|Year : 2022 | Volume
| Issue : 3 | Page : 265-270
Knowledge and attitude toward electroconvulsive therapy among MBBS interns
BP Uma Gayathri, Suvarna Jyothi Kantipudi, Ramanathan Sathianathan
Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
|Date of Submission||28-Sep-2020|
|Date of Decision||25-Jan-2021|
|Date of Acceptance||10-Jul-2021|
|Date of Web Publication||08-Jun-2022|
Dr. Suvarna Jyothi Kantipudi
Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Electroconvulsive therapy (ECT) remains the most effective modality of treatment in many major mental health disorders, which calls for a rapid response. However, the media's portrayal of ECT as inhumane has resulted in a flawed opinion among public and reduced exposure has led to lesser knowledge about ECT among the medical health professionals working in a nonpsychiatric setting. Aims: To assess the knowledge and attitude toward ECT among MBBS students doing internship. Design and Setting: This was a cross-sectional study conducted at the department of psychiatry in a tertiary care teaching institute. Materials and Methods: The study was conducted among 100 MBBS students who were undergoing internship from a tertiary teaching hospital. The students were recruited from various clinical postings, and after obtaining informed consent, their knowledge and attitude toward ECT was assessed. Statistical Analysis: SPSS version 20.0 was used. Results: Majority (59%) of the students rated their psychiatry knowledge as minimal and around 70% reported to have minimal knowledge regarding ECT. 73% of the study population felt that ECT was used to control violent patients. Almost 91% of the students felt that they needed more exposure toward ECT in their undergraduate curriculum. Conclusion: MBBS interns had some knowledge about ECT; however, they still have some misconceptions and negative attitudes about the treatment. Novel teaching strategies could be inculcated in the existing curriculum which could help with more exposure and better understanding of the subject.
Keywords: Electroconvulsive therapy, knowledge and attitude, medical interns
|How to cite this article:|
Uma Gayathri B P, Kantipudi SJ, Sathianathan R. Knowledge and attitude toward electroconvulsive therapy among MBBS interns. Ann Indian Psychiatry 2022;6:265-70
|How to cite this URL:|
Uma Gayathri B P, Kantipudi SJ, Sathianathan R. Knowledge and attitude toward electroconvulsive therapy among MBBS interns. Ann Indian Psychiatry [serial online] 2022 [cited 2022 Dec 4];6:265-70. Available from: https://www.anip.co.in/text.asp?2022/6/3/265/346895
| Introduction|| |
The concept that repeated seizure activity helped in reducing psychotic symptoms in schizophrenic patients was demonstrated by Meduna in 1934. This, in turn, was modified by Ugocerletti and LucioBini in 1937 as they attempted to induce seizures with electricity,, and electricity replaced pharmacological agents in inducing seizure activity and remained a widely used somatic treatment for schizophrenia and mood disorders as well. However, in the mid 1950s, the use of electroconvulsive therapy (ECT) declined, because of the advent of antipsychotics and mood stabilizers, which was seen as a less intrusive method of treating major mental disorders and also because of the negative portrayal of ECT as a cruel and inhumane approach to the management of psychiatric disorders by the media. Even though the use of ECT has been increasing in the recent past due to advances such as the use of general anesthesia, proper oxygenation, and muscle relaxants, its use has been widely debated among the general public as well as the medical fraternity. ECT remains the most effective modality of treatment in conditions such as major depression where the patient is actively suicidal, psychotic depression, mania, catatonia, and schizophrenia, which calls for a rapid response on medical or psychiatric grounds or failure or intolerance in responding to pharmacotherapy. The negative stance employed by the media plays a role in shaping the attitude of general public toward ECT. Studies have consistently shown that the general public are critical about ECT as a treatment modality which could be due to the preconceived faulty notions, lesser knowledge about ECT, the influence of media, and the stigma surrounding the field.,,, Further studies also showed that medical health professional working in a nonpsychiatric setting also have less knowledge about ECT and tend to view ECT in a negative light. For years, patients with psychiatric disorders have been stigmatized to a great extent and studies have shown that such prejudices exist in the medical fraternity as well which could be attributed to lesser exposure in their undergraduate (UG) period and the perceived poor public image.,, This study attempts to evaluate and asses the knowledge and attitudes of ECT among MBBS interns and thus attempt to uncover the lacunae in the existing teaching and learning module and include novel teaching strategies, which would help them get a proper understanding about ECT, its indications, and its mechanism of action. This would help combat the stigma produced by the negative portrayal of ECT by the media and would help them make decisions or referrals regarding whether a patient needs ECT or not.
| Materials and Methods|| |
A cross-sectional survey was employed for the assessment of knowledge and attitude toward electroconvulsive therapy.
This study was conducted in a tertiary care center with a medical college setting. The institute has a 40-bedded inpatient ward with three cycles of ECT being given per week after obtaining anesthetic clearance. A total of 100 MBBS students doing internship in 2019 constituted the sampling frame for the study. All the interns who were willing to participate in the study and gave written informed consent were included in the study.
Sample size was not determined a priori, and we intended to include most of the interns of that year. We got 75% response rate and 100 interns were assessed, similar to most of the studies done in the past.
Data collection methods
One hundred MBBS interns were assessed with a self-rating questionnaire which was employed in a previous study. After getting permission from the author, the questionnaire used by Gazdag et al., which was used in several Indian studies, was slightly modified, which would assess their knowledge and attitude toward ECT. The modified questionnaire was administered to the participants.
The questionnaire consisted of a total of 35 questions in three different formats. The questionnaire was divided into three segments with the first segment assessing general medical knowledge, psychiatry knowledge, knowledge about ECT, and the likelihood of choosing psychiatry as a profession, which was rated from 1 to 3 with 1 being minimal and 3 being high. The next set was yes or no questions which assessed their knowledge and indications for ECT. The third set comprised true or false questions which assessed their attitude toward ECT.
The study was carried out over a period of 2 months from November 2019 to December 2019.
The data collected were entered and analyzed using SPSS version 20.0 (IBM SPSS Statistics for Windows,Version 20.0.Armonk,NY:IBM Corp.IBM Corp.Released 2012). Frequencies and percentages were employed for categorical variables. Chi-square tests were employed for calculating statistical significance for categorical variables. P ≤ 0.05 was considered statistically significant.
The study was conducted after obtaining clearance from the Institutional Ethics Committee, SRIHER. The data were anonymized to ensure confidentiality.
| Results|| |
A total of 100 participants were recruited in the study and analyzed. They were further divided into two groups based on their completion of prior psychiatry postings during their clinical rotation.
[Table 1] shows the general attitude of interns toward psychiatry. Fifty-nine percentage of participants had rated their psychiatry knowledge as minimal even though 45% had completed their psychiatry postings. Seventy percentage of the participants rated their ECT knowledge as minimal even though 54% had completed their psychiatry postings. Ninety-one percentage of the participants felt that they needed more exposure toward ECT in their UG medical curriculum.
|Table 1: Distribution of participants based on general attitude toward psychiatry|
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[Table 2] and [Table 3] show the attitude and knowledge of interns toward ECT, respectively. Fifty-three percentage of the participants knew the indication for ECT, whereas only 37% had witnessed ECT. On assessing the misconceptions regarding ECT, majority of the participants felt that ECT was used to control violent patients and used as a means of punishing uncooperative patients. Most of the participants also felt that ECT should only be used as a final resort and should not be used in people more than 65 years of age.
|Table 2: Distribution of participants according to attitude toward electroconvulsive therapy|
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|Table 3: Distribution of participants according to knowledge regarding electroconvulsive therapy|
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| Discussion|| |
This is a cross-sectional observational study which attempted to understand the attitude and knowledge among MBBS interns toward ECT. The results showed that even though majority of the study participants had completed psychiatry postings, 59% rated their psychiatry knowledge as minimal and 70% rated their ECT knowledge as minimal. A sizable portion of the participants did not want to opt for psychiatry as a career choice which could be attributed to poor understanding of the subject or lesser exposure due to the limited time spent in psychiatry postings during their clinical rotation. This is in keeping with previous studies which show an overall negative attitude toward psychiatry in general as this could be explained by the prevailing stigma surrounding the field and a lack of clear understanding of the subject as 2 weeks of postings in psychiatry is not enough to get a brief overview of the subject. Most of the students tend to view psychiatry as lacking a solid scientific basis regarding the etiopathogenesis and as of having limited financial benefits. This in addition to the fact that psychiatry is a largely neglected subject in the UG level with lesser distribution of marks in the theory examinations could also have played a role in shaping their attitude toward psychiatry. Even though their general attitude toward psychiatry was found to be lacking, most of their source of knowledge regarding ECT was primarily from psychiatry postings and lectures, which is a good sign as they rely on a scientific source which could lessen the misconceptions with only 33% resorting to media as their source of knowledge for ECT. Most of the interns (91%) felt that they would be benefitted by more exposure to ECT in their UG curriculum. This further highlights the importance of incorporating mandatory viewing of ECT sessions during their clinical rotation.
On assessing the student's attitude toward ECT, 74% said that they will give consent for ECT if indicated even though only 37% had actually witnessed the procedure. More than half of the participants knew the indications for ECT. This is another encouraging find which could be attributed to the fact that majority of the students relied on lectures and journals as their source of information even if they did not witness the procedure directly.
The study participants were also assessed for the various myths and misconceptions regarding ECT.Majority of the participants felt that ECT was used to control violent patients and used a treatment modality to punish uncooperative patients which is in accordance with previous studies which have shown a negative bias among ECT towards medical students., This could be due to the fact that a significant portion of the students had not actually witnessed the procedure and could have resorted to less than accurate source of information regarding ECT which could have colored their views. Previous studies also support this view as there was a significant improvement in knowledge regarding ECT among MBBS interns after an educational intervention,,.Studies have also shown a significant improvement in the knowledge and attitude after they witnessed an ECT session.,, The attitude and knowledge towards ECT improved after lectures on ECT with a better outcome after viewing the procedure among medical students as reported by past studies.,,,, 69% felt that ECT should be used only as a final resort which is in accordance with a study done in Nigeria and 58% felt that ECT should not be used over the age of 65 which conflicts with the finding of more than half the participants reporting that they knew the indications for ECT.Most of the students were aware of the procedures involved in modified ECT and were able to refute the other common misconceptions.We hypothesized that medical undergraduates would have better knowledge regarding ECT owing to their training and accurate source of information regarding the procedure.But the study disproved the hypothesis that medical students have better knowledge which could be attributed to the limited number of psychiatry postings and lesser exposure to ECT.
| Conclusion|| |
This study attempted to uncover the lacunae in the existing teaching and learning module by assessing the student's existing knowledge and attitudes toward ECT. More ECT sessions can be made available to UGs to help them have a better understanding toward ECT and they can be encouraged to interact with patients who had received ECT to get a full understanding of their firsthand experience. It is imperative to address the lacunae in the existing module to enable the students to have an unbiased and unflawed opinion regarding ECT, which in turn would play an important role in shaping the public opinion of ECT as well.
Novel teaching strategies could be inculcated in the existing curriculum which could lessen the stigma they have toward psychiatry as a profession and ECT in general.
The lesser sample size limits the generalizability of the findings. Since this is a cross-sectional study, the longitudinal course after an intervention could not be assessed.
Instituitional ethics committee statement
The study was approved by the Institutional Ethics Committee with reference number CSP-MED/19/NOV/57/182.
Declaration of participant consent
Participant consent statement was taken from each participant as per the Institutional Ethics Committee along with consent taken for participation in the study and publication of scientific results/clinical information/image without revealing their identity, name, or initials.
I would like to thank the Dean, SRIHER, for permission to proceed with the study and the study participants for their kind cooperation. I would also like to thank Dr. Gazdag. for permission to employ and modify the questionnaire used in his study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Accornero F. An eyewitness account of the discovery of electroshock. Convuls Ther 1988;4:40-9.
Bini L. Professor Bini's notes on the first electro-shock experiment. Convuls Ther 1995;11:260-1.
Shorter E, Healy D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. New Brunswick, New Jersey,United States: Rutgers University Press; 2007. 404 p.
Babigian HM, Guttmacher LB. Epidemiologic considerations in electroconvulsive therapy. Arch Gen Psychiatry 1984;41:246-53.
McDonald A, Walter G. The portrayal of ECT in American movies. J ECT 2001;17:264-74.
McFarquhar TF, Thompson J. Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public. J ECT 2008;24:244-53.
Grözinger M, Smith ES, Conca A. On the significance of electroconvulsive therapy in the treatment of severe mental diseases. Wien Klin Wochenschr 2015;127:297-302.
Teh SP, Helmes E, Drake DG. A Western Australian survey on public attitudes toward and knowledge of electroconvulsive therapy. Int J Soc Psychiatry 2007;53:247-73.
Sienaert P. Based on a true story? The portrayal of ECT in international movies and television programs. Brain Stimul 2016;9:882-91.
Chakrabarti S, Grover S, Rajagopal R. Perceptions and awareness of electroconvulsive therapy among patients and their families: A review of the research from developing countries. J ECT 2010;26:317-22.
Lauber C, Nordt C, Falcato L, Rössler W. Can a seizure help? The public's attitude toward electroconvulsive therapy. Psychiatry Res 2005;134:205-9.
Kerr RA, McGrath JJ, O'Kearney RT, Price J. ECT: misconceptions and attitudes. Aust N Z J Psychiatry 1982;16:43-9.
Dowman J, Patel A, Rajput K. Electroconvulsive therapy: Attitudes and misconceptions. J ECT 2005;21:84-7.
AlHadi AN, AlShahrani FM, Alshaqrawi AA, Sharefi MA, Almousa SM. Knowledge of and attitudes towards electroconvulsive therapy (ECT) among psychiatrists and family physicians in Saudi Arabia. Ann Gen Psychiatry 2017;16:16.
Jiloha RC. Image of psychiatry among medical community. Indian J Psychiatry 1989;31:285-7.
] [Full text]
Malhi GS, Parker GB, Parker K, Carr VJ, Kirkby KC, Yellowlees P, et al
. Attitudes toward psychiatry among students entering medical school. Acta Psychiatr Scand 2003;107:424-9.
Minhas FA, Mubasher MH. Attitude of medical students towards psychiatry in Pakistan. Coll Physicians Surg Pak 2003;10:69-72.
Murthy RS, Khandelwal S. Undergraduate training in Psychiatry: World perspective. Indian J Psychiatry 2007;49:169-74.
] [Full text]
Gazdag G, Kocsis-Ficzere N, Tolna J. Hungarian medical students' knowledge about and attitudes toward electroconvulsive therapy. J ECT 2005;21:96-9.
Balhara Y, Yadav T, Mathur S, Kataria D. The impact of a “Brief ECT Orientation Module” on the knowledge and attitudes of medical students towards ECT in India. Ann Med Health Sci Res 2012;2:140-5.
] [Full text]
Sartorius N, Gaebel W, Cleveland HR, Stuart H, Akiyama T, Arboleda-Flórez J, et al
. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 2010;9:131-44.
Clothier JL, Freeman T, Snow L. Medical student attitudes and knowledge about ECT. J ECT 2001;17:99-101.
Mausling MB, Macharia M, Jordaan GP. Junior medical students' knowledge about and attitudes towards electroconvulsive therapy in a South African setting. S Afr J Psychiatr 2017;23:1062.
Solomon S, Simiyon M, Vedachalam A. Effectiveness of an educational intervention on medical students' knowledge about and attitude towards electroconvulsive therapy. Acad Psychiatry 2016;40:295-8.
Trenton A, Pelchat R. Medical students' perceptions of electroconvulsive therapy: The impact of direct exposure. J ECT 2016;32:20-2.
Pranjkovic T, Degmecic D, Medic Flajsman A, Gazdag G, Ungvari GS, Kuzman MR. Observing electroconvulsive therapy changes students' attitudes: A survey of croatian medical students. J ECT 2017;33:26-9.
Shah N, Averill PM. Third-year medical students' understanding, knowledge, and attitudes toward the use of electroconvulsive therapy: A pre-exposure and postexposure survey. J ECT 2009;25:261-4.
Kinnair D, Dawson S, Perera R. Electroconvulsive therapy: Medical students' attitudes and knowledge. Psychiatrist 2010;34:54-7.
James BO, Omoaregba JO, Olotu OS. Nigerian medical students attitudes to unmodified electroconvulsive therapy. J ECT 2009;25:186-9.
[Table 1], [Table 2], [Table 3]