Agitated Depression; The Challenges in Management and the Role of Maintenance Electroconvulsive Therapy

This case report highlights the challenges encountered and the role of maintenance electroconvulsive therapy (ECT) in the management of a depressed patient who presented with symptoms of agitation. Despite on an adequate dosage and duration of medications, the patient showed poor improvement and persistent agitation. Upon commencing maintenance ECT in addition to the pharmacotherapy, the patient’s condition markedly improved. As conclusion, maintenance ECT may be another option in managing agitated depression.

The Effectiveness of Auricular Acupuncture on the Levels of Cortisol in a Depressed Patient

The article's abstract is no available.

‘Delusional’ consent in somatic treatment: the emblematic case of electroconvulsive therapy

Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient’s inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the ’error’ committed for which the depressed patient blames himself and the social repression of the maniacal patient’s affirmation of his inflated self-esteem.