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Revista de Psiquiatria do Rio Grande do Sul

Print version ISSN 0101-8108

Rev. psiquiatr. Rio Gd. Sul vol.26 no.3 Porto Alegre Sept./Dec. 2004

http://dx.doi.org/10.1590/S0101-81082004000300014 

BOOK REVIEW

 

Book review: Eletroconvulsoterapia, by Sérgio Paulo Rigonatti, Moacyr Alexandro Rosa, and Marina Odebrecht Rosa (orgs.)

 

Reseña del libro Eletroconvulsoterapia, de Sérgio Paulo Rigonatti, Moacyr Alexandro Rosa y Marina Odebrecht Rosa (orgs.)

 

 

José Carlos Souza

Psychiatrist, PhD in Mental Health (Unicamp, Brazil), Postdoc and Professor, School of Medicine of Lisbon and Universidade Católica Dom Bosco, Campo Grande, MS, Brazil

 

 

ELETROCONVULSOTERAPIA (163 p.)

Sérgio Paulo Rigonatti, Moacyr Alexandro Rosa, and Marina Odebrecht Rosa (orgs.)
São Paulo: Vetor; 2004

 

 

After having met Prof. Dr. Sérgio Rigonatti personally at the launch of this book, and having read it twice, I took the liberty of writing this review.

The book has two other organizers in addition to Prof. Rigonatti — Dr. Marina O. Rosa and Dr. Moacyr A. Rosa — and 19 contributors, together making an eminent multidisciplinary team. The preface is by Prof. Dr. Carol Sonenreich, and presentation is by the puissant Prof. Dr. Marco Antonio Brasil.

The book is written in objective, logical language that is clear and easy to understand even for those who are laymen in the area, which, for a theme that is so stigmatized, is of great merit.

Chapter 1 presents a chronological history of the best-known psychiatric treatments of which electroconvulsive therapy (ECT) was the first biological treatment with proven efficacy throughout history. Currently, ECT is performed on a large scale in many countries, including Brazil — probably more at private clinics than at public ones.

In the second chapter the authors discuss, didactically, the mechanisms by which ECT acts, stating that, while this is not yet completely understood, there are important theories on the subject, the three principal of which are: the classical neurotransmission theory, the neuroendocrine theory and the anticonvulsive theory. They describe this last as claiming that the antidepressive effect of ECT is the result of its profound anticonvulsive effect on the brain.

In the third chapter the authors demystify the ECT technique about which many health professionals active in areas related to psychiatry and also the general public know so little. They discuss the pros and cons of each technique and emphasize the need for psychiatry to be linked with the other medical specialties, in particular cardiology.

In the fourth chapter, Prof. Rigonatti together with three contributors (Dr. Demétrio Rumi, post-graduate Cardiology student, Júlio Takada and Dr. Maria Solimene) present the indications and contraindications for ECT. It is worth pointing out that certain international studies discuss the first-choice indications for ECT in a manner that is more bland and less complex than do the Latin American authors. Special cases, such as expectant mothers and infants, are dealt with in greater detail in Chapter V, together with the pre-ECT evaluation, which should be performed with care, taking into account the patient and not the diseases, in addition to medication being used, psychotropic or otherwise, and the environment in which the ECT sessions will be administered.

In Chapter VI, Dr. Irimar Posso, Professor de Anesthesiology discusses the need for pre- and post-anesthetic assessments, the Informed Consent Form and the complex area of pharmacological interactions.

In the seventh chapter the adverse effects of ECT are dealt with, which can be counted among the most mediocre arguments used by those ignorant of the subject and by antipsychiatrists against this efficient biological technique.

The eighth chapter discusses the course of treatment. This is truly one of the most difficult decisions for psychiatrists and their multidisciplinary teams. Every service will have their own protocol, but the objective that is common to all should always be the improvement of patient quality of life.

Nurses Elizabeth Jóia, Iara Bellegarde and Maguida Stefanelli deal with the role of the psychiatric nursing team in ECT in chapter IX, pointing out the prime importance of the psychiatrist's work to a multidisciplinary team.

Prof. Rigonatti and the Psychologist Antônio Serafim deal with the ethical aspects of ECT, in Chapter X, highlighting the concepts of autonomy and competence; and, why not add, training. There ought to be specialization courses in ECT in Brazilian States.

In the penultimate chapter, the organizers, together with, the psychiatrists Marco Antonio Marcolin and Demétrio Rumi, the psychologists Paulo Boggio and Martin Myczkowski, the Doctor of Sciences Felipe Fregni and the psychiatry residents at the Instituto de Psiciatria at the Universidade de São Paulo Medical Faculty's Hospital das Clínicas Carlos Mansur, Carolina Santos and José Gallucci Neto discus an as-yet little-known theme, transcranial magnetic stimulation (TMS), which can be used in clinical and experimental neurology and also in psychiatry. They cite several different disorders such as obsessive-compulsive disorder, post-traumatic stress disorder, Tourette's syndrome and even schizophrenia, and state that despite this the majority of clinical research has concentrated on depressive disorders, both using TMS in isolation and as a potentializer for antidepressants, going on to claim that efficacy is similar for the treatment of patients with major depression as with other therapies with the advantages of having a faster onset of action and very good toleration due to the absence of side-effects.

In the last chapter, the psychologists Cristina de Oliveira and Emerson de Oliveira the music therapist Ana Cascarani and the psychiatrist Rita Ferreira discourse on complementary treatments of importance: art therapy and music therapy. The first the describe as a psychotherapy modality the studio for which can be set up in the waiting room at the place where ECT will be administered. Music therapy, the say, is one of the group of expressive therapies and the music therapists can help the client before during or after ECT.

At the end of the book, the Federal Medical Council (Conselho Federal de Medicina) Resolutions on the Practice of Electroconvulsive therapy (1640/02) and on Anesthesia (1363/93) are presented as an Appendix, the aims of which are to facilitate and standardize the practice of this therapy throughout Brazil and also to help psychiatrists to inform the lay population about the procedure.

Concluding, the book Eletroconvulsoterapia will treat Brazilian medical literature to information that is of extreme techno-scientific and social relevance.

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