly selecting other neurons much nearer the electrode's tip. This is due to activation of neurons being determined by whether they do or do not have axons or dendrites that pass within a radius of 15 μm near the tip of the electrode. As the current is increased the volume around the tip that activates neuron axons and dendrites increases and with this the number of neurons activated. Activation is most likely to be due to direct depolarization rather than synaptic activation.

Therapeutic applications Examples of therapeutic EBS are: •Cranial electrotherapy stimulation (CES) •Deep brain stimulation (DBS) •Transcranial direct current stimulation (tDCS) •Electroconvulsive therapy (ECT) •Functional electrical stimulation (FES) •Magnetic seizure therapy (MST) •Vagus nerve stimulation (VNS) Strong electric currents may cause a localized lesion in the nervous tissue, instead of a functional reversible stimulation. This property has been used for neurosurgical procedures in a variety of treatments, such as for Parkinson's disease, focal epilepsy and psychosurgery. Sometimes the same electrode is used to probe the brain for finding defective functions, before passing the lesioning current (electrocoagulation).

Electroconvulsive therapy Electroconvulsive therapy Intervention ICD-10-PCS

GZB

ICD-9-CM

94.27

MeSH

D004565

OPS-301 code:

8-630

MedlinePlus

007474

Electroconvulsive therapy (ECT), formerly known as electroshock, is a standard psychiatric treatment in which seizures are electrically induced in anesthetized patients for symptom remission. Its mode of action is unknown. The use of electroconvulsive therapy evolved out of convulsive therapy. Long before electric shocks were being administered to induce seizures, doctors were using other drugs and methods to induce seizures as a means of treatment for severe depression and schizophrenia. Today, ECT is used as a treatment for clinical depression that has not responded to other treatment, and sometimes for mania and catatonia. It was first introduced in 1938 by Italian neuropsychiatrists Ugo Cerletti and Lucio Bini, and gained widespread popularity as a form of treatment in the 1940s and 1950s.5 In popular culture, it is usually depicted as a painful procedure, but in western countries ECT is usually administered under anesthetic with a muscle relaxant.6 Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT. In the United Kingdom and Ireland, drug therapy usually is continued during ECT. About 70 percent of ECT patients are women, since they are at twice the risk of depression than are men.7 Although a large amount of research has been carried out, the exact mechanism of action of ECT remains elusive, and ECT on its own does not usually have a sustained benefit. There is usually a risk of memory loss with ECT. It is deemed by the World Health Organization, that obtaining the written, informed consent of the patient is necessary before ECT is administered.8 In the United Kingdom, around a third of patients who are receiving ECT haven't consented to it. They are deemed by the legal system as being too mentally ill to provide consent and ECT is still provided since the legal system feels it's in their best self-interest.9 Likewise is the case when ECT is often administered on adolescents.10 Psychiatrists and other mental health professionals differ on when and if ECT should be used as a first-line treatment or if it should be reserved for patients who have not responded to other interventions such as medication and psychotherapy. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women.11

5Psychology Frontiers and Applications – Second Canadian Edition (Passer, Smith, Atkinson, Mitchell, Muir) 6http://psychcentral.com/lib/5-outdated-beliefs-about-ect/00011255 7http://umm.edu/health/medical/reports/articles/depression 8World Health Organisation (2005). WHO Resource Book on Mental Health, Human Rights and Legislation. Geneva, 64. 9http://www.bbc.co.uk/news/health-23414888 10http://www.annals-general-psychiatry.com/content/12/1/17 11http://ps.psychiatryonline.org/article.aspx?articleID=77626

History As early as the 16th century, agents to induce seizures were used to treat psychiatric conditions. In 1785, the therapeutic use of seizure induction was documented in the London Medical Journal. Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures first with camphor and then metrazol (cardiazol). Ladislas Meduna is thought to be the father of convulsive therapy. In 1937, the first international meeting on convulsive therapy was held in Switzerland by the Swiss psychiatrist Muller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide. Italian Professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1937, experimented for the first time on a person. It was known early on that inducing convulsions aided in helping those with severe schizophrenia. Cerletti had noted a shock to the head produced convulsions in dogs. The idea to use electroshock on humans came to Cerletti when he saw how pigs were given an electric shock before being butchered to put them in an anesthetized state. Cerletti and Bini practiced until they felt they had the right parameters needed to have a successful human trial. Once they started trials on patients they found that after 10-20 treatments the results were significant. Patients had much improved. A positive side effect to the treatment was retrograde amnesia. It was because of this side effect that patients could not remember the treatments and had no ill feelings toward it. ECT soon replaced metrazol therapy all over the world because it was cheaper, less frightening and more convenient.12 Cerletti and Bini were nominated for a Nobel Prize but did not receive one. By 1940, the procedure was introduced to both England and the US. In Germany and Austria it was promoted by Friedrich Meggendorfer. Through the 1940s and 1950s, the use of ECT became widespread.

12Cerletti, U (1956). "Electroshock therapy". In AM Sackler et al. (eds) The Great Physiodynamic Therapies in Psychiatry: an historical appraisal. New York: Hoeber-Harper, 91–120.

In the early 1940s, in an attempt to reduce the memory disturbance and confusion associated with treatment, two modifications were introduced: the use of unilateral electrode placement and the replacement of sinusoidal current with brief pulse. It took many years for brief-pulse equipment to be widely adopted. 13 In the 1940s and early 1950s ECT was usually given in "unmodified" form, without muscle relaxants, and the seizure resulted in a full-scale convulsion. A rare but serious complication of unmodified ECT was fracture or dislocation of the long bones. In the 1940s psychiatrists began to experiment with curare, the muscle-paralysing South American poison, in order to modify the convulsions. The introduction of suxamethonium (succinylcholine), a safer synthetic alternative to curare, in 1951 led to the more widespread use of "modified" ECT. A short-acting anesthetic was usually given in addition to the muscle relaxant in order to spare patients the terrifying feeling of suffocation that can be experienced with muscle relaxants. The steady growth of antidepressant use along with negative depictions of ECT in the mass media led to a marked decline in the use of ECT during the 1950s to the 1970s. The Surgeon General stated there were problems with electroshock therapy in the initial years before anesthesia was routinely given, and that "these now-antiquated practices contributed to the negative portrayal of ECT in the popular media." The New York Times described the public's negative perception of ECT as being caused mainly by one movie. "For Big Nurse in One Flew Over the Cuckoo's Nest, it was a tool of terror, and, in the public mind, shock therapy has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and overused". In 1976, Dr. Blatchley demonstrated the effectiveness of his constant current, brief pulse device ECT. This device eventually largely replaced earlier devices because of the reduction in cognitive side effects, although as of 2012 some ECT clinics still were using sine-wave devices.14 The 1970s saw the publication of the first American Psychiatric Association (APA) task force report on electroconvulsive therapy (to be followed by further reports in 1990 and 2001). The report endorsed the use of ECT in the treatment of depression. The decade also saw criticism of ECT.15 Specifically critics pointed to shortcomings such as noted side effects, the procedure being used as a form of abuse, and uneven application of ECT. The use of ECT declined until the 1980s, "when use began to increase amid growing awareness of its benefits and cost-effectiveness for treating severe depression". In 1985 the National Institute of Mental Health and National Institutes of Health convened a consensus development conference on ECT and concluded that, while ECT was the most controversial treatment in psychiatry and had significant side-effects, it had been shown to be effective for a narrow range of severe psychiatric disorders. 13Kiloh, LG, Smith, JS, Johnson, GF (1988). Physical Treatments in Psychiatry. Melbourne: Blackwell Scientific Publications, 190–208. ISBN 0-86793-112-4 14Leiknes KA, et al (2012) Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav. 2(3):283-344 15See Friedberg, J (1977). "Shock treatment, brain damage, and memory loss: a neurological perspective". American Journal of Psychiatry 134:1010–1014; and Breggin, PR (1979) Electroshock: its brain-disabling effects. New York: Springer

Due to the backlash noted previously, national institutions reviewed past practices and set new standards. In 1978, The American Psychiatric Association released its first task force report in which new standards for consent were introduced and the use of unilateral electrode placement was recommended. The 1985 NIMH Consensus Conference confirmed the therapeutic role of ECT in certain circumstances. The American Psychiatric Association released its second task force report in 1990 where specific details on the delivery, education, and training of ECT were documented. Finally in 2001 the American Psychiatric Association released its latest task force report. This report emphasizes the importance of informed consent, and the expanded role that the procedure has in modern medicine.

Mechanism of action Despite decades of research, the exact mechanism of action of ECT remains elusive. Ladislas J. Meduna believed that chemically induced seizures, brought on by drugs, could change the chemical makeup of the brain of a patient with schizophrenia. Modern electroconvulsive therapy operates under a similar hypothesis, though in modern practice a therapeutic clonic seizure is induced by electrical current via electrodes placed on an anesthetized, unconscious patient. It is known that the central nervous system is regulated by small electrical current; disrupting or "restarting" that current by induced seizure (colloquially, "jumpstarting the brain"), has shown positive effects in patients with severe depression or schizophrenia. Peter Breggin, an outspoken and controversial critic of evidence-based psychiatry, claims that ECT induces "a closed-head injury caused by an overwhelming current of electricity sufficient to cause a grand mal seizure" and that the improvements in mood seen in patients receiving ECT are resultant from brain damage.16 Such claims are rejected as wholly unsubstantiated by the consensus of the scientific and medical community. There is a vast body of literature on the effects of ECT in animals; however, though human and animal brains are very similar, animal models of depression are widely acknowledged to parallel only limited aspects of depressive illness, a uniquely human disease. Some suggest pruning of normally dense synaptic connections in the hippocampus, a richly connected area deep in the temporal lobe vital in controlling both mood and memory, seen in animal studies may play a role in its effectiveness.

16Dr. Peter Breggin for Huffington Post. February 9, 2008. Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex

Selection of patients for ECT Experts disagree on whether ECT is an appropriate first-line treatment or if it should be reserved for patients who have not responded to other interventions such as medication and psychotherapy. The American Psychiatric Association 2001 guidelines give the primary indications for ECT among patients with depression as a lack of response to, or intolerance of, antidepressant medications; a good response to previous ECT; and the need for a rapid and definitive response (e.g. because of psychosis or a risk of suicide). The decision to use ECT depends on several factors, including the severity and chronicity of the depression, the likelihood that alternative treatments would be effective, the patient's preference and capacity to consent, and a weighing of the risks and benefits.17 Some guidelinesWikipedia:Avoid weasel words recommend cognitive behavioral therapy or other psychotherapy before ECT is used. However, treatment resistance is widely defined as lack of therapeutic response to two antidepressants at adequate doses for an adequate duration and with good compliance. The APA states that at times patients will prefer to receive ECT over alternative treatments, but commonly the opposite will be the case. The APA ECT guidelines state that severe major depression with psychotic features, manic delirium, or catatonia are conditions where there is a clear consensus favoring early ECT. The UK's National Institute for Health and Clinical Excellence 2003 (NICE) guidelines recommended ECT for patients with severe depression, catatonia, or prolonged or severe mania. It did not recommend the use of ECT as a maintenance therapy in depressive illness as "the long-term benefits and risks ... had not been clearly established":5–6 and those recommendations were unchanged in the 2010 update.:526 The 2001 APA guidelines support the use of ECT for relapse prevention. The 2001 APA ECT guidelines say that ECT is rarely used as a first-line treatment for schizophrenia, but is considered after unsuccessful treatment with antipsychotic medication, and may also be considered in the treatment of patients with schizoaffective or schizophreniform disorder. The 2003 NICE ECT guidelines do not recommend ECT for schizophrenia, and this has been supported by meta-analytic evidence showing no or little benefit versus placebo, or in combination with antipsychotic drugs, including Clozapine. The NICE 2003 guidelines state that doctors should be particularly cautious when considering ECT treatment for women who are pregnant and for older or younger people, because they may be at higher risk of complications with ECT. The 2001 APA ECT guidelines say that ECT may be safer than alternative treatments in the infirm elderly and during pregnancy, and the 2000 APA depression guidelines stated that the literature supports the safety for mother and fetus, as well as the efficacy during pregnancy. 17Lisanby, S.H. (2007) Electroconvulsive Therapy for Depression Volume 357, No. 19, pp. 1939– 1945

ECT has been used in selected cases of depression occurring in the setting of multiple sclerosis, Parkinson's disease, Huntington's chorea, developmental delay, brain arteriovenous malformations and hydrocephalus.

Efficacy Non-clinical patient characteristics About 70 percent of ECT patients are women. This is almost entirely due to women being at twice the risk of depression. Older and more affluent patients are also more likely to receive ECT. The use of ECT is not as common in ethnic minorities.

Degree of effectiveness and risks Scientific papers and articles reviewing studies of ECT effectiveness have reached conflicting conclusions. A meta-analysis done on the effectiveness of ECT in unipolar and bipolar depression was conducted in 2012. Findings showed that although patients with unipolar depression and bipolar depression responded very differently to other medical treatments both groups responded equally as well to ECT. Overall remission rate for patients with unipolar depression was 51.5% and 50.9% in those with bipolar depression. The severity of each patient’s depression was assessed at the same baseline in each group. In 2003, The UK ECT Review group published a systematic review and metaanalysis comparing ECT to placebo and antidepressant drugs. This meta-analysis demonstrated a large effect size (high efficacy relative to the mean in terms of the standard deviation) for ECT versus placebo, and versus antidepressant drugs. In 2006, a research article by Dr. Colin A. Ross found that no studies had ever shown that ECT was more effective than a placebo (sham ECT) treatment as of 1 month posttreatment. In 2008, a meta-analytic review paper found in terms of efficacy, "a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs." In 2010, a paper by Dr. John Reed and Dr. Richard Bentall found that ECT was only minimally more effective than a placebo during the treatment period, and that there was no difference in effect after the treatment period. In light of this finding, and the risk of side-effects, the authors concluded that the use of ECT "cannot be scientifically justified".

A 2011 paper in the Journal of Psychiatric Nurses Association reported that ECT was effective.18 Surveys of public opinion, the testimony of former patients, legal restrictions on its use and disputes as to the efficacy, ethics and adverse effects of ECT within the psychiatric and wider medical community indicate that the use of ECT remains controversial. This is reflected in the recent vote by the United States Food and Drug Administration's (FDA's) Neurological Devices Advisory Panel to recommend that FDA maintain ECT devices in the Class III device category for high risk devices except for patients suffering from catatonia. This may result in the manufacturers of such devices having to do controlled trials on their safety and efficacy for the first time.19 In justifying their position, panelists referred to the memory loss associated with ECT and the lack of long-term data.

Duration of effect ECT on its own does not usually have a sustained benefit. Half those who remit then relapse within six months. This is similar to the rate of relapse after discontinuing antidepressant medication, and it has been suggested that it is due to the severity and chronicity of pre-existing illness for which ECT is generally used.20 The relapse rate in the first six months is reduced by the use of psychiatric medications or further ECT, but remains high.

Probability of remission The 1999 U.S. Surgeon General's Report on Mental Health summarized psychiatric opinion at the time about the effectiveness of ECT. It stated that both clinical experience and published studies had determined ECT to be effective (with an average 60 to 70 percent remission rate) in the treatment of severe depression, some acute psychotic states, and mania. Its effectiveness had not been demonstrated in dysthymia, substance abuse, anxiety, or personality disorder. The report stated that ECT does not have a long-term protective effect against suicide and should be regarded as a short-term treatment for an acute episode of illness, to be followed by continuation therapy in the form of drug treatment or further ECT at weekly to monthly intervals.21

18http://jap.sagepub.com/content/17/3/217.short 19Duff Wilson for the New York Times. January 28, 2011 F.D.A. Panel Is Split on Electroshock Risks 20Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, Greenberg RM, Crowe RR, Cooper TB, Prudic J.(2001) Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001 Mar 14; 285(10):1299–307. 21Surgeon General (1999). Mental Health: A Report of the Surgeon General, chapter 4.

A 2004 large multicentre clinical follow-up study of ECT patients in New York — describing itself as the first systematic documentation of the effectiveness of ECT in community practice in the 65 years of its use — found remission rates of only 30 to 47 percent, with 64 percent of those relapsing within six months. However, when patients with co-morbid personality disorders or who were suffering from schizoaffective disorder were removed from the analysis, the remission rates climbed to 60-70%.

Related experimental therapeutics Recent research has investigated whether implantable devices such as those used in DBS (deep brain stimulation) could result in clinical improvements for patients with treatment-resistant depression. However, in North America, DBS has not been authorized as an approved, effective therapy for treatment-resistant depression.

Adverse effects Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia; the U.S. Surgeon General's report says that there are "no absolute health contraindications" to its use.:259 Immediately following treatment, the most common adverse effects are confusion and memory loss. The state of confusion usually disappears after a few hours. It can be tolerated by pregnant women who are not suffering major complications. It can be used with diabetic or obese patients, and with caution in those whose cancers are in remission or under control. It can be used in some immunocompromised patients. It must be used very cautiously in people with epilepsy or other neurological disorders because by its nature it provokes small tonic-clonic seizures, and so would likely not be given to a person whose epilepsy is not well controlled. Some patients experience muscle soreness after ECT. This is due to the muscle relaxants given during the procedure and rarely due to muscle activity. ECT, especially if combined with deep sleep therapy, may lead to brain damage if administered in such a way as to lead to hypoxia or anoxia in the patient.22 The death rate due to ECT is around 4 per 100,000 procedures.23 There is evidence and rationale to support giving low doses of benzodiazepines or else low doses of general anesthetics which induce sedation but not anesthesia to patients to reduce adverse effects of ECT.

22E. Wilson 2003 Psychiatric abuse at Chelmsford Private Hospital, New South Wales, 19601980s. In C. Coleborne and D. MacKinnon Madness in Australia: histories, heritage and the asylum. Queensland: 121-34 23Gelder, M., Mayou, R., Geddes, J. (2006) Psychiatry. 3rd edition. Oxford: Oxford University Press

Effects on memory It is the purported effects of ECT on long-term memory that give rise to much of the concern surrounding its use. The acute effects of ECT can include amnesia, both retrograde (for events occurring before the treatment) and anterograde (for events occurring after the treatment).24 Memory loss and confusion are more pronounced with bilateral electrode placement rather than unilateral, and with outdated sine-wave rather than brief-pulse currents. The use of either constant or pulsing electrical impulses also varied the memory loss results in patients. Patients who received pulsing electrical impulses as opposed to a steady flow seemed to incur less memory loss. A 2007 study on the long term effects of ECT showed that global cognitive impairment followed all forms of ECT in varying extent. The vast majority of modern treatment uses brief pulse currents. Research by Harold Sackeim has shown that excessive current causes more risk for memory loss, and using right-sided electrode placement may reduce verbal memory disturbance. It was his '07 study that also showed global cognitive impairment in all forms of ECT, including the most benign[citation needed]. Retrograde amnesia is most marked for events occurring in the weeks or months before treatment, with one study showing that although some people lose memories from years prior to treatment, recovery of such memories was "virtually complete" by seven months post-treatment, with the only enduring loss being memories in the weeks and months prior to the treatment. Anterograde memory loss is usually limited to the time of treatment itself or shortly afterwards. In the weeks and months following ECT these memory problems gradually improve, but some people have persistent losses, especially with bilateral ECT. One published review summarizing the results of questionnaires about subjective memory loss found that between 29% and 55% of respondents believed they experienced long-lasting or permanent memory changes. In 2000, American psychiatrist Sarah Lisanby and colleagues found that bilateral ECT left patients with more persistently impaired memory of public events as compared to RUL ECT. Some studies have found that patients are often unaware of cognitive deficits induced by ECT. For example, in June 2008, a Duke University study was published assessing the neuropsychological effects and attitudes in patients after ECT. Forty-six patients participated in the study, which involved neuropsychological and psychological testing before and after ECT. The study documented substantial cognitive impairment after ECT on a variety of memory tests, including "verbal memory for word lists and prose passages and visual memory of geometric designs." Based on their findings, the authors issued the following recommendation:

24Benbow, SM (2004) "Adverse effects of ECT". In AIF Scott (ed.) The ECT Handbook, second edition. London: The Royal College of Psychiatrists, pp. 170–174.

When ECT is provided to adolescents, the potential impact of such cognitive changes should be discussed with the patients and their parents or guardians in terms of implications for not only the patient's emotional functioning but cognitive functioning as well, particularly upon his or her academic performance. In summary, we argue that an individual cost-benefit analysis should be made in light of the implications of the potential benefits versus costs of ECT upon improving emotional functioning and the impact that potential memory changes may have on real-world functioning and quality of life. Severe memory loss from ECT is described in an autobiographical book, Doctors of Deception: What They Don't Want You to Know about Shock Treatment.

Controversy over long-term effects on general cognition According to prominent ECT researcher Harold Sackeim, "despite over fifty years of clinical use and ongoing controversy", until 2007 there had "never been a large-scale, prospective study of the cognitive effects of ECT." In this first-ever large-scale study (347 subjects), Sackeim and colleagues found that at least some forms (namely bilateral application and outdated sine-wave currents) of ECT "routine[ly]" lead to "adverse cognitive effects," including global cognitive deficits and memory loss, that persist for up to six months after treatment, suggesting that the induced deficits may be permanent. The authors also warned that their findings did not suggest that right-unilateral ECT did not also lead to chronic cognitive deficits. Harold Sackeim can be seen in a videotaped deposition briefly discussing the findings of this study and why, in his opinion, earlier studies had failed to find evidence of long-term harm from ECT. Despite over fifty years of clinical use, Sackeim states that prior to 2001, "the field itself never really had an opportunity to have a discussion about patients who have complaints about long-term memory loss." In this video clip, Sackeim also reveals that at a California ECT conference with 200 practitioners present, when polled as to whether they think ECT can lead to chronic cognitive deficits, two-thirds raised their hands. Sackeim says this was "almost a watershed moment for the field", and was the "first time publicly that the field itself said 'no' to the position that it can't happen."

In July 2007, a second study was published concluding that ECT routinely leads to chronic, substantial cognitive deficits, and the findings were not limited to any particular forms of ECT. The study, led by psychiatrist Glenda MacQueen and colleagues, found that patients treated with ECT for bipolar disorder show marked deficits across multiple cognitive domains. According to the researchers, "Subjects who had received remote ECT had further impairment on a variety of learning and memory tests when compared with patients with no past ECT. This degree of impairment could not be accounted for by illness state at the time of assessment or by differential past illness burden between patient groups." Despite the findings of chronic, global cognitive deficits in post-ECT patients, MacQueen and colleagues suggest that it is "unlikely that such findings, even if confirmed, would significantly change the risk–benefit ratio of this notably effective treatment." Six months after the publication of the Sackeim study documenting routine, longterm memory loss after ECT, prominent ECT researcher Max Fink published a review in the journal Psychosomatics concluding that patient complaints of memory loss after ECT are "rare" and should be "characterized as somatoform disorders, rather than as evidence of brain damage, thus warranting psychological treatment for such disorders." Based on his findings, Fink suggests that, "Instead of endorsing these reports as the direct consequence of ECT, especially in patients who have recovered from their depressive illness, lost their suicidal drive, and have improved social functioning, is it not more useful to accept the complaint as a somatoform disorder, explore the basis in the individual's history and experience, and offer appropriate supportive treatment?" A number of reviews of the literature and other articles continue to characterize ECT as safe and effective. For example, in June 2009, Portuguese researchers published a review on the safety and efficacy of ECT in an article entitled, Electroconvulsive Therapy: Myths and Evidences. In their review, the researchers conclude that ECT is an "efficient, safe and even life saving treatment for several psychiatric disorders." In 2008, Yale researchers published a review on the safety and efficacy of ECT in elderly patients. According to the authors, "ECT is well established as a safe and effective treatment for several psychiatric disorders." And in a June 2009 article published in the Journal of ECT, Iranian researchers observe that, "Despite the wide consensus over the safety and efficacy of electroconvulsive therapy (ECT), it still faces negative publicity and unfavorable attitudes of patients and families."

Breggin, chief editor of the journal Ethical Human Psychology and Psychiatry, is a leading critic of ECT who believes the procedure is neither safe nor effective. In a published article reviewing the findings of Harold Sackeim's 2007 study on the cognitive effects of ECT, Breggin accuses Max Fink and other pro-ECT researchers of having a history of "systematically covering up damage done to millions of [ECT] patients throughout the world." He disagrees with the position that findings of chronic, global cognitive deficits should have no bearing on the risk-benefit ratio of ECT, and he believes it's important to address the "actual impact of these losses on the lives of individual patients." In his 2007 paper, a section is entitled Destroying Lives, and in it, Breggin writes, "Even when these injured people can continue to function on a superficial social basis, they nonetheless suffer devastation of their identities due to the obliteration of key aspects of their personal lives. The loss of the ability to retain and learn new material is not only humiliating and depressing but also disabling. Even when relatively subtle, these activities can disrupt routine activities of living." A study published in 2004 in the Journal of Mental Health reported that 35 to 42% of patients responding to a questionnaire reported ECT resulted in loss of intelligence.25 The study also reported, "There is no overlap between clinical and consumer studies on the question of benefit." Doctors of Deception: What They Don't Want You to Know About Shock Treatment reports before-and-after IQ testing of persons receiving ECT, including the author, that show 30 to 40 point losses.

Effects on brain structure Considerable controversy exists over the effects of ECT on brain tissue, although a number of mental health associations — including the American Psychiatric Association — have concluded that there is no evidence that ECT causes structural brain damage. A 1999 report by the U.S. Surgeon General states, "The fears that ECT causes gross structural brain pathology have not been supported by decades of methodologically sound research in both humans and animals". However, not all experts agree that ECT does not cause brain damage, and two studies have been published since 2007 finding that at least some forms of ECT may result in widespread, persisting, generalized cognitive dysfunction, which might support claims that ECT causes brain damage.

25Philpot M, Collins C, Trivedi P, Treloar A, Gallacher S, Rose D: Eliciting users' views of ECT in two mental health trusts with a user-designed questionnaire. Journal of Mental Health 13(4): 403–413, 2004

Peter Breggin, a psychiatrist, has published books and journal reviews of the literature purporting to show that ECT routinely causes brain damage as evidenced by a considerable list of studies in humans and animals. In particular, Breggin asserts that animal and human autopsy studies have shown that ECT routinely causes 'widespread pinpoint hemorrhages and scattered cell death.' According to Breggin, the 1990 APA task force report on ECT ignored much of the scientific literature pointing out the negative effects of electroshock therapy. For example, in 1952 Hans Hartelius conducted and published an animal study on cats entitled Cerebral Changes Following Electrically Induced Convulsions in which a double-blind microscopic pathology examination showed that it was possible to distinguish the 8 shocked animals from the 8 non-shocked animals with remarkable accuracy based on statistically significant structural changes to the brain, including vessel wall changes, gliosis, and nerve cell changes. Based on the detection of shadow cells and neuronophagia, Hartelius determined that there was irreversible damage to neurons associated with electroshock. Proponents argue that the addition of hyperoxygenation and refinement in technique in the last thirty years has made ECT safe, and a majority of published reviews in recent decades have reflected this position. A 2004 study was designed to evaluate whether modern ECT techniques lead to identifiable brain damage, In the study: "Twelve adolescent Macaca mulatta, the initial subjects in an ongoing study of the cognitive and anatomic effects of ECT and magnetic seizure therapy, were divided into cohorts of three and matched for age, weight, and sex. Each cohort was housed in a group. Within each cohort, the monkeys were randomly assigned to ECT, magnetic seizure therapy, or sham. All staff not involved in the delivery of the interventions were masked to group assignment. This study was approved by the Institutional Animal Care and Use Committee of New York State Psychiatric Institute. Interventions were performed 4 days per week for 6 weeks. A 5-week recovery period was interposed before the last intervention week to permit maturation of possible neuropathological effects. Animals were euthanized 3 days after the last intervention." Their brains were compared to monkeys undergoing anesthesia alone. According to the researchers, "None of the ECT-treated monkeys showed pathological findings." Many expert proponents of ECT maintain that the procedure is safe and does not cause brain damage. Dr. Charles Kellner, a prominent ECT researcher and former chief editor of the Journal of ECT, stated in a 2007 interview that, "There are a number of well-designed studies that show ECT does not cause brain damage and numerous reports of patients who have received a large number of treatments over their lifetime and have suffered no significant problems due to ECT." Dr. Kellner cites a study purporting to show an absence of cognitive impairment in eight subjects after more than 100 lifetime ECT treatments. Dr. Kellner stated "Rather than cause brain damage, there is evidence that ECT may reverse some of the damaging effects of serious psychiatric illness."

Effects in pregnancy If steps are taken to decrease potential risks, ECT is generally accepted to be relatively safe during all trimesters of pregnancy, particularly when compared to pharmacological treatments. Suggested preparation for ECT during pregnancy includes a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. Much of the medical literature in this area is composed of case studies of single or twin pregnancies, and although some have reported serious complications, the majority have found ECT to be safe.

Administration ECT is selected as a therapy as described above, and normally requires the informed consent of the patient.26:1880 Whether psychiatric medications are terminated prior to treatment or maintained, varies.:188527 However, drugs that are known to cause toxicity in combination with ECT, such as lithium, are discontinued, and benzodiazepines, which increase seizure thresholds, are either discontinued, a benzodiazepine antagonist is administered at each ECT session, or the ECT treatment is adjusted accordingly.:1879:1875 The placement of electrodes, as well as the dose and duration of the stimulation is determined on a per-patient basis.:1881 Both electrodes can be placed on the same side of the patient's head. This is known as unilateral ECT. Unilateral ECT is used first to minimize side effects (memory loss). When electrodes are placed on both sides of the head, this is known as bilateral ECT. In bifrontal ECT, an uncommon variation, the electrode position is somewhere between bilateral and unilateral. Unilateral is thought to cause fewer cognitive effects than bilateral but is considered less effective if the dose administered is close to the seizure threshold.:1881 In the USA most patients receive bilateral ECT. In the UK almost all patients receive bilateral ECT.

26 27Haskett RF and Loo C (2010) Role of Adjunctive Psychotropic Medications during ECT in the Treatment of Depression, Mania and Schizophrenia J ECT. 2010 September; 26(3): 196–20

The electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT.:1881 Below these levels treatment may not be effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more severe cognitive impairment without additional therapeutic gains. Seizure threshold is determined by trial and error ("dose titration"). Some psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly estimating a patient's threshold according to age and sex. Older men tend to have higher thresholds than younger women, but it is not a hard and fast rule, and other factors, for example drugs, affect seizure threshold. Immediately prior to treatment, a patient is given a short-acting anesthetic such as methohexital, etomidate, or thiopental, a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation. The patient's EEG, ECG, and blood oxygen levels are monitored during treatment.:1882 ECT is usually administered three times a week, on alternate days, over a course of two to four weeks.:1882–1883

ECT devices Most modern ECT devices deliver a brief-pulse current, which is thought to cause fewer cognitive effects than the sine-wave currents which were originally used in ECT. A small minority of psychiatrists in the USA still use sine-wave stimuli. Sine-wave is no longer used in the UK or Ireland. Typically, the electrical stimulus used in ECT is about 800 milliamps and has up to several hundred watts, and the current flows for between one and 6 seconds.28 In the USA, ECT devices are manufactured by two companies, Somatics, which is owned by psychiatrists Richard Abrams and Conrad Swartz, and Mecta. The Food and Drug Administration has classified the devices used to administer ECT as Class III medical devices.29 Class III is the highest-risk class of medical devices. In the UK, the market for ECT devices was long monopolized by Ectron Ltd, although in recent years some hospitals have started using American devices. Ectron Ltd was set up by psychiatrist Robert Russell, who together with a colleague from the Three Counties Asylum, Bedfordshire, invented the Page–Russell technique of intensive ECT.

28 29Federal Register (1979), p. 51776

Variations in international practice There is wide variation in ECT use between different countries, different hospitals, and different psychiatrists. International practice varies considerably from widespread use of the therapy in many western countries to a small minority of countries that do not use ECT at all, such as Slovenia.30 Guidelines on the use of ECT are stringent in the USA and the UK. Modern standards are not always followed throughout the world and not all countries that use ECT have written technical standards. The use of both anesthesia and muscle relaxants is universally recommended in the administration of ECT. If anesthesia and muscle relaxants are not used the procedure is called unmodified ECT. In a minority of countries such as Japan, India, and Nigeria, ECT may be used without anesthesia. WHO has called for a worldwide ban on unmodified ECT and the topic is currently being debated in countries like India. The practice has been recently abolished in Turkey's largest psychiatric hospital. A major difficulty for developing countries in eliminating unmodified ECT is a lack of trained anesthesiologists available to administer the procedure. A small minority of countries never seek consent before administering ECT. This significantly uneven application of ECT around the world continues to make ECT a controversial procedure. Sarah Hall reports, "ECT has been dogged by conflict between psychiatrists who swear by it, and some patients and families of patients who say that their lives have been ruined by it. It is controversial in some European countries such as the Netherlands and Italy, where its use is severely restricted".31

30See the Slovenian government website for information about ECT in Slovenia. 31Rise In Electric Shock Therapy In County. Sarah Hall, Norwich Evening News 24, June 4, 2008. Accessed: June 4, 2008.

United States ECT became popular in the United States in the 1940s. At this time psychiatric hospitals were overrun with patients whom doctors were desperate to treat and cure. The practices of ECT and lobotomies became popular because they held some promise of addressing the overpopulation problem. Whereas lobotomies would reduce a patient to a more manageable submissive state ECT helped to improve mood in those with severe depression. In the United States, a survey of psychiatric practice in the late 1980s found that an estimated 100,000 people received ECT annually, with wide variation between metropolitan statistical areas. Accurate statistics about the frequency, context and circumstances of ECT in the United States are difficult to obtain because only a few states have reporting laws that require the treating facility to supply state authorities with this information. One state which does report such data is Texas, where in the mid-1990s ECT was used in about one third of psychiatric facilities and given to about 1,650 people annually. Usage of ECT has since declined slightly; in 2000– 01 ECT was given to about 1500 people aged from 16 to 97 (in Texas it is illegal to give ECT to anyone under sixteen).32 ECT is more commonly used in private psychiatric hospitals than in public hospitals, and minority patients are underrepresented in the ECT statistics. In the United States, ECT is usually given three times a week; in the UK, it is usually given twice a week. Occasionally it is given on a daily basis. A course usually consists of 6–12 treatments, but may be more or fewer. Following a course of ECT some patients may be given continuation or maintenance ECT with further treatments at weekly, fortnightly or monthly intervals. A few psychiatrists in the USA use multiple-monitored ECT (MMECT) where patients receive more than one treatment per anesthetic. Electroconvulsive therapy is not a required subject in US medical schools and not a required skill in psychiatric residency training. Privileging for ECT practice at institutions is a local option: no national certification standards are established, and no ECT-specific continuing training experiences are required of ECT practitioners.33

32Texas Department of State (2002) Electroconvulsive therapy reports. 33Fink, M. & Taylor, A.M. (2007) Electroconvulsive therapy: Evidence and Challenges JAMA Vol. 298 No. 3, p330–332.

United Kingdom In the United Kingdom in 1980, an estimated 50,000 people received ECT annually, with use declining steadily since then to about 12,000 per annum in 2002. It is still used in nearly all psychiatric hospitals, with a survey of ECT use from 2002 finding that 71 percent of patients were women and 46 percent were over 65 years of age. Eighty-one percent had a diagnosis of mood disorder; schizophrenia was the next most common diagnosis. Sixteen percent were treated without their consent.34 In 2003, the National Institute for Clinical Excellence, a government body which was set up to standardize treatment throughout the National Health Service in England and Wales, issued guidance on the use of ECT. Its use was recommended "only to achieve rapid and shortterm improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode".35 The guidance received a mixed reception. It was welcomed by an editorial in the British Medical Journal but the Royal College of Psychiatrists launched an unsuccessful appeal.36 The NICE guidance, as the British Medical Journal editorial points out, is only a policy statement and psychiatrists may deviate from it if they see fit. Adherence to standards has not been universal in the past. A survey of ECT use in 1980 found that more than half of ECT clinics failed to meet minimum standards set by the Royal College of Psychiatrists, with a later survey in 1998 finding that minimum standards were largely adhered to, but that twothirds of clinics still fell short of current guidelines, particularly in the training and supervision of junior doctors involved in the procedure. A voluntary accreditation scheme, ECTAS, was set up in 2004 by the Royal College, but as of 2006 only a minority of ECT clinics in England, Wales, Northern Ireland and the Republic of Ireland have signed up.37

India The Union Health Ministry of India has decided in the Mental Health Care Bill of 2010 that they will no longer use direct ECT. The Health Ministry recommended a ban on the whole procedure.38

Legal status

34 35NICE 2003. Electroconvulsive therapy (ECT). Retrieved on 2007-12-29. 36NICE (2003). Appraisal of electroconvulsive therapy: decision of the appeal panel. London: NICE. 37Royal College of Psychiatrists (2006). ECTAS newsletter issue 5. 38Electroshocks for mentally ill patients to be banned (2011). [0] Teena Thacker

Informed consent It is widely acknowledged internationally that obtaining the written, informed consent of the patient is important before ECT is administered. The World Health Organization, in its 2005 publication "Human Rights and Legislation WHO Resource Book on Mental Health," specifically states, "ECT should be administered only after obtaining informed consent." In the US, this doctrine places a legal obligation on a doctor to make a patient aware of: the reason for treatment, the risks and benefits of a proposed treatment, the risks and benefits of alternative treatment, and the risks and benefits of receiving no treatment. The patient is then given the opportunity to accept or reject the treatment. The form states how many treatments are recommended and also makes the patient aware that the treatment may be revoked at anytime during a course of ECT. The Surgeon General's Report on Mental Health states that patients should be warned that the benefits of ECT are short-lived without active continuation treatment in the form of drugs or further ECT, and that there may be some risk of permanent, severe memory loss after ECT. The report advises psychiatrists to involve patients in discussion, possibly with the aid of leaflets or videos, both before and during a course of ECT. To demonstrate what he believes should be required to fully satisfy the legal obligation for informed consent, one psychiatrist, working for an anti-psychiatry organisation, has formulated his own consent form using the consent form developed and enacted by the Texas Legislature as a model.39 According to the Surgeon General, involuntary treatment is uncommon in the United States and is typically used only in cases of great extremity, and only when all other treatment options have been exhausted. The use of ECT is believed to be a potentially life-saving treatment.40 However, caution must be exercised in interpreting this assertion as, in an American context, there does not appear to have been any attempt to survey at national level the usage of ECT as either an elective or involuntary procedure in almost twenty years.41 In one of the few jurisdictions where recent statistics on ECT usage are available, a national audit of ECT by the Scottish ECT Accreditation Network indicated that 77% of patients who received the treatment in 2008 were capable of giving informed consent.

39Texas Legislature (2004). Health & Safety Code Chapter 578, Electroconvulsive And Other Therapies Sec.578.001. 40 41Data from a survey by the APA's Psychiatric Activities Survey 1988-89 indicated that at that time somewhat less than 8% of U.S. psychiatrists provided ECT for their patients, although this rate was highly variable. There was no data on the usage of involuntary ECT, however. . In regard to the variability in the use of ECT by psychiatrists in the U.S. Carl Salzman suggests that this may indicate a degree of professional ambivalence towards the procedure

In the UK, in order for consent to be valid it requires an explanation in "broad terms" of the nature of the procedure and its likely effects.42 One review from 2005 found that only about half of patients felt they were given sufficient information about ECT and its adverse effects43 and another survey found that about fifty percent of psychiatrists and nurses agreed with them. A 2005 study published in the British Journal of Psychiatry described patients' perspectives on the adequacy of informed consent before ECT. The study found that, "About half (45–55%) of patients reported they were given an adequate explanation of ECT, implying a similar percentage felt they were not." The authors also stated: "Approximately a third did not feel they had freely consented to ECT even when they had signed a consent form. The proportion who feel they did not freely choose the treatment has actually increased over time. The same themes arise whether the patient had received treatment a year ago or 30 years ago. Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales."

Involuntary ECT Procedures for involuntary ECT vary from country to country depending on local mental health laws. Legal proceedings are required in some countries, while in others ECT is seen as another form of treatment that may be given involuntarily as long as legal conditions are observed. Involuntary electroshock contravenes the principle of autonomy in medical ethics. The maxim of autonomy is "Voluntas aegroti suprema lex." This rule states that the will of the patient is supreme. It implies that a patient has the right to consent to, or to refuse a medical treatment, such as ECT. Persons considered not to be of sound mind are in many jurisdictions considered incapable of giving true consent. In such a case, the patient's "assent" may be sought; opinions are divided as to whether this should be routinely done, or whether a patient who is not competent to consent to therapy should retain the right to refuse it. Citizens in western societies often undergo emergency medical procedures when they have lost the capacity to consent (such as neurosurgery after head injury). Under these circumstances, the principles of beneficence and non-maleficence must be adhered to.

42Jones, R (1996) Mental Health Act Manual, 5th edition. London: Sweet and Maxwell, page 225. 43Rose D, Wykes T, Bindman J, Fleischmann P (2005) "Information, consent and perceived coercion: patients' perspectives on electroconvulsive therapy". British Journal of Psychiatry 186:54–59.

United States In most states in the USA, a judicial order following a formal hearing is needed before a patient can be forced to undergo involuntary ECT. Patients may be represented by legal counsel at the hearing. According to the Surgeon General's Report on Mental Health, "As a rule, the law requires that such petitions are granted only where the prompt institution of ECT is regarded as potentially lifesaving, as in the case of a person in grave danger because of lack of food or fluid intake caused by catatonia." However, ECT can also be involuntarily administered in situations with less immediate danger. Suicidal intent is a common justification for its involuntary use, especially when other treatments are ineffective.

United Kingdom Until 2009 in England and Wales, the Mental Health Act 1983 allowed the use of ECT on detained patients whether or not they had capacity to consent to it. However, following amendments which took effect in 2009, ECT may not generally be given to a patient who has capacity and refuses it, irrespective of his or her detention under the Act.44 In fact, even if a patient is deemed to lack capacity, if they made a valid advance decision refusing ECT then they should not be given it; and even if they do not have an advance decision, the psychiatrist must obtain an independent second opinion (which is also the case if the patient is under age of consent).45 However, there is an exception regardless of consent and capacity; under Section 62 of the Act, if the treating psychiatrist says the need for treatment is urgent they may start a course of ECT without authorization.46 About 2,000 people a year in England and Wales are treated without their consent under the Mental Health Act.47 Concerns have been raised by the official regulator that psychiatrists are too readily assuming that patients have the capacity to consent to their treatments, and that there is a worrying lack of independent advocacy.48 In Scotland the Mental Health (Care and Treatment) (Scotland) Act 2003 also gives patients with capacity the right to refuse ECT.49

44The Mental Health Act 1983 (updated version) Part IV, Section 58. Care Quality Commission 45Care Quality Commission (2010) ECT: Your rights about consent to treatment 46The Mental Health Act 1983 (updated version) Part IV, Section 62. Care Quality Commission 47The Mental Health Act Commission (2005) In Place of Fear? eleventh biennial report, 2003– 2005, 236. The Stationery Office. 48Care Quality Commission (2011) CQC says care for people treated under the Mental Health Act still needs to improve 49The Mental Health (Care and Treatment) (Scotland) Act 2003, Part 16, sections 237–239.

Patient experience NICE ECT guidelines report that some individuals consider ECT to have been a beneficial and lifesaving treatment, while others reported feelings of terror, shame and distress, and found it positively harmful and an abusive invasion of personal autonomy, especially when administered without their consent.

Individual positive depictions Kitty Dukakis, wife of politician Michael Dukakis, reports in a Newsweek article mostly positive effects from electroconvulsive therapy, and regards memory loss as an acceptable price to pay for relief from depression. For me, the memory issues are real but manageable. Things I lose generally come back. Other memories I prefer to lose, including those about the depression I was suffering. But there are some memories—of meetings I have attended, people's homes I have visited—that I don't want to lose but I can't help it. They generally involve things I did two weeks before and two weeks after ECT. Often they are just wiped out....I have learned ways to partly compensate for whatever loss I still experience. I call my sister Jinny, Michael and my kids, asking what my niece Betsy's phone number is, what we did yesterday and what we are planning to do tomorrow. I apologize prior to asking. I wonder when they are going to run out of patience with "Kitty being Kitty." I hate losing memories, which means losing control over my past and my mind, but the control ECT gives me over my disabling depression is worth this relatively minor cost. It just is. American psychotherapist Martha Manning's autobiographical Undercurrents acknowledges the downside of treatment: "I felt like I'd been hit by a truck for a while, but that was, comparatively speaking, not so bad," as well as the upside: "Afterwards, I thought, do regular people feel this way all the time? It's like you've not been in on a great joke for the whole of your life." In his autobiographical book Electroboy, American writer Andy Behrman describes undergoing ECT as a treatment for bipolar disorder while under housearrest: "I wake up thirty minutes later and think I am in a hotel in Acapulco. My head feels as if I have just downed a frozen margarita too quickly. My jaws and limbs ache. But I am elated." Curtis Hartmann, a lawyer in western Massachusetts, stated: "ECT, a treatment of last resort for severe, debilitating depression, is all that has ever worked for me. I awaken about 20 minutes later, and although I am still groggy with anesthesia, much of the hellish depression is gone. It is a disease that for me, literally steals me from myself—a disease that executes me and then forces me to stand and look down at my corpse. Thankfully, ECT has kept my monster at bay, my hope intact".

Beverley Callard is a British actress, best known for her role as Liz McDonald in Coronation Street. In her recently published autobiography titled "Unbroken", she describes her experience with ECT for severe depression, stating that the treatment was in part responsible for her recovery. Carrie Fisher, an American actress and author best known for her role as Princess Leia in Star Wars, praises ECT as an ongoing treatment for her bipolar disorder in her autobiographical books Wishful Drinking and Shockaholic. Kay Redfield Jamieson also wrote about the experience of having ECT as a positive experience, that relieved her from the crushing pain of untreatable depression.

Individual negative accounts Accounts of severe long-term, permanent memory loss In a letter to the editor published in the Washington Post in December, 2000, registered nurse Barbara C. Cody wrote that her life was forever changed by 13 outpatient ECTs she received in 1983. She wrote, "Shock 'therapy' totally and permanently disabled me. EEGs [electroencephalograms] verify the extensive damage shock did to my brain. Fifteen to 20 years of my life were simply erased; only small bits and pieces have returned. I was also left with short-term memory impairment and serious cognitive deficits. ... Shock 'therapy' took my past, my college education, my musical abilities, even the knowledge that my children were, in fact, my children. I call ECT a rape of the soul." Similarly, writer Johnanton Cott claims to have completely lost 15 years of memory in On the Sea of Memory: A Journey from Forgetting to Remembering.50

50Johnanton Cott, On the Sea of Memory: A Journey from Forgetting to Remembering Random House, October 4, 2005, ISBN 1-4000-6058-3, ISBN 978-1-4000-6058-0

Despite former patients having reported devastating, permanent amnesia and cognitive impairment since ECT was first invented, the first lawsuit for ECT amnesia, Marilyn Rice v. John Nardini, was not brought until 1975; dozens of suits followed. While there have been a few settlements, including one for half a million dollars, no former patient had won a case until 2005. In a 2005 South Carolina court proceeding, Peggy S. Salters became the first ECT survivor to win a jury verdict and compensation. Ms. Salters sued Palmetto Baptist Medical Center in Columbia, as well as the three doctors responsible for her care, for an intensive course of outpatient ECT that she received in 2000, at age 55 years old, that caused her to lose all memories of the past 30 years of her life, including all memories of her husband of three decades, then deceased, and the births of her three children. She held a Masters of Science in nursing and, prior to the ECT, had a long career as a psychiatric nurse; but, as a result of the ECT, lost her knowledge of nursing skills and was unable to return to work. The jury awarded Salters $635,177 in compensation for her inability to work. The judgement was upheld upon appeal in an unpublished opinion.

Accounts of severe cognitive diminishment Liz Spikol, the senior contributing editor of Philadelphia Weekly, wrote of her ECT in 1996, "Not only was the ECT ineffective, it was incredibly damaging to my cognitive functioning and memory. But sometimes it's hard to be sure of yourself when everyone 'credible' — scientists, ECT docs, researchers — are telling you that your reality isn't real. How many times have I been told my memory loss wasn't due to ECT but to depression? How many times have I been told that, like a lot of other consumers, I must be perceiving this incorrectly? How many times have people told me that my feelings of trauma related to the ECT are misplaced and unusual? It's as if I was raped and people kept telling me not to be upset—that it wasn't that bad."

Involuntary or other problems in administrating ECT ECT received a lot of bad press much like psychosurgery did. There were cases publicized of it being administered improperly. The news would boast examples of ECT being used as a means of punishment for patients in mental institutions with chronic behavior problems. At times these treatments were even administered without proper anesthetics or restraints. In 2007, a judge canceled a two-year-old court order that allowed the involuntary electroshock of Simone D., a psychiatric patient at Creedmoor Psychiatric Center in the state of New York.51 Although Simone spoke only Spanish, she rarely received access to staff fluent in her language.52 Simone previously had 200 electroshocks. However, she communicated that she did not want more electroshock. Simone stated, "Electroshock causes more pain. I suffer more from shock treatment! " In 2008, David Tarloff, a psychiatric patient who had received electroshock, assaulted two therapists in the city of New York. Tarloff injured one therapist and killed the other. One of the therapists was Kent Shinbach, a psychiatrist who had an interest in electroconvulsive therapy. "It is not clear whether Dr. Shinbach played any role in Mr. Tarloff's shock therapy". However, Tarloff told investigators that Shinbach had given Tarloff psychiatric treatment at a psychiatric facility initially in 1991.

Other descriptions In an interview with Houston Chronicle in 1996, Melissa Holliday, a former extra on Baywatch and model for Playboy stated the ECT she received in 1995, "ruined her life." She went on to state, "I've been through a rape, and electroshock therapy is worse. If you haven't gone through it, I can't explain it."

Historical Accounts Ernest Hemingway, American author, committed suicide shortly after ECT at the Mayo Clinic in 1961. He is reported to have said to his biographer, "Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient...."53 In a poem, The Hanging Man, by Sylvia Plath ECT is described: 1. By the roots of my hair some god got hold of me. 2. I sizzled in his blue volts like a desert prophet. 51MindFreedom International. Another victory against forced electroshock. Simone D. wins! August 28, 2007. Accessed: April 18, 2008. 52Lauren Tenney. Testimony from Lauren Tenney, Member of FUTURE Views and the Mental Patients Liberation Alliance. New York State Office of Mental Health, October 5, 2007. Accessed: April 18, 2008. 53A. E. Hotchner, Papa Hemingway: A Personal Memoir, ISBN 0-7867-0592-2; pg 280

3. The nights snapped out of sight like a lizard's eyelid: 4. A world of bald white days in a shadeless socket. 5. A vulturous boredom pinned me in this tree. 6. If he were I, he would do what I did.

Public perception and mass media A questionnaire survey of 379 members of the general public in Australia indicated that more than 60% of respondents had some knowledge about the main aspects of ECT. Participants were generally opposed to the use of ECT on depressed individuals with psychosocial issues, on children, and on involuntary patients. Public perceptions of ECT were found to be mainly negative.

Fictional examples Electroconvulsive therapy has been depicted in fiction and works based on true experiences. These include A Clockwork Orange, The Snake Pit, Quantum Leap, Stargate, Frances, Requiem for a Dream, the novel One Flew Over the Cuckoo's Nest by Ken Kesey as well as the movie adaptation, the literary works of Janet Frame, Melrose Place, A Beautiful Mind, The Caretaker, The Best of Youth, House; The Bell Jar by Sylvia Plath, Shine, the movie adaptation of The Beverly Hillbillies, the film version of Girl, Interrupted, Insanitarium, Changeling, Ciao! Manhattan, Next to Normal, Return to Oz, Private Practice, Ghost Whisperer, Shutter Island, From Beyond, the novel Zen and the Art of Motorcycle Maintenance, Helen, Oz, Six Feet Under, House on Haunted Hill, Royal Pains, The Wolfman, Homeland, Wrong Turn 4, Constantine, The A-Team (2010 Film), Cold Case,Supernatural, General Hospital, American Horror Story: Asylum and Mad Men. It is also referred to in the lyrics of the Eels, The Mars Volta, Morrissey and Public Image Limited.

External links •Position Statement on Electroconvulsive Therapy (ECT) [PDF] – from the American Psychiatric Association. •MIND on ECT – information on ECT from MIND (leading mental health charity in England and Wales). •About to have ECT? ... – Psychiatric Times article on the portrayal of ECT by Hollywood •ECT - information from mental health charity The Royal College of Psychiatrists

Electroencephalography EEG Intervention

An EEG recording at Dalhousie University ICD-9-CM

89.14

MeSH

D004569

OPS-301 code:

1-207

Electroencephalography (EEG) is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain. In clinical contexts, EEG refers to the recording of the brain's spontaneous electrical activity over a short period of time, usually 20–40 minutes, as recorded from multiple electrodes placed on the scalp. Diagnostic applications generally focus on the spectral content of EEG, that is, the type of neural oscillations that can be observed in EEG signals. In neurology, the main diagnostic application of EEG is in the case of epilepsy, as epileptic activity can create clear abnormalities on a standard EEG study.54 A secondary clinical use of EEG is in the diagnosis of coma, encephalopathies, and brain death. A third clinical use of EEG is for studies of sleep and sleep disorders where recordings are typically done for one full night, sometimes more. EEG used to be a first-line method for the diagnosis of tumors, stroke and other focal brain disorders, but this use has decreased with the advent of anatomical imaging techniques with high (