Information And Consent Form For Electro-Convulsive Therapy (ECT)

REASONS FOR TREATMENT, LIKELIHOOD OF A SUCCESSFUL RESPONSE, AND TREATMENT ALTERNATIVES.

Dr. Benjamin Franklin has recommended that I receive treatment with electroconvulsive therapy (ECT). ECT has been shown to be an effective treatment for a number of conditions. ECT is most commonly used to treat patients with severe depressions. For some patients it may be the safest, fastest, and most effective treatment available for this illness.

Treatment of depression has improved remarkably over the past twenty-five years. The techniques of administering ECT have also improved considerably since its introduction. During the ECT procedure, a small amount of electrical current is passed through the brain. That current induces a seizure that affects the entire brain, including the parts that control mood, appetite, and sleep. ECT is believed to correct biochemical abnormalities that underlie severe depressive illness. (ECT may also be used in the treatment of patients with manic-depressive illness and in selected patients with schizophrenia or related disorders.)

I agree to receive ECT to treat my psychiatric condition. I understand that there may be other alternative treatments for my condition which may include medications and psychotherapy. I also understand that medications and/or psychotherapy may be necessary following the course of ECT in order to sustain the improvement.

This would be a good place to be honest about the temporary nature of ECT, and that if medications and other treatments don't work on follow-up, maintenance ECT will be advised.

Whether ECT or an alternative treatment is most appropriate for me depends on my prior experience with these various treatments, the nature of my psychiatric condition, and other considerations such as drug intolerance or the state of my physical health. I understand that the likelihood of success with electroconvulsive therapy depends upon my specific condition. All of my symptoms may not respond to the treatment. Dr. Franklin has specifically discussed the likelihood of a successful outcome in my condition, and which symptoms he believes will respond to the treatment. The alternatives to ECT treatment include: No treatment; use of other medications; continuation of treatment with current medications; various forms of psychotherapy; and/or social therapies (such as family or vocational counseling). The probable degree and duration of improvement or remission expected with and without such treatment have been discussed with me.

I would like to think that Dr. Franklin has truly discussed the alternatives, the possible outcomes of ECT and the expectations of success. But, in reality, when psychiatric appointments are often limited to 15 minutes every few weeks, is this a realistic statemtent? I'm afraid that this informed consent statement, when given, is *the* educational series offered. And it's often given (when given) once the person has made up his/her mind, and is already in hospital.

I UNDERSTAND THE ABOVE INFORMATION, AND HAVE DISCUSSED WITH DR. Franklin THE REASONS FOR TREATMENT, THE LIKELIHOOD OF A SUCCESSFUL OUTCOME, AND TREATMENT ALTERNATIVES.

(patient initials here)

THE PROCEDURE FOR ECT TREATMENT

Before ECT begins, my medical condition will be assessed with a general medical history, physical examination, laboratory tests including blood tests and an electrocardiogram. ECT involves a series of treatments. To receive each treatment I will be brought to a specifically equipped room at XYZ Hospital. Because the treatments involve general anesthesia, I will have had nothing to eat or drink for at least seven hours before each treatment. When I come to the treatment room, a needle will be placed into a vein so that I can be given medications. I will be given an anesthetic drug that will put me quickly to sleep. I will then be given a drug that will paralyze my muscles. I may be given other medications to increase the effectiveness of the procedure or to reduce and control complications that arise from the procedure, as deemed appropriate by Dr. Franklin. Because I will be fully anesthetized, I will not experience pain or discomfort during the procedure. I will not feel the electrical current.

To prepare for the treatments, a blood pressure cuff will be placed on one of my limbs and monitoring sensors may be placed on my head and other parts of my body. This is done to monitor my blood pressure, my brain waves, my electrocardiogram and the level of oxygen in my blood, before, during and after the treatment. These recordings involve no pain or discomfort. I will be given oxygen to breathe, before, during and after the treatment. I will receive either bilateral or unilateral ECT, depending upon where the electrodes are placed. In bilateral ECT, one electrode is placed on the left side of the head, the other on the right side. In unilateral ECT, both electrodes are placed on the same side of the head.

Shouldn't the patient know beforehand whether s/he is receiving bilateral or unilateral ECT?

After I am fully asleep, a small, carefully controlled amount of electricity will be passed between two electrodes that have been placed on my head. When the current is passed, a generalized seizure is produced in the brain. Because I will have been given medications to relax my muscles, muscular contractions in my body that would ordinarily accompany a seizure will be minimal or absent. The seizure will last for approximately forty seconds to two minutes. Within a few minutes following the seizure, the anesthetic drug will wear off and I will awaken. After awakening from the anesthesia, I will be observed by specially trained, professional nursing staff until it is time to leave the treatment area.

I UNDERSTAND THE INFORMATION DESCRIBING THE ECT TREATMENT AS PRESENTED ABOVE, AND DR. FRANKLIN HAS ANSWERED MY QUESTIONS ABOUT THE PROCEDURE.

(patient initials here)

NUMBER OF TREATMENTS AND POSSIBLE MEDICAL SIDE EFFECTS

The exact number of treatments I receive cannot be predicted ahead of time. The number of treatments will depend on my psychiatric condition, how quickly I respond to the treatment, and the medical judgment of Dr. Franklin. Typically, six to twenty treatments are given. However, some patients respond slowly and more treatments may be required. Treatments are usually given two or three times a week, but the frequency of the treatments may vary depending on needs. Regarding the illness for which ECT is being recommended-as with all other forms of medical treatment, some patients recover quickly, some patients achieve only a partial recovery, some patients recover only to relapse again and require further treatment, while still others fail to respond at all.

This is so honest. I like it. How many doctors are this honest?

Like other medical procedures, ECT involves some risks. When I awaken after each treatment, I may experience some confusion. The confusion usually goes away within an hour. Shortly after the treatment, I may have a headache, muscle soreness, or nausea. These side effects usually respond to simple treatment. More serious medical complications from ECT are rare. With modern ECT techniques, dislocations or bone fracture, and dental complications very rarely occur. As with any general anesthetic procedure, there is a remote possibility of death. It is estimated that fatality associated with ECT occurs approximately 4 per 100,000 treatments (or 1 per 10,000 patients). While rare, the most common medical complications from ECT are irregularities in heart rate and rhythm and elevations of blood pressure. On very rare occasions patients may develop prolonged or spontaneous seizures between and after treatments.

I UNDERSTAND THE INFORMATION PRESENTED ABOVE AND HAVE DISCUSSED WITH DR. FRANKLIN THE NUMBER OF TREATMENTS THAT MAY BE NEEDED AND THE POSSIBLE MEDICAL SIDE EFFECTS.

(patient initials here)

POSSIBLE CONFUSION AND MEMORY LOSS

Many patients experience permanent loss of some memories with ECT.

A round of applause!!!

There is no consistent evidence that properly conducted ECT causes permanent brain damage. The degree of reduction of memory is likely to be related to the number of treatments given and their type. A smaller number of treatments is likely to produce less memory impairments than a larger number of treatments. Unilateral ECT (two electrodes on one side of the head) is likely to produce milder and shorter lived memory impairments than that following bilateral ECT (one electrode on each side of the head). However bilateral treatments are more certain to produce the quickest therapeutic response.

The memory difficulties with ECT have a characteristic pattern. Shortly following a treatment the problems with memory are most pronounced. As time from treatment increases, memory functioning improves. Shortly after the course of ECT, I may experience difficulties remembering events that happened before and while I received ECT. This spottiness in memory for past events may extend back to several months before I received ECT, and in rare instances to one to two years. Many of those memories will return during the first several weeks to months following the ECT course. However, I may be left with some permanent gaps in memory, particularly for events that occurred close in time to the ECT course.

Attention, language and other higher functions of thinking, including reasoning, ability to perform calculations, social awareness, judgement, comprehension, abstract thinking as well as visual/motor and perceptual skills, will be unaffected after recovery from the acute treatment course.

This is a blanket statement that may be incorrect. Many patients have reported problems in this area, and therefore, it should be noted in a true informed consent statement that these problems may occur.

However, for a short period following the ECT, I may experience difficulty in learning and remembering new information. This difficulty in forming new memories is usually temporary and will most likely subside within several weeks following the ECT course. Individuals may vary considerably in the extent to which they experience confusion and memory problems during and shortly following treatment with ECT. However, in part because psychiatric conditions themselves produce impairments in learning and memory, many patients actually report that their learning and memory functions improved after ECT compared to their functioning prior to the treatment course.

A small minority of patients, perhaps 1 in 200, reports severe problems that remain for months or even years.

  Here's where the real problems with this form begin! This figure, 1 in 200, comes from Dr. Max Fink, considered one of the top researchers in the field. He recently admitted that he got the figure from a survey he did, advertising in newspapers for participants in the survey.

While I'm not against that kind of sampling method, Dr. Fink has acknowledged that he "cannot remember" which newspapers he placed the ads in, what years, and he does not have the surveys anymore. Dr. Fink has said this sworn under oath. This is not heresay, and I will be putting the testimony in these pages when it arrives.

This kind of scientific mayhem is disturbing, especially when the APA quotes this statistic widely, and the stat is considered gospel. Yet in going to the original research...he cannot remember, nor does he have the original information. It's called pathetic science, if it's science at all. It could be making a number up in his head. Regardless, it's outrageous and the APA should question his methods and his honesty.

When dealing with such serious after-effects of ECT, these statistics need to be well documented. I publicly call on Dr. Max Fink to explain himself. Max, you may write me here.

The reasons for these rare reports of long lasting impairment are not fully understood. Because of the possible problems with confusion and memory, it is important that I not make any important personal or business decisions during the course of ECT or immediately following the course.

I have never heard of a doctor telling this to a patient. It needs to be told. There are tales of people who have unknowingly engaged in all kinds of unusual behavior, including putting themselves at high risk of AIDS.

This may mean postponing decisions regarding family or financial matters. After the treatment course, I will begin a "convalescence period", usually one to three weeks, which varies from patient to patient. During this period I should refrain from driving, transacting business, or other activities for which impairment of memory may be problematic, unless so advised by Dr. Franklin.

I UNDERSTAND THE INFORMATION PRESENTED ABOVE AND HAVE DISCUSSED WITH DR. FRANKLIN THE POSSIBLE CONFUSION AND MEMORY LOSS I MAY HAVE.

(patient initials here)

OFFICIAL/LEGAL CONSENT FOR ELECTROCONVULSIVE THERAPY

The ECT will be conducted by Dr. Benjamin Franklin, (a board certified psychiatrist with approved privileges for the performance of ECT) or by his designee.

I consent to xxx number of treatments between (starting date) and (ending date). The above period of time does not exceed 30 days.

While electroconvulsive therapy is a widely accepted form of treatment, I understand that there does remain, in the medical community, some controversy regarding its use.

BRAVO for honesty!

I understand the information presented in this consent form and have had the opportunity to discuss the information with Dr. Franklin. I understand that I am free to ask questions about ECT at this time or any time during the course of ECT or thereafter from Dr. Franklin, from my primary physician, from my therapist, or from another psychiatrist of my choosing, or from any other member of the treatment team. I understand that my decision to agree to ECT is being made on a voluntary basis, and that I may withdraw my consent verbally or in writing to have my treatments stopped at any time.

The nature of this treatment, including risks and benefits that I may experience, has been fully described to me and I give my consent to be treated with ECT. I have been given a copy of this consent to keep. This consent is valid for the time period specified above (not to exceed thirty days)

Date document signed by patient: mm/dd/yy
Patient's name, printed:
Patient's signature:
Treating Psychiatrist' Name: Benjamin Franklin, M.D.
Dr. Franklin's Signature:
Second Opinion Psychiatrist's name printed:
I concur that ECT is a most appropriate form of treatment for this patient.
Second Opinion Psychiatrist's signature:

top

home | about me | studies & statistics | media | official statements | news
sex, lies, & eegs | brain | misc. | ect bulletin board | send to friend