Electroconvulsive Therapy [Hardcover]

Richard Abrams (Author)

Book Description

ISBN-10: 0195109449 | ISBN-13: 978-0195109443 | Publication Date: January 15, 1997 | Edition: 3

In this third edition of his indispensable textbook on ECT, Dr. Richard Abrams draws upon more than 30 years of clinical and research experience to provide a unique guide to the theory and practice of ECT that stresses both its medical physiology and its application to the high-risk patient.
Important new material has been added on the nature of the electrical stimulus and the relation of stimulus parameters and dosage to the physiology of the cerebral neuron and the quality of the treatment. Extensive detail is now provided on the latest approaches to the complex subject of EEG monitoring, with specific instructions on assessing the therapeutic impact of an induced seizure. The relative roles of unilateral and bilateral ECT are re-examined in light of this new approach, leading to updated recommendations for maximizing the therapeutic yield of ECT in the treatment-resistant patient.
The section on management of cardiovascular risks and complications--especially in the geriatric patient--has been thoroughly updated to emphasize the role of beta-blockers. The widespread use of caffeine for lengthening seizures is critically reassessed, and new recommendations have been added concerning the anesthetic agent propofol and the pre-anesthetic atropine. Techniques of stimulus titration are now extensively covered, with new information and recommendations regarding the utility as well as potential risks of this procedure. Clinical entities recently appearing in the literature, such as myocardial stunning and nonconvulsive status epilepticus, are critically evaluated, as is the role of isoflurane anesthesia as a potential replacement for ECT. Of particular importance to clinicians are Dr. Abrams updated and exquisitely detailed step-wise guide to the practical administration of ECT, and his advice on the optimal handling of its medico-legal aspects, based on his extensive experience as an expert witness.
In this lucid and comprehensive work, Dr. Abrams traces the historical development of convulsive therapy and explores its physiological, ethical, biochemical, political, neuroanatomical, and clinical aspects. He covers such diverse topics as the prediction of treatment response, the results of sham ECT studies, patients attitudes towards the treatment, neuropsychological and cognitive effects, the nature of the ECT stimulus, medico-legal considerations, and theories concerning its mechanism in action. In full accordance with the American Psychiatric Associations guidelines for the practice of ECT, this essential resource remains the primary reference and guide for those who prescribe, perform, or assist with ECT.

Editorial Reviews

Review

" ... this book reflects the author's intimate knowledge of an indispensable psychiatric treatment. ... I recommend it for psychiatrists -- particularly those who prescribe or administer ECT, for residents, for clinical psychologists and for anyone else with clinical or research interests in ECT. ... This comprehensive review of a complex and sometimes controversial topic by one of the leading researchers in the field is highly recommended for both the clinician and researcher." Journal of Psychiatry and Neuroscience (1999)

Praise for previous editions:

"This single-authored text is clearly written from a unique and independent point of view. It expresses the opinions and experiences of more than a quarter century of active study of electroconvulsive therapy....Abrams may justly be proud of this accomplishment which will surely improve the standard of modern psychiatric practice."--Convulsive Therapy

"The coverage of neuropsychiatric disorders is excellent, and the description of the clinical parameters of practice, such as the number of ECT treatments to administer and the characteristics of depressed patients most likely to respond, is comprehensive....Virtually all the issues of concern to clinicians are covered. This is a well written, easy-to-read book on ECT that should serve as a standard reference for both clinicians and researchers in the field."--Journal of Neuropsychiatry

"This book represents the standard of practice for electroconvulsive therapy....I recommend this book to all training programs in psychiatry and active ECT practitioners. It is the most authoritative text in ECT at present."--The Journal of Nervous and Mental Disease

"A thorough, scholarly addition to the field of ECT. The textbook draws upon the extensive clinical and research experience of the author and displays his comprehensive knowledge of the literature and serves as an adequate guide for the administration of ECT....I highly recommend Dr. Abrams'...textbook. This is, overall, the best general textbook covering the topic presently available. It provides a comprehensive overview of the preclinical and clinical use of electroconvulsive therapy and should be considered must reading for all psychiatric residents and clinicians who practice ECT."--Depression

"An excellent, concise, fair, and up-to-date review of this form of therapy....Abrams' book should help the practitioner weigh the pros and cons of ECT himself and aid him and his patients in making enlightened treatment decisions."--Psychiatry

"Dr. Abrams has produced a masterpiece that summarizes...much of what psychiatrists want to know about ECT. The style is crisp and the ideas flow cogently and clearly."--Annals of Clinical Psychiatry

"A book that has proven to be influential in the area of somatic treatments for affective disorders....There is an abundance of information that would be useful to the psychologist working in a setting where ECT is used....This book provides a synopsis of the important areas to be considered and is therefore very useful in a clinical setting. It is easy to read and understand, and it is the best source of information on ECT for the clinician."--Contemporary Psychology

"An outstanding and comprehensive third edition...Any clinician that is involved i nthe treatment of patients with mental illness should read this book. All psychiatry residents should be required to know the relevant topics that this book covers."--Doody's Journal

"...this book is unique in the field....Written in an engaging style, this book reflects the author's intimate knowledge of an indispensable psychiatric treatment....The result is a refined and up-to-date disquistion on a complex and multifaceted shubject. I recommend it for psychiatrists...for residents, for clinical psychologists and for anyone esle with clinical or research interests in ECT....this book would provide an ideal structure on which to base a course on ECT for residents....a trainee would quickly acquire the expertise needed to deliver ECT....This comprehensive review of a complex and sometimes controversial topic by one of the leading researchers in the field is highly recommended for both the clinician and resarcher."-- ournal of Psychiatry and Neuroscience

About the Author

Richard Abrams, M.D., is Professor of Psychiatry at The Chicago Medical School. He has conducted clinical and basic science research on ECT for more than a quarter of a century, during which time he has authored over 70 articles, books, and chapters on the subject. Dr. Abrams is also a widely-respected lecturer, whose many dozens of conferences and workshops on ECT have been enthusiastically received by thousands of practitioners attending them over the years. He has been a member of the Editorial Board of the journal Convulsive Therapy since its inception. Dr. Abrams also has numerous ECT-related patents to his credit, and is President of Somatics, Inc., a firm that manufactures and distributes the Thymatron ECT device.

Product Details

• Hardcover: 382 pages
• Publisher: Oxford University Press, USA; 3 edition (January 15, 1997)
• Language: English
• ISBN-10: 0195109449
• ISBN-13: 978-0195109443
• Product Dimensions: 8.8 x 6 x 1.4 inches
• Shipping Weight: 7.2 ounces
• Average Customer Review: 4.0 out of 5 stars  See all reviews (4 customer reviews)
• Amazon Best Sellers Rank: #3,394,605 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

19 of 26 people found the following review helpful:

3.0 out of 5 stars ECT from an expert's view, April 16, 2001

By 

R. Davis "rddrn" (Madison, AL US) - See all my reviews
(REAL NAME)   

This review is from: Electroconvulsive Therapy (Hardcover)

Electroshock therapy, or ECT as it is called these days, dates to early in the 20th century and has a reputation for being, well, bad for patients. Abrams' book is apparently the definitive textbook for physicians/ psychiatrists/ psychologists looking to learn the techniques and trappings. The third edition was published in 1997 and is still current. Primarily, the text describes the use of ECT in elderly patients with histories of psychosis or depression previously unresponsive to chemical treatment. Critics have questioned the motive behind this text, suggesting it is purely financial and to encourage a practice in which he has personal economic interest. (Abrams has also led seminars on the subject, and rumor has it he controls a portion of the company that manufactures ECT equipment.)

Concerning the content of the book: Abrams knows what he's talking about. He is the acknowledged expert in ECT, and if anyone is qualified to write a book about it, it is he. However, the text does not touch heavily enough (in my opinion) on the downside of ECT - the potential for very serious side effects and complications, including permanent memory loss, organic brain dysfunction, and even death. The clinical information is pertinent, and the format is understandable and logical. I didn't see the earlier editions of this text, but the chapters noted as being new do indeed contain relevant information.

For any professional interested in ECT in practice or even in theory, this is a valuable resource, but it should be balanced with a dissenting voice. Unfortunately, research on this issue tends to be lopsided and incomplete, with experts like Abrams claming very high success rates, and former patients giving anecdotal evidence of severe and long-lasting aftereffects.

13 of 20 people found the following review helpful:

5.0 out of 5 stars No anecdotal information should serve as evidence., March 14, 2002

By 

Dr. Woo (AL USA) - See all my reviews

This review is from: Electroconvulsive Therapy (Hardcover)

I... that Dr. Abrams is an expert in ECT and his book is well written. However I would argue that the critique on not being "balanced with dissenting voice" has no scientific/logic base.

Our society is so poisened by political demands (correctness) that the scientific truth is often submerged by mass desire. When we evaluate a medical procedure, we must base our argument on scientific data. I have read literature in this field extensively, and I have not yet found any solid research data showed that ECT imposed danger of "permanent memory loss, organic brain dysfunction, and even death". To me, case reports are no data, anecdotal opinion is no data. For only the sake of discussion, please consider this: if we did ECT on 1000 patients, and 2 of them dead, 3 of them got brain injury, and the families of these 5 patients went to the press. All we may hear now is that ECT killed or damaged people. However, the hidden truth might be: without ECT 10% of the 1000 patients would have killed themselves, 20% would have health damage out of malnushiment due to financial difficulty (e.g., loss job), alcohol and substance, other medical conditions that were worsened by depression, and 5% of them were killed by chemical treatment, and etc. ECT may have dramatically improved the life quality of 70% of this 1000 patients. We will never know the truth if we stop at the anecdotal information provided by the 5 cases.

Anecdotal, according to American Heritage Dictionary, means: based on personal observation, case study reports, or random investigations rather than systematic scientific evaluation. I am not a zealous advocator of ECT, but I trust only scientific evidence. If anyone would tell me ECT caused brain damage, please show me the scientific evidence. Don't tell me you or your uncle or your sister was damaged by ECT. Don't tell me how many psychiatrists admitted the "downside" of ECT. Show me the well designed research, show me the well controlled data.

Truth is never "balanced dissenting voice". Truth can only be found through scientific research. Three hundred years ago, the balanced dissenting voice said the earth is the center of the universe. The man argued against the balanced dissenting voice was killed. However, the truth was, as it was 1 million years ago, as it is today, as it will be 1 million years later, that the globe is not the center of the universe. How do we know that? Through scientific research!

3 of 5 people found the following review helpful:

3.0 out of 5 stars Very technically written, but informative., April 1, 2005

By 

LookingForHelp (Colorado) - See all my reviews

This review is from: Electroconvulsive Therapy (Hardcover)

The book is very informative, but can be quite technical for the non-medical person. Also, with the FDA approval of vagus nerve stimulation for chronic depression, I would recommend a great book about this medical breakthrough procedure: "Out of the Black Hole: The Patient's Guide to Vagus Nerve Stimulation and Depression". It is written by a patient for patients. Apparently this new therapy has none of the side effects of ECT.
Depression is still dismal, so anything that offers hope other than ECT sounds good to me.