Editorial board editor-in-chief

Dificulties in developing algorithms for application of physical methods…
or fever therapies. The antidepressant and antipsychotic drugs 
that are used today were developed as late as the middle of the 
20
th
century. Before that time, various herbal medicines including 
opiates, alcohol and hypericum extracts were used in treatment 
of mental disorders [4].
Since the Antiquity numerous physical methods using mag-
netic or electric phenomena have been used. Therapies tried to 
make use of the natural sources of these phenomena, like amber, 
magnetite or electric ish. In a later period, due to the progress 
of technology, medicine started to use Voltaic piles, electrostatic 
generators and various electric stimulators as well as artiicial 
magnets and magnetic ield generators [5, 6].
The best known method of physical treatment in psychiatry is 
electroconvulsive therapy (ECT) introduced into clinical practice 
in 1938 by Cerletti and Bini. They were the result of numerous 
and long-lasting attempts at using electric stimulation in therapy 
of mental disorders based on observations connected with 
chemically induced (indoklon, cardiazol) convulsions. Cerletti 
and Bini managed to select the current parameters that were 
able to trigger seizure activity of the brain [7]. It is interesting 
that the irst application of ECT was preceded by several years 
of experiments of animals, which was then (in the 1940s) hardly 
ever practiced, and which is now an obligatory requirement 
of admission of new pharmacologically active substances for 
clinical studies [8]. 
Electroconvulsive therapy proved to be highly effective at 
controlling of both psychotic symptoms and affective disorders 
(in depression as well as in mania), making it possible for chronic 
patients to function fairly well in everyday life [9]. As compared 
to the chemical methods of inducing convulsions, ECY turned 
out to be safer and easier to administer. It was easier to control 
the dose of the stimulus (here: electric current) necessary to 
trigger a seizure. Moreover, convulsions were manifested im
-
mediately and not after a longer or shorter delay (in the case 
of chemically induced convulsions), during which the patient 
experienced discomfort. 
Electroconvulsive technique was readily adopted in numerous 
psychiatric centers and soon became quite popular – initially 
applied larga manus in most psychiatric disorders. 
The irst two decades since the introduction of ECT into 
clinical practice were the period of intensive clinical studies, 
application of electroconvulsive procedures in various psychi-
atric disorders and accumulation of experience which allowed 
physicians to develop optimum (effective and safe) schemes of 
treatment, e.g. [8]:
–
indications and counter-indications for application of ECT 
were developed (renouncing application of ECT in disor-
ders in which it proved little effective),
–
the regime of 4-15 procedures in a series was introduced, 
replacing mega-schemes (several dozen to several hun-
dred procedures in a series, which could be highly danger-
ous and threatening with numerous side-effects),
–
sine waves of the current were replaced by square waves 
(less burdening energetically),
–
unilateral procedures were proposed in the place of bilater-
al ones (which, on the one hand, is safer as regards the risk 
of the occurrence of memory disorders and disturbances of 
other cognitive functions, but, on the other hand, is clinically 
less effective),
–
application of pharmacologically modiied procedures 
(short-term general anesthesia + muscle relaxation + oxy-
genation) decreased the risk of complication in the osseous 
system and cardiovascular system,
–
monitoring of the seizure activity was introduced (seizures 
lasting at least 30 seconds were recognized as clinically 
effective, shorter ones were described as abortive – having 
no clinical effectiveness),
–
appropriate legal mechanisms for application of ECT were 
developed (the procedure of obtaining the patient’s in-
formed consent was introduced).
The 1960s witnessed a certain „downfall” of ECT [10]. Three 
main reasons for this state of things can be discerned:
–
Indications for application of ECT were seriously limited as 
a result of hitherto observations and studies indicating little 
effectiveness of ECT or its absence in nervous disorders, 
situational disturbances, personality disorders, etc.
–
Modern antidepressant and antipsychotic drugs were in-
troduced and popularized in clinical practice, assuming the 
role of irst-stage treatment in most psychiatric disorders.
–
Patient’s rights movement developed, demanding drastic 
limitation of application of ECT and even completely reject-
ing psychiatry as a medical science (here the most impor-
tant trend was the so-called anti-psychiatry).
In turn, in the recent decades we have had to do with 
a speciic revival of ECT. Pharmacotherapy has not fulilled the 
hopes pinned upon it. Its effectiveness amounting to 60-65% 
is recognized as lower than that of ECT (70-90%). There are 
still many patients for whom pharmacological therapy proves to 
be insuficiently effective and the intensity of ailments requires 
more invasive treatment including electroconvulsive therapy. 
Introduction of the mechanisms listed above allowed for signiicant 
improvement of safety of the therapy as well as the patient’s 
comfort. Thus, so far, anti-psychiatry and its epigones have not 
managed to marginalize psychiatry or get rid of biological methods 
of psychiatric treatment (anti-psychiatry rejected not only ECT 
but also pharmacological therapy).
Present status quo
Electroconvulsive therapy is practically one of the old physical 
methods of psychiatric treatment, which managed to survive up 
today - mostly due to its high effectiveness and signiicant safety. 
More frequent use of ECT procedures is seriously limited by 
their unfavorable associations and the necessity of application 
in hospital conditions with the use of anesthetic techniques (gen-
eral anesthesia and muscle relaxation) as well as the traditions 
of application of ECT in a given center and availability of ECT 
equipment. Moreover, as it has already been mentioned, mental 
disorders of lesser intensity or of situational etiology respond fairly 
well to pharmacological treatment in outpatient clinics. Hence, 
prescribing of ECT in this kind of cases would be unjustiied.
Also, numerous more severe cases of mental disorders 
respond fairly well to intensive pharmacotherapy applied in hos-
pitals, so there is no need to apply ECT procedures. 
Due to its high safety, good availability, easy administration 
and low cost, pharmacological treatment is commonly recognized 
as the irst-choice therapy. Patients suffering from mental disor
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