Under the amended Mental Health Act 2007, electroconvulsive therapy (ECT) can only be authorized in an incapacitated patient providing it is not in conflict with the decision of the donee of lasting power of attorney. To assess the ability of surrogates to correctly predict a subject's preference for treatment with ECT Tiffany Signature bangle before and after viewing an educational video. The effect of the educational video on attitudes to ECT was also examined. Twenty-five subject-surrogate pairs were recruited from relatives of psychiatric patients. The subjects' treatment preferences regarding the ECT and the surrogates' predictions of these preferences were assessed by means of 2 hypothetical scenarios before and after viewing an educational video. An attitude to ECT questionnaire (Questionnaire on Attitudes and Knowledge of ECT) was completed by all participants before and after the video. Subject-surrogate concordance was high, 84% for scenario 1 (treatment-resistant depression) before and after the video. In scenario 2 (life-threatening depression), concordance rose from 80% before the video to 96% after the video. The greatest increase in concordance occurred in pairs in which neither subject nor surrogate had Tiffany & Co. bangle experience of ECT. Attitude scores were significantly more positive after the video. Surrogates were able to predict the subjects' preference for ECT with high levels of accuracy. This finding is contrary to similar studies involving end-of-life treatment. Providing surrogates with clear, detailed, and accurate information about the proposed treatment may improve surrogate accuracy particularly in treatments such as ECT where widespread misperceptions prevail.
The science of using neuroimaging techniques to diagnose psychiatric conditions is in a Tiffany 1837 interlocking circles bangle stage. There are promising data from Fu and colleagues2 that functional magnetic resonance imaging (MRI) methods combined with a support vector machine (SVM) pattern classification method can correctly sort depressed patients and controls into their appropriate categories with a sensitivity of 84% and a specificity of 89%. More recently the same group used a general probabilistic classification method to produce measures of confidence for MRI data.3 Another group also used SVM applied to grey matter (structural) scans of patients with autism spectrum disorder and correctly classified affected participants with a specificity of 86.0% and a sensitivity of 88.0%.4 There was a relation between symptom severity and the extent to which a participant differed from the test margin.
Although these are compelling results, differentiating a depressed patient from a Tiffany & Co. bangle patient is not usually as challenging as being able to ascertain whether a first depression represents the first episode of a major depressive disorder or a bipolar disorder, or whether psychotic symptoms represent the onset of schizophrenia or a drug-induced psychosis in a young substance-abusing patient. To date, there are a limited number of studies that have specifically used SVM to differentiate between patient groups. One group was able to show that SVM was Tiffany 1837 interlocking circles bangle to radiologists in both separating patients with sporadic Alzheimer disease from normal aging and in separating patients with sporadic Alzheimer disease from patients with frontotemporal lobar degeneration.5 There is a need for large studies that include a range of patient populations to establish the specificity and sensitivity of these measures in distinguishing various illnesses not just from healthy brains but also from other illness states.
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