ELECTROCONVULSIVE THERAPY DEFINITION ECT is an electric shock

ELECTROCONVULSIVE THERAPY

DEFINITION ECT is an electric shock delivered to the brain through electrodes that are applied to both temples. An artificially induced grand mal seizure is produced by passing an electrical current of 70 -130 volts for 0. 10. 5 sec. Artificial induction of a grand mal seizure (tonic phase 10 -15 sec, clonic phase 30 -60 sec) through the application of electrical current to the brain, the stimulus is applied through electrodes.

HISTORY ECT was first introduced by Italian psychiatrist Ugo Cerletti and Lucio Bini in April 1938. Insulin coma therapy and pharmacoconvulsive therapy were replaced by ECT. Insulin coma therapy was introduced by the German psychiatrist Manfred Sakel in 1933.

HISTORY Pharmacoconvulsive therapy was introduced in Budapest in 1934 by Ladislas Meduna. In 1974, the APA’s council on research and development appointed a task force on ECT. The APA task force on ECT, in 1976, gave its report which provided clear guidelines for use of ECT.

MECHANISM OF ACTION Neurotransmitter theory. ECT works like anti-depressant medication, changing the way brain receptors receive important mood -related chemicals. Anti-convulsant theory. ECT-induced seizures teach the brain to resist seizures. Neuroendocrine theory. The seizure causes the hypothalamus to release a neuropeptide that regulates mood.

MECHANISM (End) Brain damage theory. An illusion that problems are gone, and euphoria, which is a frequently observed result of brain injury. Psychological theory. Depressed people often feel guilty, and ECT satisfies their need for punishment.

INDICATION Severe depression Schizophrenia Mania (Not improved with medications) Post-partum psychosis Schizo-affective disorders Medical disorders (NMS, Parkinson’s Disease, etc. ) Need for rapid antidepressant response (e. g. due to failure to eat or drink in depressive stupor; high suicide risk).

INDICATION Failure of drug treatments. Patients who are unable to tolerate side- effects of drug treatment (e. g. puerperal depressive disorder) Previous history of good response to ECT. Patient preference. g Suicidal ideas Severe Catatonia When medications are insufficient or symptoms are severe

CONTRA-INDICATIONS Increased ICP Cardiovascular (Coronary artery disease, HTN, aneurysms, arrhythmias) Myocardiac infaction (Recent 3 mths. ), cerebral infarction, active pumonary disease Contraindication to anesthesia & other agents Atropine (Glaucoma, arrhythmias, etc. ) Succinylcholine (Myasthenia gravis, family H/o pseudo-cholinesterase) –

CONTRA-INDICATIONS Cerebrovascular effects (Recent strokes, space occupying lesions, aneurysms) � Severe pulmonary diseases (T. B, Pneumonia, Asthma) Barbiturates (Hepatic disorders, resp. disorders, etc. ) Psychological (Hysteria, hypochondriasis, OCD, etc. )

TYPES OF ECT The type of ECT depends on – a) Mode of its administration: Bilateral or Unilateral b) Use of other agents (1). Direct or unmodified (no anesthesia) (2). Indirect or modified ( anesthesia is used)

MATERIALS ECT Team: Psychiatrist, anaesthetist, the psychiatric nurse & paramedical staff ECT machine, electrodes, medications etc Treatment centre: Waiting hall, preparation room, ECT suite & recovery room � Seizure monitoring: - Hamilton’s Cuff Method - EEG method

TECHNIQUE OF ECT ELECTRODE PLACEMENT: Each electrode is placed 2. 5 -4 cm(1 - 1. 5 inches) on the midpoint on a line joining the tragus of the ear and the lateral canthus of the eye. COURSE OF ECT: ECT is usually given 3 times a week, reduced to twice a week or once a week once symptoms begin to respond. This limits cognitive problems.

TREATMENT Treatment of depression usually consists of 6 -12 treatments. Treatment-resistant psychosis and mania up to (or sometimes more than)20 treatments. Catatonia usually resolves in 3 -5 treatments.

MEDICATIONS USED IN ECT Inj. Atropine 0. 6 mg �Inj. Scoline 25 -40 mg �Sodium Pendothal 150 -250 mg A pretreatment medication such as atropinsulfate , glycopyrolate is administered IM 30 minutes before treatment, ( to decrease secretion/counteract the effect of vagal stimulation induced by ECT. A short acting anesthesia Muscle relaxant ( to prevent muscle contraction during the seizure reduction of possibility of fracture or dislocated bone

Role of Nurse Before ECT Check for written, informed consent from the patient/relative Check that a thorough physical examination (including blood Hb, serum electrolytes, urea/creatinine, RBS, Routine Urinalysis, ECG, etc. is done and that results are available Provide detailed explanation to the patient and relatives The patient should be kept nil orally for at least 8 hrs. prior to ECT (3 -4 hrs. in case of emergency ECT) Remove metallic articles (watch, bangles, ring, hair clips, etc. )

Role of Nurse Before ECT Remove artificial dentures or check for loose teeth Remove lipstick, nail polish or any other makeup Loosen tight clothes. Ensure that the pt. empties bowel/bladder Oil free hair (Bad conductor) Give pre-medication Place the pt. on a trolley in the waiting room

Role of Nurse During ECT Transfer to a well-padded bed in dorsal position Reassure the patient Administer Thio & Scoline. Verify dosage Place padded mouth gag Support shoulder/arms, restrain thighs with hands Hyperextend head with support to chin Give oxygen (100%) Provide electrodes dipped in saline/jelly Note occurrence of GTCS Suction 10. For patent airway 11. Give oxygen 11. Prevent complications

Role of Nurse After ECT Observe, record vitals Put up railings, place lateral position, wipe secretions Record vitals, BP, LOC every 15 minutes, once stable every 30 mts till recovery Allow patient to sleep Reassure pt. 5. Re-orient to ward, etc. Record/inform injuries/pt. complaints Keep the unit tidy.

SIDE EFFECTS Dizziness, dryness of mouth, headache, muscle pain, nausea, vomiting, jaw pain Unsteady gait, poor concentration, anxiety, incontinence.

COMPLICATIONS Tongue bite Cardiac arrest Delirium Temporary memory impairment Decreased hepatic function Memory Loss Medical Complications: Heart problems � Small risk of death �same as other procedures using anesthesia