Doctors at Johns Hopkins University say their clinical practice of using electroconvulsive therapy (ECT) to treat people with severe mental illness is “cognitively dissonant” to the treatment of the most common psychiatric disorder, schizophrenia.

     The neuroscientists, researchers and doctors said that, despite the fact that most people with schizophrenia do not have any known underlying neurological disorders, it is their “psychotic symptoms” that make them vulnerable to ECT and, by extension, to the “cures” of conventional psychiatry.

    This is because of the fact they experience a strong urge to avoid negative associations between their symptoms and their mental health conditions.

    Dr. Robert H. Leach, a neurologist who leads the Hopkins research team, and Dr. James B. B. Shulman, an associate professor of psychiatry at Johns, have written a paper in the journal Psychological Bulletin in which they say that the cognitive dissonance is due to the fact patients do not see the brain as being responsible for their symptoms.

    “Many of the patients we see do not feel they have schizophrenia, or even that they have a psychotic illness,” Dr. Lech said.

    The research is important for both patients and psychiatrists because it provides evidence that ECT is effective for patients with schizophrenia, even when it is not appropriate for treatment.

    While there is no evidence that schizophrenia patients are more likely to experience negative associations with ECT than the general population, they are more vulnerable to the cognitive distortions that come with being a “schizophrenic,” Dr Leach said.

    In a series of experiments with participants, the researchers showed the participants pictures of faces that were either negative or positive.

    In the negative pictures, people had a tendency to make eye contact with the people on the left.

    If a person’s brain activity was blocked, the participants could not make eye contacts, as would be expected.

    When participants were shown positive images, the subjects were able to make more eye contact.

    But in the negative images, when the researchers presented the negative faces, the negative-positive association was more pronounced.

    Participants with schizophrenia had stronger association with negative pictures than did the healthy controls.

    The results suggest that patients with severe schizophrenia are not “psychotics,” but that they are susceptible to negative associations that may make them more susceptible to ECC.

    What the research shows is that people with psychotic symptoms, including those with schizophrenia and those who are psychotic, do not appear to have a “psychic” brain state, Dr Lech and Dr Shulmans said.

    The researchers, who are members of the American Psychiatric Association’s Task Force on Cognitive Neuroscience and Behaviour, also found that people who had schizophrenia had a weaker tendency to associate negative feelings with the brain’s activity than the healthy participants.

    They were also less likely to associate positive feelings with brain activity when they saw the brain activity in the patients’ brain.

    So, while the study is interesting, it has not yet been scientifically conclusive, Dr B.H. and Dr B, Shulmen said.

    They also cautioned that the findings do not mean that ECC is not safe for people with psychiatric conditions, even though they have not studied the subjects.

    We don’t know whether this is a safe or a harmful practice, they said.

    But they also said they are hopeful that future studies will help clarify whether ECC can help patients who have schizophrenia.

    “We want to learn more about what happens when patients with this disorder have ECT, how that affects their mental well-being, and what it might mean for the treatment they receive,” Dr B said. 

    The study was funded by the National Institute of Mental Health.


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