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Descartes Li
Descartes Li

ECT was developed in the 1930s-1940s by Meduna, Cerletti, and Kalinowsky. It involves inducing seizures through electricity to treat psychiatric conditions. ECT is regulated by California law AB1032 and requires documentation by two psychiatrists or neurologists. Patients must receive a detailed explanation of ECT at least 24 hours before providing consent.

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A Self-guided, Learning activity, about Electro-Convulsive Therapy: author: Johagen Descartes Li, M.D. Health Sciences Clinical Professor University of California, San Francisco descartes.li@ucsf.edu History and legal issues
Objectives • Know that Meduna, Cerletti, and Kalinowsky developed ECT and led its introduction to the U.S. in 1940. • Realize that ECT is specifically regulated by California Law, AB1032. • Understand that ECT requires documentation by two Board-certified psychiatrists or neurologists. • Know that a detailed explanation of ECT must occur 24 hours before consent form can be signed By the end of this independent learning activity, the learner will:
History of ECT 1932: Ladislas Meduna observed cell over- and under- growth in brains of patients with epilepsy and schizophrenia, resp. 1933: Animal trials to find medication that could reliably induce seizures 1934: First trial of camphor induced seizures in humans Ladislas J. Meduna (1896– 1964), Hungarian neurologist and neuropathologist, http://en.wikipedia.org/wiki/Ladislas_J._Meduna
History of ECT 1934: Camphor replaced by pentylenetetrazol (Metrazol) 1938: Ugo Cerletti and Lucio Bini use electricity to stimulate seizures. Ugo Cerletti (1877-1963) Italian neurologist http://en.wikipedia.org/wiki/Ugo_Cerletti
History of ECT 1940: Kalinowsky introduces ECT to the U.S. Lothar B. Kalinowsky (1899 –1992) In my opinion, these first ECT practitioners were rather freaky looking.
Current practice of ECT We have an elective in ECT!
Current practice of ECT UCSF Ambulatory Surgery Center
Electro-Convulsive Therapy About 50,000 people receive ECT each year. The number of ECT procedures performed in the U.S. exceeds coronary bypass, appendectomy or hernia repair. American Psychiatric Association Committee on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. 2nd ed. Washington, DC: American Psychiatric Association; 2001.
ASC Reception and Waiting Room
Legal Issues: California 1977 – Assembly Bill 4481, severely restricts use of ECT in California [Legal challenge by Association for Convulsive Therapy, led to replacement by less restrictive AB1032]
Legal Issues: California 1982 – Berkeley, California passes referendum: administration of ECT punishable by a fine of $500 or 6m in prison. [Later reversed by Alameda County Superior Court] 1991 – San Francisco Board of Supervisors passes a resolution against the use or financing of ECT [this resolution has little practical effect]
Legal Issues: ECT in California •Regulated by State law •Requires documentation by two BC psychiatrists [or neurologists] every 30 days • Detailed explanation of procedure must occur 24 hours before consent form can be signed
Legal Issues: ECT in California • Family must be notified, or notification of family must be specifically rejected by the patient • Banned for minors less than 12
Summary • Meduna developed seizure treatments for schizophrenia • Cerletti developed ECT • ECT is specifically regulated by California Law, AB1032. • ECT requires documentation by two Board-certified psychiatrists or neurologists. • Detailed explanation of ECT must occur 24 hours before consent form can be signed
Sherwin Nuland, M.D., on ECT

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1 ect hx+legal

  • 1. A Self-guided, Learning activity, about Electro-Convulsive Therapy: author: Johagen Descartes Li, M.D. Health Sciences Clinical Professor University of California, San Francisco descartes.li@ucsf.edu History and legal issues
  • 2. Objectives • Know that Meduna, Cerletti, and Kalinowsky developed ECT and led its introduction to the U.S. in 1940. • Realize that ECT is specifically regulated by California Law, AB1032. • Understand that ECT requires documentation by two Board-certified psychiatrists or neurologists. • Know that a detailed explanation of ECT must occur 24 hours before consent form can be signed By the end of this independent learning activity, the learner will:
  • 3. History of ECT 1932: Ladislas Meduna observed cell over- and under- growth in brains of patients with epilepsy and schizophrenia, resp. 1933: Animal trials to find medication that could reliably induce seizures 1934: First trial of camphor induced seizures in humans Ladislas J. Meduna (1896– 1964), Hungarian neurologist and neuropathologist, http://en.wikipedia.org/wiki/Ladislas_J._Meduna
  • 4. History of ECT 1934: Camphor replaced by pentylenetetrazol (Metrazol) 1938: Ugo Cerletti and Lucio Bini use electricity to stimulate seizures. Ugo Cerletti (1877-1963) Italian neurologist http://en.wikipedia.org/wiki/Ugo_Cerletti
  • 5. History of ECT 1940: Kalinowsky introduces ECT to the U.S. Lothar B. Kalinowsky (1899 –1992) In my opinion, these first ECT practitioners were rather freaky looking.
  • 6. Current practice of ECT We have an elective in ECT!
  • 7. Current practice of ECT UCSF Ambulatory Surgery Center
  • 8. Electro-Convulsive Therapy About 50,000 people receive ECT each year. The number of ECT procedures performed in the U.S. exceeds coronary bypass, appendectomy or hernia repair. American Psychiatric Association Committee on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. 2nd ed. Washington, DC: American Psychiatric Association; 2001.
  • 9. ASC Reception and Waiting Room
  • 10. Legal Issues: California 1977 – Assembly Bill 4481, severely restricts use of ECT in California [Legal challenge by Association for Convulsive Therapy, led to replacement by less restrictive AB1032]
  • 11. Legal Issues: California 1982 – Berkeley, California passes referendum: administration of ECT punishable by a fine of $500 or 6m in prison. [Later reversed by Alameda County Superior Court] 1991 – San Francisco Board of Supervisors passes a resolution against the use or financing of ECT [this resolution has little practical effect]
  • 12. Legal Issues: ECT in California •Regulated by State law •Requires documentation by two BC psychiatrists [or neurologists] every 30 days • Detailed explanation of procedure must occur 24 hours before consent form can be signed
  • 13. Legal Issues: ECT in California • Family must be notified, or notification of family must be specifically rejected by the patient • Banned for minors less than 12
  • 14. Summary • Meduna developed seizure treatments for schizophrenia • Cerletti developed ECT • ECT is specifically regulated by California Law, AB1032. • ECT requires documentation by two Board-certified psychiatrists or neurologists. • Detailed explanation of ECT must occur 24 hours before consent form can be signed