How Specialist ECT Consultants Inform Patients About Memory Loss
Total Page：16
File Type：pdf, Size：1020Kb
Forrester et al Hospital transfer outcomes and delays from two London prisons 7 Department of Health. National Scheme. A prospective study of the 13 Wilson S, ForresterA.Too little, too 14 Riviere v. France (2006) ECHR. Schedule of Reference Costs transfer of mentally disordered late? The treatment of mentally Application no. 33834/03, 2006-2007 for NHS Trusts. remand prisoners from prison to incapacitated prisoners. J Forensic 11July. original Department of Health, 2007. psychiatric units. BrJ Psychiatry Psychiatry 2002; 13:1-8. 1995; 166:802-5. papers 8 HMInspectorate of Prisons.Patientor *Andrew Forrester Consultant and Honorary Senior Lecturer in Forensic Prisoner? A New Strategy for Health- 11 Isherwood S, Parrott J. Audit of Psychiatry, Healthcare Department, HM Prison Brixton, Jebb Avenue, London SW2 care in Prisons. Home Office,1996. transfers under the Mental Health 5XF, email: andrew.forrester@ slam.nhs.uk, Christopher Henderson Act from prison - the impact of Formerly Research Associate, Bracton Centre Medium Secure Unit, Bexley, 9 Robertson G, Dell S, James K, organisational change. Psychiatr Simon Wilson Consultant and Honorary Senior Lecturer in Forensic Psychiatry, Grounds A. Psychotic menremanded Bull 2002; 26:368-70. Oxleas NHS FoundationTrust and Institute of Psychiatry, London, Ian Cumming in custody to Brixton Prison. BrJ 12 McKenzie N, Sales B. New Consultant in Forensic Psychiatry, HM Prison Belmarsh, London, Miriam Psychiatry1994; 164:55-61. procedures to cut delays in transfer Spyrou Assistant Psychologist, Bracton Centre Medium Secure Unit, 10 Banerjee S, O’Neill-Byrne K, of mentally ill prisoners to hospital. Bexley, Janet Parrott Consultant in Forensic Psychiatry, Bracton Centre ExworthyT, ParrottJ.The Belmarsh Psychiatr Bull 2008; 32:20-2. Medium Secure Unit, Bexley Psychiatric Bulletin (2009), 33, 412^415. doi:10.1192/pb.bp.108.023739 DALIA HANNA, KERRY KERSHAW AND ROBERT CHAPLIN How specialist ECT consultants inform patients about memory loss AIMS AND METHOD RESULTS CLINICAL IMPLICATIONS A questionnaire was distributed to The response rate was 64%.There is Patients need to be informed about consultants with a special interest in consensus on informing patients the possibility of permanent memory electroconvulsive therapy (ECT) at about the possibility of permanent loss before consenting to ECT.Clinical clinics participating in an ECT accred- memory loss. Memory is assessed teams need to make greater efforts itation process.This aimed to ascer- before and during an ECT course by to assess memory, particularly after tain a consensus of clinical practice clinical interview and Mini-Mental this treatment. regarding informing patients about State Examination, but rarely at long- the treatment and assessment of term follow-up. memory during ECT. Electroconvulsive therapy (ECT) is an effective short-term likely to have difficulty explaining to patients the possibi- treatment for depression and is ‘probably more effective lity of long-term cognitive side-effects, with a spread of than drug therapy’.1 However, the treatment remains opinion among them, ranging from informing patients controversial, with adverse effects being a major concern about long-term cognitive side-effects, to saying that of both patients and the public, in particular the risk of there was no evidence of such side-effects, or saying memory impairment. A review of patients’ perspectives that the issue is controversial. Just over a third recognised on ECT found that at least a third of patients reported further training needs, particularly on consent and 2 persistent memory loss after treatment. assessment of memory during and after ECT.8 There has Research into the effect of ECT on memory function been a gradual decline from 1985 to 2002 in the number is a rapidly changing field. Previously, it was accepted that of people in England receiving ECT,9 and it is likely that this treatment could cause temporary anterograde and this trend has continued. Thus referring psychiatrists will retrograde amnesia, which could be minimised by using have less experience of this treatment. unilateral rather than bilateral ECT;3 however, current The aim of our study was to gain a greater under- work is clarifying the possibility and nature of more standing of the clinical practice of psychiatrists with persistent memory loss. A recent systematic review responsibility for administration of ECT in the UK (ECT suggested that autobiographical memory impairment specialists or lead ECT clinicians, hereafter referred to as after ECT can occur, recovering after several months, ECT consultant psychiatrists), with specific reference to although a few studies reported more persistent defi- cits.4 A large prospective study found that cognitive what they tell patients about the effects of ECT on deficits, including deficits in autobiographical memory, memory and how they approach detecting and moni- were apparent 6 months after completion of a course of toring these effects. This was in order to obtain a ECT.5 consensus of expert opinion in this area. There is concern that inadequate information is given to patients about the adverse effects of ECT, specifically Method with regard to the effect on memory.6,7 The ECT Accreditation Service (ECTAS) has previously studied the The ECTAS was established in 2003 to improve the clinical practice and training needs of psychiatrists who quality of ECT provision in England, Wales, Northern refer patients for ECT. These referring psychiatrists were Ireland and Ireland. Clinics judged to provide a 412 Hanna et al Informing ECT patients about memory loss satisfactory service to patients are accredited by ECTAS. the results presented below are from this latter subgroup, At the time of this study (in 2007) ECTAS had recruited 90% of the whole sample, hereafter referred to as the 87 member clinics out of an estimated 149 clinics.10 One respondents. The responses of the seven psychiatrists original feature of signing up to the accreditation process is (10%) who were not ECT consultant psychiatrists were papers access to an email discussion forum. This forum was used excluded from further analysis. Of the 62 respondents, for the purpose of recruitment in this study. 33 (53%) were general adult psychiatrists, 28 (45%) were A questionnaire, consisting of 13 questions relating old age psychiatrists and 1 (2%) was a psychiatrist in to issues about memory and ECT, was emailed to 108 forensic learning disability. practising UK psychiatrists identified from the discussion Table 1 summarises the information respondents forum. The questionnaire included items requiring yes/no gave to patients about the possible effect of ECT on answers and open-ended questions where more detailed memory. A section of the questionnaire asking for responses could be entered. Two further mailings were any additional comments regarding information given sent around 1 week and 7 weeks after the initial mailing. on memory loss was completed by 22 of the 62 In addition, a written version of the questionnaire was respondents. Some of the themes were as follows: sent by post 3^5 months later. seven mentioned autobiographical memory loss, four Descriptive statistics were used to present the qualified that memory loss was usually temporary but results. Not all respondents answered all questions. might be permanent, three referred to the effects of the Responses to open-ended questions were analysed depression on memory and two mentioned to patients qualitatively, whereby responses were coded and that more research was needed. grouped into themes. The authors then met to agree a Of the 62 respondents, 33 answered a question final coding framework. asking them to give a brief outline if they had encountered a patient who had memory loss for longer than the period spanning ECT. Of these 33 psychiatrists, Results 8 commented that they had not encountered such a A total of 108 questionnaires were distributed, resulting patient. Twenty gave outlines, examples of which are in 69 responses (a 64% response rate). All the respon- given below. dents were consultant psychiatrists and 62 of the 69 ‘One person lost memories for events during a foreign identified themselves as ECT consultant psychiatrists. All holiday the previous year although she could recall being on the plane coming back.’ ‘Several patients complained of losing ‘‘blocks’’of long-term memory, e.g. childhood.’ Table 1. Responses to questions about the effect of ECT on memory ‘I have seen many people who have complained of Number giving ‘‘memory loss’’despite tests showing an actual improve- positive ment in cognition after ECT. A small proportion suffer response/total autobiographical lacunae, which doesn’t seem to be easily answering demonstrated on testing.’ question n/N % ‘Loss of discrete episodes of memory for events, e.g. holi- days, family, weddings, etc. But patient considered benefits Do you discuss the possibility of of ECT for him outweighed these negative effects.’ memory loss with patients who you refer for ECT? 62/62 100 Table 2 shows the respondents’ practices regarding Do you inform them that the routine assessment of memory for patients under- memory loss may be: going ECT. Several respondents commented that they Temporary? 60/60 100 tried to follow up patients to test memory at 3 months Permanent? 56/60 93 and 6 months but this was difficult to do, and one said For events just before and the referring consultant and team did this. after ECT? 59/60 98 Of the 62 respondents, 55 left comments when For events long before ECT asked how they assessed memory. Thirty-eight (retrograde amnesia)? 44/56 79 For events that occur more mentioned using the Mini-Mental State Examination 11 than 3 weeks after ECT? 17/55 31 (MMSE) or some part of it; however, six stated that the Are patients given a fact sheet MMSE as a tool was insufficient and an additional four that includes information on referred to having no suitable tool with which to assess possible memory loss? 59/62 95 memory.