Done for Aachen Hospital's ECT patient education; Dr. Michael Grözinger
ECT: Electro-convulsive Therapy
Overview
Introduction:
I came across this topic while searching for an external advisor for my brain activity during sleep. Mr Grozinger has, with his enthusiasm, enticed me to include switch the focus of my thesis to his case instead, and I can’t say I’m complaining. I found the topic very interesting myself.
His main concern was the public’s negative perception of ECT and how hard it is to convince a patient of its benefits due to its stigma. Therefore, my goal is to attempt a patient education on ECt with positive imagery that would counteract the media’s grim and gloomy depiction.
The Illustrations goals:
- Targeted for patient education
- Who might benefit from it
- What is it, and how the procedure would look like
- What to expect afterwards; possible side effects, frequency, and recurrence
- The current theories behind how it works.
Origin Story:
The concept of Electroconvulsive therapy came about from the idea of treating one illness with another, when treating Neurosyphilis (an STD or congenitally transmitted bacterial disease affecting the central nervous system and causing related symptoms) with Malaria (a mosquito-borne illness from parasites invading the blood cells causing intermitted and remittent fever in tropical areas).
In 1934 Ladislas J. Meduna observed greater brain sections in patients with epilepsy, compared with patients with schizophrenia, and theorized that seizures could be used to treat psychiatric diseases. He injected camphor, an epileptogenic agent, into a mute catatonic patient and induced a generalized tonic-clonic seizure. Although there was no immediate effect, the patient rapidly improved after four more treatments. He was soon able to walk, speak, and feed himself, although he was unable to recall most of his 4-year hospital stay.
It may have been effective but still inefficient thus two Italian physicians later applied the principle with electrical seizure induction. After much trial and error ( some including full-body electrical application leading to cardiac arrest) they’ve reached the method or focus the induction cranially for 0.2 seconds.
- "Suleman R. (2020) A Brief History of Electroconvulsive Therapy from The American Journal of Psychiatry"
What is it
Electroconvulsive therapy (ECT) is a therapeutic procedure where a small electrical current is passed through the brain under general anaesthesia, triggering a seizure.
Indications:
It is used when other treatments fail or when in a case of emergency. It can provide significant rapid improvement in severe symptoms of mental health disorders:
- Major Depression, Treatment-resistant depression ( PTSD can cause depression)
- Severe mania,
- Catatonia,
- Agitation and aggression in people with dementia.
As well as:
- During pregnancy, when medications can't be taken because they might harm the developing fetus
- In older adults who can't tolerate drug side effects
- In people who prefer ECT treatments over taking medications
- When ECT has been successful in the past
Side effects:
- Confusion,
- Memory loss,
- nausea, headache, jaw pain, muscle ache
Symptoms get better with each session.
Positive Effects:
Rapid, significant improvement of several symptoms of several mental health conditions and a quick return to society and the day-to-day life.
Mechanism:
The molecular changes allow more communication between neurons in a specific part of the brain, also known to respond to antidepressant drugs. New brain cells develop in the brain’s hippocampus after electroconvulsive therapy in a healthy mouse (top) and a mouse lacking the protein Narp (bottom). The new cells from the Narp-less mice have fewer branching dendrites needed for communication with nearby brain cells than the healthy mice do.
The Artistic Research:
The challenge is depicting a medical procedure surrounded by such dark history in a sugar-coated wrapping that a modern-day patient may accept as a treatment for his ailment.
This time I started with a rough brochure layout with titles of what patients need to know and might be interested in. To help with getting an outsider’s point-of-view, I asked my peers if they were to be undergoing the procedure, what would they ultimately want to know, especially in the case of one shrouded by so much negative association. I used their answers to build a template to work around.
I came up with three main illustrations:
- An indicator of ECT,
- The ECT procedure
- A possible mechanism of ECT.
I picked the three colours, blue, green, and yellow, for their meanings:
- Blue: sadness that a patient might feel like part of the psychiatric disorders that are indicators for ECT, I.e., Major depression, bipolar disorder, schizoaffective disorder, schizophrenia.
- Green: for harmony and balance that the Psychiatrist and team are working to achieve by using the ECT. and in western cultures green stands for hope as it is the color of green trees.
- Yellow: for optimism, cheerfulness and hope. The hope a patient has in getting out of their mental slump and returning to their daily lives.