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      La psicología ante la terapia electroconvulsiva (II): consensos interesados a falta de evidencia Translated title: Psychology and electroconvulsive therapy (II): interested consensus lacking in evidence

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Resumen Como continuación de la parte primera, el presente trabajo trata de comprender el uso del electroshock, una técnica cuya efectividad no ha sido inequívocamente demostrada. La falta de evidencia concluyente ha generado consensos que no proceden de un genuino debate interdisciplinario. El concepto de inhibición terapéutica carece de fundamento. El electroshock reduce el sentido de eficacia personal y autonomía que caracteriza un desenvolvimiento sano, e introduce un mensaje implícito de causalidad en términos de mal funcionamiento cerebral que resulta estigmatizante. No existen en España leyes específicas que regulen este procedimiento. La calidad de la información facilitada al paciente es baja y podría derivar en responsabilidad del profesional. Por su excepcionalidad, el electroshock no debería considerarse un elemento más de la cartera de servicios. Los profesionales pueden ejercer su objeción de conciencia por razones éticas y científicas. Una perspectiva interdisciplinar consiste en reivindicar alternativas de tratamiento potencialmente menos lesivas.

          Translated abstract

          Abstract This paper and its first part attempt to comprehend the use of electroshock, a technique whose effectiveness has not been unequivocally demonstrated. The lack of conclusive evidence has generated consensus, but it does not come from a genuine interdisciplinary debate. The concept of therapeutic inhibition is unfounded. Electroshock reduces the sense of personal efficacy and autonomy that characterizes a healthy functioning and introduces an implicit stigmatizing message of causality in terms of brain malfunction. There are no specific laws in Spain that regulate this procedure. The quality of the information provided to the patient is poor and could lead to professional liability. Due to its exceptional nature, electroshock should not be considered as a therapy like any other. Professionals can exercise conscientious objection for ethical and scientific reasons. An interdisciplinary perspective would be to call for potentially less harmful treatment alternatives.

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          Most cited references45

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          The 'side effects' of medicalization: a meta-analytic review of how biogenetic explanations affect stigma.

          Reducing stigma is crucial for facilitating recovery from psychological problems. Viewing these problems biomedically may reduce the tendency to blame affected persons, but critics have cautioned that it could also increase other facets of stigma. We report on the first meta-analytic review of the effects of biogenetic explanations on stigma. A comprehensive search yielded 28 eligible experimental studies. Four separate meta-analyses (Ns=1207-3469) assessed the effects of biogenetic explanations on blame, perceived dangerousness, social distance, and prognostic pessimism. We found that biogenetic explanations reduce blame (Hedges g=-0.324) but induce pessimism (Hedges g=0.263). We also found that biogenetic explanations increase endorsement of the stereotype that people with psychological problems are dangerous (Hedges g=0.198), although this result could reflect publication bias. Finally, we found that biogenetic explanations do not typically affect social distance. Promoting biogenetic explanations to alleviate blame may induce pessimism and set the stage for self-fulfilling prophecies that could hamper recovery from psychological problems. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Patients' perspectives on electroconvulsive therapy: systematic review.

            To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy. Descriptive systematic review. Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. Articles with patients' views after treatment with electroconvulsive therapy. 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.
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              Contemporary use and practice of electroconvulsive therapy worldwide

              To explore contemporary (from 1990) utilization and practice of electroconvulsive therapy (ECT) worldwide. Systematic search (limited to studies published 1990 and after) was undertaken in the databases Medline, Embase, PsycINFO, SveMed, and EBSCO/Cinahl. Primary data-based studies/surveys with reported ECT utilization and practice in psychiatric institutions internationally, nationally, and regionally; city were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria, and extracted ECT utilization and practice data from those retrieved in full text. Seventy studies were included, seven from Australia and New Zealand, three Africa, 12 North and Latin America, 33 Europe, and 15 Asia. Worldwide ECT differences and trends were evident, average number ECTs administered per patient were eight; unmodified (without anesthesia) was used in Asia (over 90%), Africa, Latin America, Russia, Turkey, Spain. Worldwide preferred electrode placement was bilateral, except unilateral at some places (Europe and Australia/New Zealand). Although mainstream was brief-pulse wave, sine-wave devices were still used. Majority ECT treated were older women with depression in Western countries, versus younger men with schizophrenia in Asian countries. ECT under involuntary conditions (admissions), use of ambulatory-ECT, acute first line of treatment, as well as administered by other professions (geriatricians, nurses) were noted by some sites. General trends were only some institutions within the same country providing ECT, training inadequate, and guidelines not followed. Mandatory reporting and overall country ECT register data were sparse. Many patients are still treated with unmodified ECT today. Large global variation in ECT utilization, administration, and practice advocates a need for worldwide sharing of knowledge about ECT, reflection, and learning from each other's experiences.
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                Author and article information

                Journal
                pappsicol
                Papeles del Psicólogo
                Pap. Psicol.
                Consejo General de Colegios Oficiales de Psicólogos (Madrid, Madrid, Spain )
                0214-7823
                1886-1415
                August 2020
                : 41
                : 2
                : 132-138
                Affiliations
                [2] orgnameServicio de Salud del Principado de Asturias. España
                [1] Asturias orgnameUniversidad de Oviedo orgdiv1Facultad de Enfermería de Gijón Spain
                [4] Asturias orgnameUniversidad de Oviedo Spain
                [3] orgnameLisbon Institute of Global Mental Health orgdiv1Comité Científico Internacional Portugal
                Article
                S0214-78232020000200132 S0214-7823(20)04100200132
                10.23923/pap.psicol2020.2924
                84ee2c0d-992c-4db9-a440-4aa542af477f

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 07 January 2020
                : 08 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 45, Pages: 7
                Product

                SciELO Spain

                Categories
                Artículos

                Mental Health,Terapia electroconvulsiva,Salud Mental,Aceptación de la atención de salud,Medicina basada en la evidencia,Legislación,Electroconvulsive therapy,Patient acceptance of health Care,Evidence-based medicine,Legislation

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