Inpatient admissions
Due to the low willingness to undergo therapy, in most cases an inpatient admission to a psychiatric hospital cannot be avoided. Unfortunately, in such cases it can happen that the mania sufferer does not follow the agreed ward rules and even leaves the ward against the agreements.If dangerous or damaging behavior occurs in the future, it is possible that the patient may be admitted to a protected ward against his or her will. The term “protected” means that the door to leave the ward cannot be opened independently by the patient.
Electroconvulsive therapy
In rare cases, similar to depression, resistance to therapy can occur. This means that none of the selected therapeutic methods leads to success, i.e. an improvement of the symptoms. In these cases, electroconvulsive therapy is a further, also well investigated possibility to get patients out of this agonizing state.
To explain ECT: ECT (Electroconvulsive Therapy): Who has not seen the pictures of Jack Nicholson in the “cuckoo’s nest” when he gets his “electric shocks”? Most patients are quite rightly unsettled by this and by a lot of hearsay and even more dubious sources of information on the Internet. Here is the truth as it is practiced in this country of ours.
First, an anesthesiologist puts the patient into a state of short anaesthesia with muscle relaxation. Then a doctor uses an ECT device to artificially provoke an epileptic seizure with the help of electricity. This procedure is stress-free and painless for the patient due to the short anaesthesia.
Unfortunately, this method has a very bad reputation (wrongly so nowadays). There are too many images in people’s minds from the time when this method was used almost indiscriminately or as a punishment and without anaesthesia. Contrary to popular opinion, this method does not cause any permanent damage.
In fact, this method can be considered one of the safest and with the fewest side effects. The most common side effects are: Lack of concentration on the day of therapy, possible confusion after awakening from anesthesia, headache and nausea. Nowadays, ECT is generally (in Germany) used in patients with severe depression with psychotic symptoms or with so-called catatonic schizophrenia (see chapter on schizophrenia), who do not experience sufficient improvement under drug therapy.
This can bring improvement to almost 60% of patients. The therapy is carried out in 8-12 sessions and may have to be repeated after a few months, because, and this should not be concealed here, the relapse rate after about 6 months can be considered high. In a few patients, the time to relapse is much shorter, so that it may be necessary to take the path of maintenance ECT. Here, ECT sessions are performed at defined intervals (1-4 weeks).
