Kommentar fra Arve Kirkevik til forskning på ECT

Eg har lese studien på 96 sider – peikar frå forskning.no:

Det er trist å lesa at psykiatrien framleis underkjenner røynslene frå dei mange ofra som får permanente skadar på hugset etter elektrosjokkbehandling.

Side 30-31
In addition to a reduced ability to encode and store new memories, ECT can result in a temporarily reduced ability to retrieve old memories. The degree of impairment can vary over the treatment pe-riod. Some patients have longstanding memory gaps throughout the treat-
ment period, and both the disease and the treatment could contribute to this phenomenon.
Some cognitive functions, including attention and concentration, tend to
improve during treatment in parallel with reduction of disease symptoms.

A recent meta-analysis showed that objective memory functions were restored within two weeks of treatment (137). Although some studies indicate that subjective memory impairments can remain for longer periods of time (34), most patients do not show any residual impairments by two to six months after the completion of treatment (138). However, even if there are no evident objective dysfunctions, temporary anterograde amnesia
during the treatment period could influence confidence in memory, and decreased confidence in memory functions may affect the subjective perception of memory (151).  influence confidence in memory, and decreased confidence in memory functions may affect the subjective perception of memory (151).

Retrograde amnesia
Neuropsychologists evaluate retrograde amnesia by testing functions important for retrieval of long-term memory (67). A recent meta-analysis concluded that there were no long-lasting impairments in these functions after ECT at the group level (137). However, some patients reported retrograde amnesia after ECT. Memories from time points around the treatment
periods are most vulnerable. However, a causal link is difficult to demonstrate from these case reports.  Sitat slutt.

Elektrosjokkofra sine røynsler vert altså reduserte til «case reports» som sjokklækjarane ikkje legg vekt på. Det er påfallande, med tanke på at Axel Nordenskjöld presenterte ei solskinnshistorie i artikkelen sin:

Side 17
I would like to share a personal anecdote that contributed to my continuing interest in electroconvulsive therapy (ECT). One of the patients I met early during my time in the psychosis department had been in compulsory inpatient care for more than one year. The patient did not speak, laid on the floor for several hours each day with a pillow over her head and occasionally started shouting and waving her arms. She had an earlier diagnosis of bipolar disorder, but her current diagnosis was “psychosis”. Several hospitalisations had been necessary after lithium treatment had been terminated due to a reduction in renal capacity. In the previous year, antidepressant medications and intramuscular antipsychotics were administered, but the patient’s status was deteriorating. The situation became urgent
when the patient stopped eating and drinking. ECT was recommended for psychotic depression with catatonia. The patient fiercely resisted and had to be escorted by four persons to the ECT treatment. After the first treatment, the patient was calm, started to eat and drink, and slept for more than twelve hours. The patient cooperated fully during the following
treatments. Within two weeks she had completely recovered. Afterwards, the patient and her family were very grateful for the ECT and for being able to celebrate Christmas together.
Sitat slutt.

Så brukarrøynsler er gangbar mynt når det (ifylgje psykiatrien) går bra – då skal det tilskrivast elektrosjokka, men ikkje når det øydelegg hugset og livet til folk, då er det berre «case report» som det ikkje vert lagt vekt på.

Harold Sackeim sin vidgjetne studie «The cognitive effects of electroconvulsive therapy in community settings» (nr. 127 på referanselista) omtalar Nordenskjöld slik:

Side 31
In one observational study, there was a dose-response relation between the number of treatments with bilateral electrode placement and memory performance as assessed with an autobiographical memory inventory short form at six months after treatment (127). However, this questionnaire has been criticised and is not validated (139). The answers given in the de-
pressed state before ECT are recorded. All later deviations from the pre-treatment answers are considered incorrect. Therefore, the patients cannot improve their performance after ECT. If something is remembered incorrectly in a depressed and confused state, but is remembered differently and clearly in a non-depressed state, then the score is zero points. This type of
construction risks that the association between the performance on the questionnaire and the different treatment intensities is biased by the severity of the disease. Therefore, although this study is interesting and widely cited, there is no firm evidence that retrograde amnesia occurs after ECT.
Sitat slutt.

Altså, når ein studie påviser skadar på hugset, vert han underkjent som «no firm evidence». Og når studiar med slike resultat vert underkjende, konkluderer dei slik når det kjem resultat som dei soknar etter:

Side 31
In fact, the results from a controlled trial indicated that long-term memory functions are similar in patients treated with ECT and patients treated pharmacologically. The authors of this trial concluded that potential memory problems are not a reason to refrain from ECT (145).
Sitat slutt.

Det verste med Nordenskjöld sin studie, er at han tilrår vedlikehaldsbehandling med elektrosjokk over lengre tid og i tillegg litium og antidepressiva for å unngå tilbakefall til depresjon etter ein serie med elektrosjokkbehandlingar. Med ei slik grotesk behandling er det ikkje rart det ikkje vert mange symptom att – det vert jo ikkje rom for å tenkja og føla noko som helst!

Den gamle lygna om at det er (berre) depresjonen (og ikkje elektrosjokk) som er årsaka til minneproblema, er tidlegare tilbakevist av Harold Robertson and Robin Pryor i artikkelen «Memory and cognitive effects of ECT: informing and assessing patients» i tidsskriftet Advances in Psyhiatric Treatment:

«People who have experienced the effects of both depression and ECT rarely mistake one for the other (Food and Drug Administration, 1982; Donahue, 2000): ECT’s effects are different and worse, they occur only after ECT and they persist in the absence of depression and drugs.» jf. link 1) nedanfor.

Alle referansane under er gamle.
Cognitive rehabilitation: assessment and treatment of persistent memory impairments following ECT
Maeve A. Mangaoang and
Jim V. Lucey:

Final Report
January 2002
Review of Consumers’ Perspectives On Electro Convulsive Therapy
Service User Research Enterprise (SURE)
Institute of Psychiatry
Commissioned by Department of Health:

International Journal of Risk & Safety in Medicine 11 (1998) 5–40 5
IOS Press
Electroshock: scientific, ethical, and
political issues:
Peter R. Breggin
Dr. Peter Breggin
Posted: April 1, 2007 06:46 PM
Disturbing News for Patients and Shock Doctors Alike

Response to Drs
Abrams and Kellner

Harold A. Sackeim, PhD
Joan Prudic, MD
Mark Olfson, MD

Shock Treatment: Efficacy, Memory Loss,
and Brain Damage – Psychiatry’s
Don’t Look, Don’t Tell Policy
Richard A. Warner
Email: windwarner@msn.com:

J ECT. 2008 Mar;24(1):40-5..
Neurobiological correlates of the cognitive side effects of electroconvulsive therapy.
Nobler MS, Sackeim HA.

J ECT. 2000 Jun;16(2):110-20.
Electrophysiological correlates of the adverse cognitive effects of electroconvulsive therapy.
Sackeim HA, Luber B, Moeller JR, Prudic J, Devanand DP, Nobler MS.

For Informasjonssenteret Hieronimus,
venleg helsing Arve Kirkevik

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