Model for ethical triaging of electroconvulsive therapy patients during the COVID-19 pandemic

BJPsych Bulletin ◽

10.1192/bjb.2020.99 ◽

2020 ◽

pp. 1-4

Author(s):

Phern-Chern Tor ◽

Jacinta Tan ◽

Colleen Loo

Keyword(s):

Electroconvulsive Therapy ◽

Mental Illnesses ◽

Ethical Framework ◽

Medical Resources ◽

Resource Limitations

Summary Electroconvulsive therapy (ECT) is an essential treatment for severe mental illnesses such as depression with suicidality and catatonia. However, its availability is being threatened by resource limitations and infection concerns due to the COVID-19 pandemic. This may necessitate the triage of patients for ECT but there is no established ethical framework to prioritise patients. We offer an application of an ethical framework for use of scare medical resources in the ECT setting.

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An international perspective on the acceptability and sustainability of electroconvulsive therapy

BJPsych International ◽

10.1192/s2056474000000891 ◽

2016 ◽

Vol 13 (1) ◽

pp. 10-12 ◽

Cited By ~ 2

Author(s):

Daniel Maughan ◽

Andrew Molodynski

Keyword(s):

Effective Treatment ◽

Electroconvulsive Therapy ◽

International Perspective ◽

Mental Illnesses ◽

Robust Evidence

There is robust evidence that electroconvulsive therapy is an effective treatment for some mental illnesses. Despite this, its use remains controversial and is declining in some countries, with a consequent loss of skills and knowledge. This, and the view of it as a ‘treatment of last resort’, may undermine its sustainability.

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Informing the Gestalt: An Ethical Framework for Allocating Scarce Federal Public Health and Medical Resources to States During Disasters

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2014.9 ◽

2014 ◽

Vol 8 (1) ◽

pp. 79-88 ◽

Cited By ~ 7

Author(s):

Ann R. Knebel ◽

Virginia A. Sharpe ◽

Marion Danis ◽

Lauren M. Toomey ◽

Deborah K. Knickerbocker

Keyword(s):

Public Health ◽

Decision Making ◽

Logic Model ◽

Ethical Framework ◽

Decision Making Process ◽

State Governments ◽

Medical Resources ◽

Individual Patient Level ◽

Federal Leaders ◽

The Individual

AbstractDuring catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters. (Disaster Med Public Health Preparedness. 2014;0:1–10)

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Decreased Clostridium Abundance after Electroconvulsive Therapy in the Gut Microbiota of a Patient with Schizophrenia

Case Reports in Psychiatry ◽

10.1155/2019/4576842 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Misako Kanayama ◽

Maiko Hayashida ◽

Sadayuki Hashioka ◽

Tsuyoshi Miyaoka ◽

Masatoshi Inagaki

Keyword(s):

Gut Microbiota ◽

Electroconvulsive Therapy ◽

Pharmacological Treatment ◽

Antipsychotic Drugs ◽

Bacterial Flora ◽

Mental Illnesses ◽

Healthy Individuals ◽

First Report ◽

Therapeutic Mechanisms

Relationships between gut microbiota and various disease pathogeneses have been investigated, but those between the pathogeneses of mental illnesses, including schizophrenia, and gut microbiota have only recently attracted attention. We observed a change in the gut microbiota of a patient with schizophrenia after administering electroconvulsive therapy (ECT). A 59-year-old woman was diagnosed with schizophrenia at 17 years of age and has been taking antipsychotic drugs since the diagnosis. Clostridium, which occupied 86.5% of her bacterial flora, decreased to 72.5% after 14 ECT sessions, while Lactobacillus increased from 1.2% to 5.5%, and Bacteroides increased from 9.1% to 31.5%. Previous studies have shown that Clostridium spp. are increased in patients with schizophrenia compared with those in healthy individuals and that Clostridium is reduced after pharmacological treatment. Our report is the first report on the gut microbiota of a patient with schizophrenia receiving ECT. Our results indicate that studies focusing on Clostridium to clarify the pathogenesis of schizophrenia as well as potential therapeutic mechanisms may be beneficial. However, further studies are needed.

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Whom Should Be Saved? A Proposed Ethical Framework for Allocating Scarce Medical Resources to COVID-19 Patients Using Fuzzy Logic

Frontiers in Medicine ◽

10.3389/fmed.2021.600415 ◽

2021 ◽

Vol 8 ◽

Author(s):

Heba Saadeh ◽

Maha Saadeh ◽

Wesam Almobaideen

Keyword(s):

Fuzzy Logic ◽

Fuzzy Inference ◽

Main Idea ◽

Disease Status ◽

Relevant Information ◽

Ethical Principles ◽

Ethical Framework ◽

Modern World ◽

Medical Resources ◽

Inference Systems

COVID-19 is a global pandemic that affected the everyday life activities of billions around the world. It is an unprecedented crisis that the modern world had never experienced before. It mainly affected the economic state and the health care system. The rapid and increasing number of infected patients overwhelmed the healthcare infrastructure, which causes high demand and, thus, shortage in the required staff members and medical resources. This shortage necessitates practical and ethical suggestions to guide clinicians and medical centers when allocating and reallocating scarce resources for and between COVID-19 patients. Many studies proposed a set of ethical principles that should be applied and implemented to address this problem. In this study, five different ethical principles based on the most commonly recommended principles and aligned with WHO guidelines and state-of-the-art practices proposed in the literature were identified, and recommendations for their applications were discussed. Furthermore, a recent study highlighted physicians' propensity to apply a combination of more than one ethical principle while prioritizing the medical resource allocation. Based on that, an ethical framework that is based on Fuzzy inference systems was proposed. The proposed framework's input is the identified ethical principles, and the output is a weighted value (per patient). This value can be used as a rank or a priority factor given to the patients based on their condition and other relevant information, like the severity of their disease status. The main idea of implementing fuzzy logic in the framework is to combine more than one principle when calculating the weighted value, hence mimicking what some physicians apply in practice. Moreover, the framework's rules are aligned with the identified ethical principles. This framework can help clinicians and guide them while making critical decisions to allocate/reallocate the limited medical resources during the current COVID-19 crisis and future similar pandemics.

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Old people and ECT: what difficulties are encountered in obtaining anaesthetics for the elderly?

Psychiatric Bulletin ◽

10.1192/pb.15.6.324 ◽

1991 ◽

Vol 15 (6) ◽

pp. 324-325

Author(s):

Susan M. Benbow

Keyword(s):

Elderly Patients ◽

Elderly People ◽

Old Age ◽

Electroconvulsive Therapy ◽

Mentally Ill ◽

Late Life ◽

The Elderly ◽

Mental Illnesses ◽

Old People ◽

Physical Problems

Since developing an interest in the use of electroconvulsive therapy (ECT) in late life, I have received correspondence from psychiatrists describing difficulties in obtaining anaesthetics for elderly patients who are perceived as frail or physically unwell. Nevertheless, Pippard & Ellam (1981) found in their survey of the use of ECT in 1980 that 37% of courses were given to people aged 60 years and over. I decided to survey old age psychiatrists' views on ECT, and to look at difficulties encountered in obtaining anaesthetics. Old age psychiatrists specialise in the care of mentally ill elderly people and are dealing with patients who are particularly likely to have physical problems in addition to mental illnesses. Their experience of ECT is therefore of wider relevance to all who prescribe ECT for elderly or physically ill people.

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A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000211 ◽

2013 ◽

Vol 41 (1) ◽

pp. 69-74 ◽

Cited By ~ 10

Author(s):

Frank Häßler ◽

Olaf Reis ◽

Steffen Weirich ◽

Jacqueline Höppner ◽

Birgit Pohl ◽

...

Keyword(s):

Case Report ◽

Treatment Response ◽

Electroconvulsive Therapy ◽

Rating Scale ◽

Combined Treatment ◽

Adolescent Patient

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

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