Side effects of Electroconvulsive therapy (ECT)

ECT or electroconvulsive therapy is a procedure performed by the doctors to induce an artificial seizure (fit). It is because, seizures are found to reduce psychiatric symptoms. This effect was observed in people who have both psychosis and epilepsy. Doctors treating these patients observed that psychotic symptoms were reduced immediately after they experienced a seizure. Later when they induce seizures to people who have psychosis, same effect was observed.

Earlier days, doctors used to induce seizures by way of injecting large doses of insulin. This causes severe hypoglycemia which induces the fit (It was depicted in the popular film “beautiful mind”). However, it was found to be quite dangerous and caused unacceptable side effects.

After that doctors start to induce seizures by way of passing an electric current through the brain. It is called Electroconvulsive therapy.

Common uses of ECT (Electroconvulsive therapy)

ECT is useful in patients with severe depression and severe mania with aggressiveness and exhaustion. In addition, ECT is indicated in psychiatric patients with poor oral food and water intake. ECT is also given to mothers with psychotic symptoms, immediately after delivery. In addition, ECT is also given to patients with significant suicidal and homicidal ideas with plans. However, ECT is not indicated in uncomplicated schizophrenia.Basically ECT is indicated when a rapid symptom relief is needed such as in a case with a mother with a small infant. It is because drugs usually take around two to three weeks to show any action.

How to prepare for ECT

Preparation is similar to any procedure that is performed under general anesthesia. Salient features are

1.Fasting for solid foods for eight hours. Four hours for water.

2.Bowels and bladder should be emptied before the procedure

3.May need to undertake several blood tests and electrocardiographic tests before the procedure.

Some procedures may vary from institution to institution.

Side effects and problems of ECT

1.Problems of general anesthesia: - ECT or Electroconvulsive therapy is given under general anesthesia. Problems of general anesthesia includes allergic reactions, difficulty in getting up from anesthesia, muscle pain and stuff in the stomach going into the lungs (aspiration).

2.Memory loss: - ECT or Electroconvulsive is associated with loss of memory for certain events. This loss is usually irreversible. In addition, level of memory loss is directly proportionate to the amount of electric current given (dose).

3.Possibility of aggravating intra-cranial (inside the head) problems: - If the patient has a defect in blood vessels inside the brain then there is a possibility intracranial hemorrhage that can be lethal.

4.Possibility of getting uncontrollable fits (status epilepticus): - If the patient has a history of epilepsy then there is a limited chance of getting a seizure that is prolonged.

Pathological Alcohol intoxication (mania a potu)

This is a type of abnormal state associated with alcoholism. Pathological alcohol intoxication is an extraordinary severe response to alcohol, especially to small amounts marked by apparently senseless violent behavior, usually followed by exhaustion, sleep and amnesia for the episode.
















However it is a rare phenomenon. In addition it is important to note that it is used by criminals to form a legal defense against their criminal activities. e.g. I killed that person because I took quarter of glass beer and I am having pathological intoxication. But most experts can differentiate real pathological intoxication from a fake one.

But some doctors think that there is no entity called pathological intoxication and there is no evidence based data to back it up.

In addition, this condition is not associated with bipolar mania (as the name suggests). You can read my blog post on relationship between alcohol and bipolar mania here

How Pathological intoxication differs from usual intoxication?

In usual alcohol intoxication person usually takes significant amount of alcohol. In addition he/she has physical features of alcohol intoxication such as slow reaction time and impaired coordination. Here behavior can become violent, but sometimes not.

In pathological state, behavior is always violent. After the violent episode the person complain lack of memory of the behavior. Usually in pathological intoxication behavior is more organized than the common alcohol intoxication. In addition in pathological intoxication, the person is not addicted to the alcohol. He/she usually takes alcohol occasionally and gets a severe reaction to it, then stops taking alcohol for a while.

How to differentiate pathological intoxication from delirium tremens

It should be distinguished from delirium tremens which is associated with alcohol withdrawal. Delirium tremens is a state that follows after a reduction in amount of alcohol taken by an alcohol dependent person. Person who abuses alcohol for some time may take less than the usual amount of alcohol and then he/she may go into develop delirium tremens. 

Here person sees abnormal things and hears voices/sounds that are not real. In addition in delirium the person can becomes violent, but usually due to the wrong interpretation of surroundings and people. Organized criminal activity is extremely rare in delirium tremens and if not treated it can become life threatening. However pathological intoxication is never a life threatening condition.

Relationship to the Movie : Final analysis

The movie "Final Analysis" directed by Phil Joanou and acted by Richard gere, Kim bassinger and Uma Thurman depicts pathological alcohol intoxication. In fact, it is quite accurate in terms of scientific perspective. Here you can see a trailer of this 1992 movie. 

Summary

Pathological intoxication is a rare abnormally violent response to minute amounts of alcohol. Pathological intoxication per se is not life threatening. It can be differentiated from the common alcohol intoxication. In addition it can used in legal defense.   

Further reading on alcohol related issues

Why is alcohol so addictive ?

A case history of Pathological alcohol intoxication - PsycNET - American psychological association

Pathological intoxication, Is there such an entity (Pubmed abstract)

Librium for alcohol withdrawal

Uses and side effects of Nodict tablets : A medication prescribed for alcohol relapse prevention.

Sources

Symptoms of mind by Andrew Sims