scholarly journals Beyond the Cuckoo’s Nest: Patient and Public Attitudes about Psychiatric Electroceutical Interventions

Author(s):  
Laura Y. Cabrera ◽  
Maryssa M. C. Gilbert ◽  
Aaron M. McCright ◽  
Eric D. Achtyes ◽  
Robyn Bluhm

AbstractRecent research emphasizes the role of psychiatric electroceutical interventions (PEIs), bioelectronic treatments that employ electrical stimulation to affect and modify brain function, to effectively treat psychiatric disorders. We sought to examine attitudes about three PEIs—electroconvulsive therapy, transcranial magnetic stimulation, and deep brain stimulation—among patients with depression and members of the general public. As part of a larger study to assess different stakeholders’ attitudes about PEIs, we conducted semi-structured key informant interviews with 16 individuals living with depression and 16 non-depressive members of the general public. We used a purposive sampling approach to recruit potential participants based on eligibility criteria. We performed qualitative content analysis of interview transcripts. Participants from both groups expressed an overall cautionary attitude towards PEIs, yet there were mixed attitudes in both groups. Patients commonly described electroconvulsive therapy as scary, traumatic, or intense, while members of the general public often referenced the treatment’s negative portrayal in One Flew over the Cuckoo’s Nest. Patients and the general public saw transcranial magnetic stimulation as a potentially viable option, but in most cases only if medication was not effective. Deep brain stimulation attitudes were predominantly negative among patients and cautionary among public. The overall cautionary attitudes towards PEIs, together with the technological features and social aspects underlying those attitudes, highlight the need for unbiased education to fill the gaps in knowledge and inform perceptions of those who may benefit from these treatments.

2018 ◽  
Author(s):  
Scott Aaronson ◽  
Paul Croarkin

Neurostimulation modalities in psychiatric practice and research efforts use magnetic and electric fields to modulate neuronal functioning. Physicians have used these modalities since ancient history, but most modern brain stimulation treatments developed after the inception electroconvulsive therapy in 1937. Noninvasive brain stimulation generally refers to treatments that do not require surgery, such as electroconvulsive therapy, repetitive transcranial magnetic stimulation, and transcranial current stimulation. Conversely, deep brain stimulation and vagal nerve stimulation are the two most researched invasive brain stimulation modalities for psychiatric disorders. Treatment with repetitive transcranial magnetic stimulation has been shown to be effective for the treatment of resistant major depressive disorders but is less rapid acting and may be optimal for a different patient population as compared to electroconvulsive therapy. Research focused on transcranial direct current stimulation continues to expand, but its role in clinical psychiatric practice is currently not well defined. Despite mixed and, in some cases, disappointing results, invasive brain stimulation techniques such as deep brain stimulation and vagal nerve stimulation will likely continue to have an important role for certain treatment-resistant populations in psychiatric practice. This review examines the development, basic physiologic mechanisms, and evidence base of neurostimulation modalities in psychiatry.   This review contains 4 figures, 6 tables and 38 references Key Words: deep brain stimulation, invasive, neurostimulation, noninvasive, transcranial direct current stimulation, transcranial electrical stimulation, transcranial magnetic stimulation, treatment-resistant depression, vagal nerve stimulation


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