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Electroconvulsive Therapy (ECT) - PDF

   

Added on  2021-06-15

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Research proposalName of the student:Name of the University:Author’s note1

Table of ContentsBackground:...................................................................................................................3Research question:.........................................................................................................6Research objective:........................................................................................................6Methodology:.................................................................................................................7Validity of the research:...............................................................................................12Ethical consideration:...................................................................................................12References:...................................................................................................................162

Background: Depression is one of the leading causes of disability worldwide and it isprojected that by 2020, it will become the second leading cause of disability (Kessle& Bromet 2013). Major depressive disorder is a mental health condition associatedwith high rate of chronicity and disability in the workforce. Evidence exists regardingrange of adverse effects of major depression in affected individuals. Apart from effectof depression on work function and productivity, depressive symptoms also result inpoor functioning in family and social relationship. This kind of functional impairmentis caused because of cognitive dysfunction in patients with Major DepressiveDisorder (MDD) (Lam et al. 2014). Culpepper, Lam and McIntyre (2017) explainthat cognitive impairment is often disproportionately found in patient with depressionwho have not returned to full psychosocial functioning. Cognitive impairment such aspoor attention, deficit in memory, visual processing, verbal and non-verbal learningare the common complaints in patient with MDD. Such patients often have distortedinformation processing and they are most likely to move towards negative stimuli andabnormal responses during decision making (Lam et al. 2014). To promote recovery of patient with MDD, the goal should be to promote fullfunctional recovery in patient. Various treatment options are available to improvecognitive functioning in MDD such pharmacological treatment and psychotherapeutictreatment. These are useful to meet unmet needs of patient. Morimoto et al. (2015)suggest that delivery of antidepressant therapy along with psychosocial intervention isuseful in treating depression in geriatric patient. The efficacy of differentpharmacological treatment differs based on age and types of symptoms observed inpatient. Electroconvulsive therapy (ECT) is one effective and rapid treatment optionsfor treating patients with depression and bipolar disorder. It is treatment process in3

which electrical stimulus is provided to patient to produce a generalized seizure. ECTis most widely utilized for the treatment of geriatric population because of severalreasons. Firstly, medication does not produce optimal effect in elderly patients withdepression. Secondly, due to the effect of ageing, elderly people have lower toleranceto medication because of changes in pharmacokinetics with age. Another advantage ofECT for elderly population is that it is associated with less complication and bettertreatment response in elderly people compared to younger adults (Kerner & Prudic2014). However, as cognitive symptoms are common complaints in MDD patients,investigating the effect of the therapy on cognitive function improvement is alsonecessary. The efficacy of ECT on treatment response and recovery in patients withdepression is well-established. ECT is effective in short term treatment of patientswith MDD and has higher therapeutic effective compared to drug therapy. However,one of the concerns that affect uptake of ECT as a treatment option is presence ofcognitive impairment as a side-effect of the therapy. (Oremus et al. 2015) supports theview that use of ECT is controversial in clinical setting because of concerns related totemporary cognitive impairment in post-treatment period. Fear of cognitive side-effects limits the application of ECT for treatment of depression. For this reason, ECTis often linked with cognitive function outcomes in depressive patients. However,evidence exists regarding positive effect of ECT on cognitive functions too. Verwijket al. (2014) showed improvement in neuro-cognitive function of elderly people insome case. However, the credibility of the research is low because many patients werefound to have serious cognitive impairment before the start of ECT. The prevalence of treatment resistant depression has become more prevalent inrecent years and ECT is the most effective treatment for such forms of depression.However, ECT has been often discouraged for negative effect on patient. Although4

current research studies have produced optimistic results, however very past studiessuch as those published in 2003 has reported about memory loss in patient aftertherapy (Bodnar et al. 2016). Hence, current evidence is consistent and fails toprovide convincing evidence to prove the negative effect of ECT on MDD patient. Itis to be noted that cognitive function is compromised in MDD patients before the startof therapy only. However, the extent to which ECT affects cognitive functioning isnot understood. Hence, as cognitive function is significantly compromised in patient,it is necessary that research is done to assess cognitive function both before and afterthe therapy. This would help to confirm whether ECT leads to negative effect ondepressive patient or not. Past studies investigating about the effect of ECT on cognitive function havegiven ambiguous results. Tmava et al. (2017) showed no difference in cognitivefunction of patients before and after ECT therapy. Hence, to address the controversyand get robust evidence regarding the effect of ECT therapy on cognitive function ofdepressive patient, there is a need to do larger studies with samples from manypopulation groups to understand the true effect of ECT on cognitive functions ofpeople with depression. The main purpose of this research proposal is to explore theexperience of patients regarding acceptance of ECT as a treatment option andanalyzed their view on impact of ECT on cognitive function. Research in this area isimportant because large number of past scientific literature has investigated about theefficacy however there are few studies that give account of patient’s experienceregarding ECT therapy. Apart from efficacy, investigation about treatmentacceptability is also important to consider ECT as a treatment option for patients withdepression. The research proposal provides overview about research design andresearch methodology to gain answer to the research question and address limitationsfound in past research. 5

Research question: The research is concerned with improving cognitive impairment function indepressive patient. Although ECT has been recognized as an effective treatmentoption for patients with depression, however review of past studies shows severalcontroversies surrounding the benefits of ECT because of reports of cognitiveimpairment in patient post the therapy. Past studies have proved such negativecognitive effect, however due to research limitation, robust evidence regardingnegative outcome in patient has not been found. Secondly, as cognitive impairment isa common complaint in MDD patient, the side-effect of ECT is not clear. The reviewof past studies has also given idea regarding ways to overcome limitation in pastresearch methodology. Therefore, the main research problem is the presence ofcognitive impairment in elderly patient with MDD post ECT. The research questionfor the proposal is framed in the form of PICO format which are as follows:P (Population): Elderly patients diagnosed with MDDI (Intervention): Electroconvulsive therapyC (Comparator): Medication management without ECTO (Outcome): improvement in cognitive functions The PICO question for the research is-What is the effectiveness of ECT treatment compared to medication management oncognitive function of elderly patients diagnosed with MDD?Research objective: To obtain answer to the research question, it is planned to conduct aqualitative research on patients with MDD to understand the negative or positive6

effect of ECT on cognitive function. The main objectives of the research proposal areas follows:To investigate about the effect of ECT on cognitive function of elderlypatients with MDDTo explore perception of target population regarding the acceptability of ECTTo make conclusion regarding the positive or negative effects of ECT oncognitive functionMethodology: Research design: As the main purpose of research is to explore the effectiveness of ECTtreatment on cognitive function of elderly patients with MDD and determineacceptance of the therapy, qualitative research approach will be used for conductingthe research. The main rational for using qualitative research approach is that it helpsin interpretation of a sample groups view on any phenomenon. The phenomenon ofinterest for this research proposal is the effectiveness of ECT for MDD patient.Hence, by the use of qualitative research design, it will be easy to understand thecontext of illness from target population group and interpret their experience on ECTtreatment (Lewis 2015). As the research aims to explore experience of elderlypatient’s with ECT therapy and the impact of therapy on cognitive outcome, theresearch is concerned with lived experience of participant. Qualitative researchapproach is the best method to capture participant’s lived experience and gain richerdata related to a research question (Smith 2015). Selection of this research design willhelp in exemplifying the effectiveness of ECT on recovery of patients withdepression. 7

Qualitative research is a naturalistic approach to interpret real world situations(Stuckey 2013). By the use of cross-sectional interview method, the main aim of theresearch proposal is to get in-depth idea about the effectiveness of ECT. As it aims togenerate new ideas or robust evidence regarding positive or negative aspects of ECT,inductive approach will be chosen for the research process. Inductive approach helpsin the generation of new theory from research data and it favors looking at previouslyresearch phenomena from a different perspective. Cross sectional interview will bedone with research participant to obtain answer to the research question. It is plannedto carry out the interview within 4 weeks. The cross sectional interview will help incollecting data to make inference about research question. It is an observational studydesign where survey tools or questionnaires are used to measure the outcome and theexposure in the study participants at the same time (Setia 2016). For this searchproposal, the main outcome of interest is cognitive improvement and the mainexposure is ECT. Research paradigm:As qualitative research with the use of cross-section interview has been chosento address the research question, it is related to interpretivism paradigm.Intrepretivism supports researchers to interpret elements of the study, hence thisparadigm will help to integrate patient’s experience of ECT into the study. Peoplewith interpretivist perspective assume that different people experience and interpretthe same reality in different ways. Researchers with interpretivism proceed with thethinking that access to reality is through social construction such as shared meaning.The interpretivism philosophy supports researchers to group together diverseapproaches and focus on meaning of participants to reflect on different aspects of theissue. Due to the selection of qualitative and interpretivist approach, interview methodhas been chosen for data collection. Primary research with the use of interview data8

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