esteem issues. Though eating disorders are not
preventable, early intervention and treatment can
prevent further health conditions and minimize
the damage to the body that severe food depriva-
tion causes.
See also BODY DYSMORPHIC DISORDER; DEPRESSION;
DIET AND HEALTH; NUTRITIONAL NEEDS; OBESITY; SOMATI-
ZATION DISORDER; STARVATION.
electroconvulsive therapy (ECT) A treatment
for severe DEPRESSION that does not respond to
treatment with ANTIDEPRESSANT MEDICATIONS. ECT is
also sometimes effective for severe MANIAor BIPO-
LAR DISORDER when either condition fails to
improve with other treatments. ECT uses a mild
electric shock to the outside of the skull to
momentarily disrupt the electrical activity of the
BRAIN. The disruption causes the brain to release a
flood of neurotransmitters, such as serotonin,
DOPAMINE, EPINEPHRINE, andNOREPINEPHRINE. These
neurotransmitters, which are biochemical messen-
gers that convey electrical impulses among the
neurons (NERVEcells) in the brain, strongly affect
mood and emotion. The typical course of treat-
ment with ECT is up to 3 treatments per week for
as many as four weeks (12 treatments total).
The psychiatrist performs ECT after the person
receives general ANESTHESIA, applying electrodes
one on each side of the person’s head. The actual
discharge of electrical energy lasts about two sec-
onds. Medications to relax the muscles and block
their ability to receive messages from the brain
during the treatment prevent the body from react-
ing to the seizures occurring in the brain. The per-
son emerges from the anesthesia about 10
minutes after the shock and goes to the recovery
room until fully awake. Some people experience
short-term memory loss and brief cognitive dys-
function or disorganization of thoughts for a short
time after the ECT.
See also COGNITIVE FUNCTION AND DYSFUNCTION;
MEMORY AND MEMORY IMPAIRMENT; NEURON; NEURO-
TRANSMITTER.
factitious disorders Psychiatric conditions in
which the person contrives the symptoms of an
illness (physical or psychologic). Despite the pur-
poseful contrivance of symptoms, the person is
unable to stop the behavior. The factitious disor-
der may have symptoms that are primarily psy-
chologic, primarily physical (also called Mun-
chausen syndrome), or a combination of
psychologic and physical. People who have facti-
tious disorders often see multiple doctors in differ-
ent clinics and hospitals and sometimes in
different cities. Frequently they have undergone
numerous invasive procedures and surgeries by
the time doctors begin to realize a psychiatric con-
dition is underlying. Characteristics of factitious
disorders include- persistent symptoms that are inconsistent with
diagnostic findings - symptoms that change after treatment begins
- eagerness to undergo invasive procedures and
surgeries - unwillingness to allow current health-care
providers to consult with previous health-care
providers - reliable treatments fail to work in the expected
ways
Diagnosis of factitious disorders is difficult
because the person typically denies any element of
contrivance about his or her health problems and
symptoms despite confrontation with evidence
such as test results. The concern is twofold: The
person may do serious harm to himself or herself
through the creation of symptoms or treatment
for them, and the person extensively consumes
expensive and often limited medical resources.
Another person, such as a family member, who
knows of the factitious disorder can sometimes
mitigate the risks to the person’s well-being by
alerting health-care providers. However, overall,
treatment for factitious disorders (and especially
Munchausen’s syndrome) is not very successful.
Factitious disorder by proxy, also called Mun-
chausen’s syndrome by proxy, is a variant in
which the person creates symptoms in another
person, often under the guise of caring for the
person, and then steps into the role of seeking
medical attention for the person. Munchausen’s
syndrome by proxy most commonly involves a
parent (usually mother) who creates symptoms in
a child; less common manifestations include an
adult child who creates symptoms in a parent or afactitious disorders 375