Electroconvulsive Therapy: A Historical and Legal Perspective
Electroconvulsive Therapy: A Historical and Legal Perspective
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电惊厥治疗：历史和法律的视角
DOI：
10.1176/appi.ajp-rj.2018.130305
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发表时间：
2018
影响因子：
17.7
通讯作者：
Hyun
中科院分区：
文献类型：
--
作者：
Hyun
直到20世纪50年代，精神疾病的药物治疗都极其有限。因此，ECT被广泛应用于药物滥用、精神分裂症、歇斯底里和焦虑。它甚至被用于同性恋，这在1973年之前一直是DSM的诊断标准。早期形式的ECT通常会导致严重的混乱和记忆力丧失，而没有正当的附带好处(1)。自那以后，安全性和副作用问题已经通过方法学的改变得到了解决，包括使用神经肌肉阻滞剂、镇静剂、生理监测、呼吸道管理、剂量滴定和不同的电极放置[2]。然而，这些历史先例导致了公众对ECT的污名化。立法障碍限制了ECT的使用和可获得性，有时导致治疗被推迟数周，而患者则在等待法庭听证(1)。与医学上的大多数其他治疗方法不同，包括更具侵入性的程序，医疗保健委托书可能不能代表患者同意电击治疗(见表1)。如果患者不能或不愿意同意，十个州需要法院批准(3)。20个州有具体的立法限制ECT的使用，有3个州的立法比APA指南更严格(3)。例如，在德克萨斯州，ECT被禁止在所有16岁以下的患者中使用，该州强制注册ECT设备和治疗机构的季度报告。对ECT的这种限制部分源于二战后的反精神病学和反独裁运动，以及媒体的负面描述(4)。这些运动为主流带来了这样的想法：
Until the 1950s, pharmacotherapy for psychiatric disorders was extremely limited. Hence, ECT was applied broadly—for substance abuse, schizophrenia, hysteria, and anxiety. It was even used for homosexuality, which remained a diagnosis in the DSM until 1973. Earlier forms of ECT often caused severe confusion and memory loss, without justifiable accompanying benefits (1). Safety and side-effect concerns have since been addressed by methodological changes, including the use of neuromuscular blockers, sedatives, physiologic monitoring, airway management, dose titration, and varied electrode placements (2). Nevertheless, such historical precedents have contributed to the stigmatization of ECT among the public.Legislative hurdles have limited the use and availability of ECT, at times resulting in treatment being delayed for weeks while patients await court hearings (1). Unlike most other treatments in medicine, including far more invasive procedures, a health-care power of attorney may not be able to consent to ECT on a patient’s behalf (see Table 1). Ten states require court approval if the patient is unable or unwilling to consent (3). Twenty states have specific legislation limiting ECT use, and three have legislation more stringent than APA guidelines (3). For example, in Texas, ECT is banned for use among all patients under age 16, and the state mandates registration of ECT devices and quarterly reports from treating facilities. Such restrictions on ECT stemmed in part from the antipsychiatry and antiauthoritarian movements of the post-World War II era, as well as negative media portrayals (4). These movements brought to the mainstream the ideas that