ELECTRO ONVULSIVE THERAPY

INTRODUCTION: Electroconvulsive therapy (ECT), previously known as electroshock, is a well-established, albeit controversial, psychiatric
treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a
treatment for severe major depression which has not responded to other treatment, and is also used in the treatment of mania (often in bipolar
disorder), and catatonia.[1] It was first introduced in the 1930s[2] and gained widespread use as a form of treatment in the 1940s and 1950s;
today, an estimated 1 million people worldwide receive ECT every year,[3] usually in a course of 612 treatments administered two or three
times a week.Non-clinical patient characteristicsAbout 70 percent of ECT patients are women.[13] This is almost entirely due to women being
at twice the risk of depression.[13][14] Older and more affluent patients are also more likely to receive ECT. The use of ECT treatment is "markedly
reduced for ethnic minorities.Adverse effectsAside from effects in the brain, the general physical risks of ECT are similar to those of brief
general anesthesia; the United States' Surgeon General's report says that there are "no absolute health contraindications" to its use.[19]
Immediately following treatment the most common adverse effects are confusion and memory loss. The state of confusion usually disappears
after a few hours. It can be tolerated by pregnant women who are not suffering major complications. It can be used with diabetic or obese
patients, and with caution in those whose cancers are in remission or under control. It can be used in some immunocompromised patients. It
must be used very cautiously in people with epilepsy or other neurological disorders because by its nature it provokes small tonic-clonic
seizures, and so would likely not be given to a person whose epilepsy is not well-controlled. [23][24] Some patients experience muscle soreness
after ECT. This is due to the muscle relaxants given during the procedure and rarely due to muscle activity. The death rate due to ECT is
around 4 per 100,000 proceduresEFFECTS ON PREGNANCY:ECT is generally accepted to be relatively safe during all trimesters of
pregnancy, particularly when compared to pharmacological treatments.[61][62][63] Suggested preparation for ECT during pregnancy includes a
pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and
administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring,
intubation, and avoidance of excessive hyperventilation are recommended.[61] Much of the medical literature in this area is composed of case
studies of single or twin pregnancies, and although some have reported serious complications,[64][65] the majority have found ECT to be safe.[66]
ECT is not performed on the fetus.AdministrationInformed consent is sought before treatment. Patients are informed about the risks and
benefits of the procedure. Patients are also made aware of risks and benefits of other treatments and of not having the procedure done at all.
Depending on the jurisdiction the need for further inputs from other medical professionals or legal professionals may be required. ECT is
usually given on an in-patient basis. Prior to treatment a patient is given a short-acting anesthetic such as methohexital, etomidate, or
thiopental,[13] a muscle relaxant such as suxamethonium (succinylcholine), and occasionally atropine to inhibit salivation.Both electrodes can be
placed one on the same side of the patient's head. This is known as unilateral ECT. Unilateral ECT is used first to minimize side effects
(memory loss). When electrodes are placed on both sides of the head, this is known as bilateral ECT. In bifrontal ECT, an uncommon variation,
the electrode position is somewhere between bilateral and unilateral. Unilateral is thought to cause fewer cognitive effects than bilateral but is
considered less effective.[13] In the USA most patients receive bilateral ECT.[67] In the UK almost all patients receive bilateral ECT.[68]The
electrodes deliver an electrical stimulus. The stimulus levels recommended for ECT are in excess of an individual's seizure threshold: about
one and a half times seizure threshold for bilateral ECT and up to 12 times for unilateral ECT.[13] Below these levels treatment may not be
effective in spite of a seizure, while doses massively above threshold level, especially with bilateral ECT, expose patients to the risk of more
severe cognitive impairment without additional therapeutic gains.[69] Seizure threshold is determined by trial and error ("dose titration"). Some
psychiatrists use dose titration, some still use "fixed dose" (that is, all patients are given the same dose) and others compromise by roughly
estimating a patient's threshold according to age and sex.[67] Older men tend to have higher thresholds than younger women, but it is not a hard
and fast rule, and other factors, for example drugs, affect seizure thresholdMechanism of actionThe aim of ECT is to induce a therapeutic
clonic seizure (a seizure where the person loses consciousness and has convulsions) lasting for at least 15 seconds. Although a large amount
of research has been carried out, the exact mechanism of action of ECT remains elusive. The main reasons for this are that the human brain
can not be studied directly before and after ECT and therefore scientists rely on animal models of depression and ECT, with major limitations.
While animal models are acknowledged to model merely aspects of depressive illness, human and animal brains are very similar at a
molecular level, enabling detailed study of the molecular mechanisms involved in ECTECS has been shown to increase levels of Brain-derived
neurotrophic factor (BDNF) and Vascular Endothelial Growth Factor (VEGF) in the rodent hippocampus.[91] This reverses the toxic effects of
depression on this area of the brain, increasing both new synapse formation and the formation of new brain cells (hippocampal neurogenesis).
Both these effects have been noted to be present in antidepressant-treated animals, however they are neither necessary nor sufficient for
antidepressant response. ECT is a more robust inducer of these neuroplastic effects than antidepressants. [92] Electroconvulsive Therapy (ECT)
has also been shown to increase serum brain-derived neurotrophic factor (BDNF) in drug resistant depressed patients.[93] This suggests a
common molecular mechanism of action, albeit in need of much further study.BIBLIOGRAPHY:Epidemiologia e Psychiatria Sociale
http://www.psychiatry.freeuk.com/ECTreview.pdfDobuzinskis, Alex (November 22, 2006). "Can electroshock therapy make you a better
singer?". Valley News Blog. Archived from the original on 2007-102http://web.archive.org/web/20071024052610/http://valleynews.com/SantaClaritaValley/Blogs/Arts-Entertainment/Music/Blog~153612.aspx.

American Psychiatric Association. "Electroconvulsive Therapy (ECT)".

http://www.psych.org/Departments/APIREandResearch/ResearchTraining/clin_res/index.aspx. Retrieved 2007-12-29.
ADMISSION AND DISCHARGING PROCEDURES FOR THE MENTALLY ILL :
Procedure for admission and discharge of mentally illThe admission in a psychiatric hospital or nursing home can be made in one of the
following manners:
1. Voluntary Admission
(a) By the patients request, if he is major
(b) By the guardian, if a minor (a new provision)
2. Admission under special circumstances It is an involuntary hospitalization when the mentally illperson does not or cannot express his
willingness for admission. Admission is made, if a relative or a friend of the mentally ill person applies in writing for admission and the medical
officer in-charge of the hospital is satisfied that the admission will be the interest of the mentally ill person. The duration of admission cannot
exceed 90 days.
3. Admission through reception orders. Reception order on ApplicationAn application for a reception order may be made by the medical
officer in-charge of a psychiatric hospital or nursing home or by the husband, wife or any other relative of the mentally ill person. This
application for admission should accompany the medical certificates from two medical practitioners of whom one should be a Government
doctor. On receipt of this application the magistrate may issue reception order for admission after he is satisfied that the alleged person is
suffering from mental illness. Reception orders on production of a mentally ill person before a Magistrate(Admission of a dangerous
wandering mentally ill person). The police officer in-charge of a police station may take into protection any person found wandering at large
whom he has reason to believe to be mentally ill. He should produce him before the nearest magistrate within 24 hours. The magistrate shall
examine the person and assess his capacity to understand and if he is satisfied that the said person is a mentally ill person, the magistrate may
pass a reception order, authorizing the detention of the said person as an inpatient in a psychiatric hospital, and later should the medical officer
certify that such a person is a mentally ill person, he should be given care and treatment in a psychiatric hospital. Every officer in charge of a
police station, who has reason to believe that any mentally ill person is cruelly treated or is not under proper care and control by relatives or
other persons, shall report this to a magistrate. This complaint to the magistrate can also be submitted by any individual. The magistrate may
summon such relatives along with the patient and order the relative or other person to take care of the mentally ill person. If this relative willfully
neglects to comply with this order he shall be punishable with a fine up to Rs 2,000. If there is no person legally bound to maintain this mentally
ill person he can issue a reception order for admission to a psychiatric hospital.
c) Admission as an in-patient for inquisition
A district court holding an inquisition regarding any person who is found to be mentally ill, may direct such a person for admission in a
psychiatric hospital. Inquisition is examination or investigation whether the person who is alleged to be mentally ill is ofunsound mind and
incapable of managing his affairs.Application can be made by Any relative. Advocate General.Public Prosecutor, orDistrict Collector.The
magistrate will give notification and the order for an enquiry
PART II - DISCHARGE
Order of discharge by medical officer in charg Notwithstanding anything contained in Chapter IV, the medical officer-in-charge of a
psychiatric hospital or psychiatric nursing home may, on the recommendation of two medical practitioners one of whom shall preferably be a
psychiatrist, by order in writing, direct the discharge of any person other than a voluntary patient detained or undergoing treatment therein as
an in-patient, and such person shall thereupon be discharged from the psychiatric hospital or psychiatric nursing home: Provided that no order
under this sub-section shall be made in respect of a mentally ill prisoner otherwise than as provided in Sec.30 of the Prisoner Act, 1900 (3 of
1900),or in any other relevant law.Where any order of discharge is made under sub-section (1)in respect of a person who had been detained or
is undergoing treatment as in-patient in pursuance of an order off any authority, a copy of such hospital/nursing home. Discharge of mentally
ill persons on application Any person detained in a psychiatric hospital or psychiatric nursing home under an order and in pursuance of an
application made under this Act, shall be discharged on an application made in that behalf to the medical officer in charge by the person on
whose application the order was made; Provided that no person shall be discharged under this section if the medical officer in charge certifies
in writing that the person is dangerous and unfit to be at large.COMMENT - This section lays down that mentally ill persons be discharged on
application, from a psychiatric hospital/nursing home and that no person be discharged unless the medical officer certifies for the same.Order
of discharge on the undertaking of relatives or friends, etc. for due care of mentally ill personsWhere any relative of friend of a mentally
ill person detained in a psychiatric hospital or psychiatric nursing home under Sec. 22, Sec. 24 or Sec. 25 desires that such person shall be
delivered over to his care and custody, he may make an application to the medical officer-in-charge who shall forward it together with his
remarks thereon to the authority under whose orders the mentally ill person is detained.

2. Where an application is received under sub-section (1), the authority shall, on such relative or friend furnishing a bond, with or without
sureties, for such amounts as such authority may specify in this behalf, undertaking to take proper care of such mentally ill person, and
ensuring that the mentally ill person shall be prevented from causing injury to himself or to others, make an order of discharge and thereupon
the mentally ill person shall be discharged. COMMENT - The section makes provision for discharge of mentally ill person from the psychiatric
hospital or psychiatric nursing home on the undertaking of relatives or friends for due care of such mentally ill person.Discharge of person on
his request Any person (not being a mentally ill prisoner) detained in pursuance of an order made under this Act who feels that he has
recovered from his mental illness, may make an application to the Magistrate, where necessary under the provisions of this Act, for his
discharge from the psychiatric hospital or psychiatric nursing home An application made under sub-section (1) shall be supported by a
certificate either from the medical officer incharge of the psychiatric hospital or psychiatric nursing home where the applicant is undergoing
treatment or from a psychiatrist; The Magistrate may, after making such inquiry as he may deem fit, pass an order discharging the person or
dismissing the application.COMMENT - This section makes provision for the discharge of mentally ill person from psychiatric hospital or
psychiatric nursing home, on his request. This section does not apply to a mentally ill prisoner.. Discharge of person subsequently found on
inquisition to be of sound mind If any person detained in a psychiatric hospital or psychiatric nursing home in pursuance of a reception order
made under this Act is subsequently found, on an inquisition held in accordance with the provisions of Chapter VI, to be of sound mind or
capable of taking care of himself and managing his affairs, the medical officer-in-charge shall forthwith, on the production of a copy of such
finding duly certified by the District Court, discharge such person from such hospital or nursing home. COMMENT - This section deals with the
matter relating to discharge of person, detained in a psychiatric hospital or psychiatric nursing home, subsequently found to be of sound
mind.Read more: Mental Health Act, 1987 - Inspection, Discharge, Leave of Absence and Removal of Mentally Ill Persons
http://www.medindia.net/Indian_Health_Act/mental-health-act-1987-inspection-discharge-leave-of-absence-and-removal-of-mentally-illpersons.htm#ixzz1BXQ0WBHuBIBLIOGRAPHYwww.medindia.net/.../mental-health-act-1987-judicial-inquisition-regarding-alleged-mentally-illperson-possessing-property-custody-of-his-person-and.
SUBSTANCE ABUSE
DEFENITION:Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered
dependent.[2] The term "drug abuse" does not exclude dependency,[3] but is otherwise used in a similar manner in nonmedical contexts.
Substance abuse is a form of substance-related disorder. Substances can be taken into the body in several ways:
o

Oral ingestion (swallowing)

Inhalation (breathing in) or smoking

Injection into the veins (shooting up)

Depositing onto the mucosa (moist skin) of the mouth or nose (snorting)

CAUSES:Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years.
RISK FACTORS:Factors within a family that influence a child's early development have been shown to be related to increased risk of drug
abuse.
o

Chaotic home environment

Ineffective parenting

Lack of nurturing and parental attachment

Factors related to a child's socialization outside the familymay alsoincrease risk of drug abuse.

Inappropriately aggressive or shy behavior in the classroom

Poor social coping skills

Poor school performance

Association with a deviant peer group

Perception of approval of drug use behavior

SYMPTOMS:
Giving up past activities such as sports, homework, or hanging out with new friends
Declining grades
Aggressiveness and irritability
Forgetfulness
Disappearing money or valuables
Feeling rundown, hopeless, depressed, or even suicidal
Sounding selfish and not caring about others
Use of room deodorizers and incense
Paraphernalia such as baggies, small boxes, pipes, and rolling paper
Getting drunk or high on drugs on a regular basis
Lying, particularly about how much alcohol or other drugs he or she is using
Avoiding friends or family in order to get drunk or high
Planning drinking in advance, hiding alcohol, drinking or using other drugs alone
Having to drink more to get the same high
Believing that in order to have fun you need to drink or use other drugs
Frequent hangovers
Pressuring others to drink or use other drugs
Taking risks, including sexual risks
Having "blackouts"-forgetting what he or she did the night before
Constantly talking about drinking or using other drugs

Getting in trouble with the law

Drinking and driving
Suspension from school or work for an alcohol or drug-related incidenCE
TREATMENT:Treatment for binge drinking and other forms of substance abuse is critical for many around the world. Behavioral interventions
and medications exist that have helped many people reduce, or discontinue, their substance abuse.

behavioral maritial therapy

Motivational Interviewing

community reinforcement approach

Exposure therapy

Contingency management[30][31]

Pharmacological therapy - A number of medications have been approved for the treatment of substance abuse.[citation needed] These
include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and
naltrexone in either short acting, or the newer long acting form (under the brand name Vivitrol). Several other medications, often
ones originally used in other contexts, have also been shown to be effective including bupropion (Zyban or Wellbutrin), Modafinil
(Provigil) and more.

Most substances abusers believe they can stop using drugs on their own, but a majority who try do not succeed. Research shows

that long-term drug use alters brain function and strengthens compulsions to use drugs. This craving continues even after your drug
use stops.
Because of these ongoing cravings, the most important component of treatment is preventing relapse. Treating substance abuse

depends on both the person and the substance being used. Behavioral treatment provides you with strategies to cope with your
drug cravings and ways to avoid relapse. Your doctor may prescribe medications, such as nicotine patches and methadone, to
control withdrawal symptoms and drug cravings.
Often, a drug user has an underlying mental disorder, one that increases risk for substance abuse. Such disorders must be treated
medically and through counseling along with the drug abuse.

PREVENTION:Substance abuse may start in childhood or adolescence. Abuse prevention efforts in schools and community settings now
focus on school-age groups. Programs seek to increase communication between parents and their children, to teach resistance skills, and to
correct children's misperceptions about cigarettes, alcohol, and drugs and the consequences of their use. Most importantly, officials seek to
develop, through education and the media, an environment of social disapproval from children's peers and families.PROGRAMS:There are
numerous community-based prevention programs that have been thought to be helpful in educating children and families about the harms of
substance abuse. There are mediating factors of classroom-based substance abuse that have been analyzed through research. There are
specific conclusions that have been generated about effective programs. First, programs that allow the students to be interactive and learn
skills such as how to refuse drugs are more effective than strictly educational or non-interactive ones.
Programs that encourage a social commitment to abstaining from drugs show lower rates of drug use.
Life Skills Training (LST) was developed by Gilbert J. Botvin in 1996 The goal of this program is to increase personal and social competence,
confidence and self-efficacy to reduce motivations to use drugs and be involved in harmful social environmentsProject ALERT includes
educational handouts, lesson plans, phone support, downloadable resources, and posters that were designed to motivate seventh and eighth
grade students to not use alcohol, tobacco, or marijuana. This program's goal is to give students motivation to resist engaging in drug use by

giving them assertiveness tools Community programs outside of school settings that aim to prevent alcohol, tobacco, and illicit drug use have
insufficient evidence that would show their effectiveness. Many of the community programs for those under age 25 are only linked to one
randomized controlled trials which in most cases is not enough to conclude that they are effective.
DAILY SCHEDULE FOR THE SUBSTANCE ABUSE PATIENTS:

DAILY SCHEDULE
6.30 am : Wake Up
6.40 am : Prayer
7.00 8.00 am : Yoga / Meditation
8.00 8.45 am : Shave / Bath
9.00 9.30 am : Breakfast
9.30 9.50 am : Silent Moments
10.00 11.15 am : Therapy Session
11.15 11.30 am : Tea
11.30 12.45 pm : Step Work / Reflection
1.00 1.30 pm : Lunch
1.30 3.00 pm : Rest
3.15 3.30 pm : Tea
3.30 4.15 pm : Thoughts & Feeling
4.15 5.00 pm : Audio / Video Session
5.00 6.45 pm : Leisure / Games
7.00 8.00 pm : AA / NA Meeting
8.00 9.00 pm : Leisure / TV
9.00 9.30 pm : Dinner
9.30 9.45 pm : TV News
10.30 pm : Lights Out
Saturday: Half Day

REFERENCES:
http://www.nap.edu/catalog.php?record_id=12480#orgs.
http://www.bentham.org/cdar/openaccsesarticle/cdar%201-3/0002CDAR.pdf.
http://www.cdc.gov/media/pressrel/2010/r100603.htm.

Sunday: Family Visits

http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12719309.
http://drugs.homeoffice.gov.uk/drug-strategy/drugs-in-workplace