The World Journal of Biological Psychiatry, 2010; 11: 525–537 ISSN 1562-2975 print/ISSN 1814-1412 online © 2010 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS) DOI: 10.3109/15622970903559925 REVIEW ARTICLE Electroconvulsive therapy: A review of knowledge, experience and attitudes of patients concerning the treatment SUBHO CHAKRABARTI, SANDEEP GROVER & RAJENDRA RAJAGOPAL Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India Abstract Objectives. Despite its proven efficacy and safety, electroconvulsive therapy (ECT) has a negative image and attracts wide- spread public criticism. In contrast, perceptions of patients who have received ECT appear to be more favourable. This review intended to encapsulate the evidence on knowledge and views concerning ECT among its recipients. Methods. Extensive electronic and manual searches were conducted to identify all relevant studies on the subject. Results. Seventy- five reports were found suitable. The evidence from these studies suggested that patients undergoing ECT were usually poorly informed about it. This was attributable to factors such as unsatisfactory pre-treatment explanations or post-ECT memory impairment. About one-third undergoing ECT reported feeling coerced to have the treatment. Fear of ECT and distressing side effects were also present in a majority. Despite these problems, a vast majority of patients perceived ECT to be helpful and had positive views regarding the treatment. Simultaneously, a sizeable proportion was quite critical, although little was known about the extent and nature of such disapproval. Conclusions. Overall, the weight of the evidence supports the notion that patients undergoing ECT are well-disposed towards it. However, much needs to be done to improve the practice of ECT and to enhance patients’ satisfaction with the experience of treatment. Key words: ECT , knowledge, perceptions, experience, patients Introduction Despite 70 years of existence and substantial proof of efficacy, electroconvulsive therapy (ECT) still continues to be one of the most controversial and misunderstood treatments in medicine (Fink 2001; Dowman et al. 2005; Bauer et al. 2007). Over the years refinements such as use of anaesthetics and muscle relaxants, and of brief pulse machines which deliver carefully titrated electrical stimuli to trigger a seizure under controlled circumstances, have ren- dered the procedure safe and less discomforting (Goodman et al. 1999). Yet considerable stigma still surrounds ECT, which undermines the public’s acceptance of this treatment. Primitive practices of the past, negative media representations, irrational fears of electricity, all contribute to this public disap- proval. Unfortunately, in this debate about its role, the opinions of patients undergoing ECT have rarely been evaluated. Professionals are partly to blame, since their research has traditionally focused on aspects such as efficacy, side effects, mechanism of action, etc. However, the realisation that mere clini- cal efficacy of ECT did not necessarily predict patients’ perceptions or satisfaction with the treat- ment has eventually propelled several investigations of the knowledge, attitudes and experience of the procedure among patients (Malcolm 1989; Johnstone 1999). The present review intended to encapsulate the findings that have emerged from this exercise and their possible implications for the practice of ECT. Method Electronic databases such as the PUBMED, Google and PSYC INFO were searched using various com- binations of the terms “knowledge”, “attitudes”, “experience”, “perceptions”, “views” and “ECT”, to Correspondence: Subho Chakrabarti, Additional Professor, Department of Psychiatry, PGIMER, Chandigarh – 160012, India. Tel: +0172 2756808/9914209808. Fax: +0172-2748020. E-mail: subhochd@yahoo.com (Received 12 August 2009; accepted 14 December 2009) World J Biol Psychiatry Downloaded from informahealthcare.com by HINARI For personal use only.