Stigma Influences Seeking Mental Health Care

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University of Perpetual Help System DALTA Alabang, Zapote Road, Pamplona, Las Pinas City College of Nursing

Electroconvulsive Therapy in Pediatric Psychiatry
30 May 2011 By Radhika Takru, MA | Editor Shaheen E Lakhan Electroconvulsive therapy (ECT) is a controversial practice of dealing with mental disorders and one that has attracted its fair share of detractors. Despite the fact that it was first used as long ago as 1938, it still carries with it a stigma that some find difficult to overlook. One might believe this method is one as harebrained as those employed in the middle ages to rid people of the demons that had possessed their minds. Unlike holes drilled into the skull, the use of ECT as a form of psychiatric treatment has continued into the present day. However, the ethical questions and legislations governing its practice mean that its use in the resolution of the severe symptoms of mental disorders in children is bound to be a delicate topic. In recent years, the research on the effective ECT has been extended to its application in pediatrics. A recent study provides hope that the may be beneficial in the treatment of the more severe symptoms of autism as well as mood disorders in children. This study, undertaken by Wachtel, Jaffe and Kellner, examined the effectiveness of pediatric ECT in treating the symptoms exhibited by an autistic prepubescent boy with bipolar affective disorder. The 11-year-old child had been diagnosed with autism when he was two and a half years old. This combined with his unpredictable mood swings had resulted in him behaving aggressively towards his own family and caregivers. However the damage meted out to those who looked after him in no way compared to that he inflicted on himself. Photographs included with the research show the child with his face and hands bloodied from self-abuse. A slew of pharmaceuticals prescribed to subdue these symptoms had no discernible effect on his behavior. As an inpatient, he was put on a new combination of drugs that led to some improvement but the violent symptoms returned in full force shortly after he was discharged. It was possibly the severity of the situation that led to his case being accepted as a candidate for pediatric ECT. Eight ECT treatments were conducted on a three-times-a-week basis. By the fourth treatment, the child who had been unable to go to school or interact with other children due to e safety concernsf and needed two adult supervisors around him at all times, could now enjoy family outings and community interaction. He was reported to be e happy and calmf and, for what might have been the first time, could sleep soundly through the night. The paper closes with a recent picture of this boy we know only as J., sliding down a tunnel in a public playground smiling broadly for the camera. Following the end of J.d s ECT treatment he still required e maintenancef ECT on a weekly or fortnightly basis to prevent the symptoms from returning. While his therapists work on weaning him off the treatment entirely, his parents and carers continue to report on his ever-increasing cache of achievements, most recently spending five days away at summer camp. Lee Wachtel has done some extensive work in the field of autism and the catatonic symptoms that accompany it in its more severe forms. She tends to focus her research on disorders that affect children and adolescents and the effectiveness of ECT on cases that are exceptionally severe. In addition to this study, Wachtel

together with Griffin, Dhossche and Reti also put together a paper documenting their work with 14 year old autistic boy who was exhibiting the standard symptoms of catatonia including waxy flexibility, mutism and unresponsiveness. In this case, the symptoms were non-violent but more resistant to treatment. A number of variants of electroconvulsive therapy were utilized before a change in behavior was evident. However, those changes in behavior include independent performance of all activities of daily living, an active return to academics via home-schooling, and participation in sports including running, swimming, basketball and even horse-riding as a component of equine therapy. The use of ECT in pediatrics is inadequately researched, not just because of the stigma associated with the practice,, but also because of legislation that governs the administration of this form of therapy on minors due to ethical concerns. In addition, Croarkin et al say that most psychologists who deal with adolescent and child psychiatry are not sufficiently trained in the use of ECT. Even more sparsely researched are the long term effects of ECT on its recipients. Though a handful of longitudinal studies do exist that attempt to cover this, the standard of the research methods employed remains ambiguous. Studies such as those conducted by Wachtel and others like her demonstrate the almost immediate benefits ECT has to offer in the field of pediatric mental health. However the question remains as to whether these benefits will hold in the long run without causing in any additional damage to the brain. Unfortunately, the answer is one we will have to wait for, but till then we can hope. Reference : http://brainblogger.com/2011/05/30/electroconvulsive-therapy-in-pediatric-psychiatry/

Summary : Electroconvulsive therapy (ECT) is a controversial practice of dealing with mental disorders and one that has attracted its fair share of detractors. Despite the fact that it was first used as long ago as 1938, it still carries with it a stigma that some find difficult to overlook. the ethical questions and legislations governing its practice mean that its use in the resolution of the severe symptoms of mental disorders in children is bound to be a delicate topic.In recent years, the research on the effective ECT has been extended to its application in pediatrics. A recent study was conducted to find treatment for mental disorders in children. This study undertaken by Wachtel, Jaffe and Kellner, examined the effectiveness of pediatric ECT in treating the symptoms exhibited by an autistic prepubescent boy with bipolar affective disorder. The 11-year-old child had been diagnosed with autism when he was two and a half years old. with his unpredictable mood swings had resulted in him behaving aggressively. Photographs included with the research show the child with his face and hands bloodied from self-abuse.A slew of pharmaceuticals prescribed to subdue these symptoms had no discernible effect on his behavior. It was possibly the severity of the situation that led to his case being accepted as a candidate for pediatric ECT.ECT treatments were conducted on a three-times-a-week basis. By the fourth treatment, the child who had been unable to go to school or interact with other children due to e safety concernsf and needed two adult supervisors around him at all times, could now enjoy family outings and community interaction. . He was reported to be e happy and calmf and, for what might have been the first time, could sleep soundly through the night. . Following the end of J.d s ECT treatment he still required e maintenancef ECT on a weekly or fortnightly basis to prevent the symptoms from returning. While his therapists work on weaning him off the treatment entirelyDhossche and Reti also put together a paper documenting their work with 14 year old autistic boy who was exhibiting the standard symptoms of catatonia including waxy flexibility, mutism and unresponsiveness. , the symptoms were non-violent but more resistant to treatment. A number of variants of electroconvulsive therapy were utilized before a change in behavior was evident. However, those changes in behavior include independent performance of all activities of daily living, an active return to academics via home-schooling, and participation in sports including running, swimming, basketball and even horse-riding as a component of equine therapy.The use of ECT in pediatrics is inadequately researched, not just because of the stigma associated with the practice,, but also because of legislation that

governs the administration of this form of therapy on minors due to ethical concerns. . Studies such as those conducted by Wachtel and others like her demonstrate the almost immediate benefits ECT has to offer in the field of pediatric mental health.

REACTION
According to the article e Electroconvulsive therapy (ECT) is a controversial practice of dealing with mental disorders and one that has attracted its fair share of detractorsf , meaning many people are opposing to the said treatment because of some ethical issues and concerns. As a nursing student and with a current exposure in the mental ward, I somehow have ideas regarding the treatment as what our clinical instructor and lecturer have discussed, all therapeutic regimens and medications being done before a patient can be a candidate for ECT. I never heard of a pediatric client being subjected to an ECT, and thinking about it, I myself would not agree, merely because I think of them as vulnerable patients and I am not sure if they can stand such treatment, BUT, after reading this article, it is stated there that there are several research and studies done concerning pediatric patients that are candidate for ECT, and it came out well, though the study was not elaborated that much in the article, for me, if the treatment would benefit the child weigh more than putting the child in risk, I would agree to the said treatment. Every treatment though has some risk and we do weigh benefit over risk. Mentally ill patients may be happy in their own world where they are accepted, it still better if they would know reality which would make them whole as a person.

Submitted by : Charmine Mae R. Lorenzo BSN 4F, Grp 3

Learning Feedback Diary

Is it a day of ambivalence for almost all of us assigned in mental ward, nervous, excited, anxious, happy, these mixed emotions is how I best describe how I am feeling that day. It is far from usual, far from a normal hospital ward. When we were there in the orientation we were taught about some therapeutic communications, as well as we are oriented to the place and to people in the area. On our duty day we were all assisted by our beautiful clinical instructor we proceed to the pre-orientation phase in which we developed self awareness,and then we were assigned us to our patients. Then we proceed to the orientation phase in which we interacted with patients. That day I learned that not all mentally ill patients are violent. I interacted with my patient and tried to gain his trust. He do respond to my questions, I did made a contract with him as well, specifically the non suicidal contract, and did agree and with that I fell better. I as well told him already the information regarding the termination. On the next day, it was Friday, we did the same routine, but sadly my patient is sleepy, and manifesting short attention span, that day I learned how to catch my patient·s attention and was able to talk to him still. We ended the day again happy and full of learnings. The following week, we had our grand socialization day, we extend our appreciation to our patient and thank them for a wonderful experience full of learnings and good memories. it is really sad say to say goodbye, but what·s good in good-bye is that.. goodbyes are not the end, but a start of another good memories in our lives.

Submitted by : Charmine Mae R. Lorenzo

BSN 4F, Grp 3

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