Electro convulsion therapy bsc nursing 3rd year

This presentation provides a comprehensive overview of Electroconvulsive Therapy (ECT), a medical treatment most commonly used for patients with severe depression, bipolar disorder, and certain types of schizophrenia. The slides cover the history, mechanism, indications, procedure, benefits, risks, and common misconceptions about ECT. Designed for students, healthcare professionals, and the general public, the presentation aims to promote a better understanding of this often misunderstood psychiatric treatment

1. P.G COLLEGE OF NURSING MENTAL HEALTH NURSING SEMINAR ON ELECTROCONVULSIVE THERAPY SUBMITTED TO SUBMITTED BY MISS TANUJA SAHU ROMI SAHU ASSISTANT PROFESSOR BSC (N) 3rd yr (mental health nursing)

2. Do you know who this girl is?

3. INTRODUCTION The ECT is a physical therapy in which electrical current is passed to the brain to produce seizures. ECT has been demonstrated to be an effective and safe treatment for many psychiatric disorder Psychiatric nurses have an important role in caring patient who receive ECT

4. DEFINITION Modified ECT is controlled medical procedure in which a seizure is induced in an anesthetized patient to produce a therapeutic effect ACC to Kavanagh & Mcloughlin Artificial induction of a grandmal seizure through the application of electrical current to the brain the stimulus is applied through electrodes which are placed either bilaterally in the fronto -temporal region or unilaterally on the non dominant side ACC to KP Neerja

5. HISTORY In 1938, Italian psychiatrist lucio bini and neurologist Ugo Cerletti performed the first electrical induction of seizure in a catatonic patient ECT was introduced in United States in the year 1960s Max Fink conducted a rigorous scientific research method to ECT Study of unilateral ECT was conducted in 1958

6. PARAMETERS OF ECT Standard dose according to American psychiatric association ,1978 1. Dose. :- 70-120 voltsl 2. Duration :- 0.7-1.5 sec

7. BENEFITS OF ECT ECT relieves very sever depressive illness when other treatments have failed ECT has saved patients lives because 15%of people with severe depression will kill themselves ECT works faster than all antidepressants

8. MECHANISM OF ACTION The exact mechanism of action is not known One hypothesis states that ECT passibly affect the catecholamine pathway between diencephalon ( from where seizure generation occurs) and limboc system ( which may be responsible for mood disorder) also involving the hypothalamus

9. TYPES OF ECT Direct ECT :- ECT is given in the absence of anesthesia and m uscular relaxation. This is not a commonly used method now modified ECT :- ECT is modified by drug induced muscular relaxation and general anesthesia

10. FREQUENCY OF ECT Frequency. :- 3 times /week or as indicated Total number. :- 6-10 ; upto 25 may be preferred as indicated

11. APPLICATION OF ELECTRODES Bilateral ECT :- each electrode is placed 2.5 – 4 cm (1-1 ½ inch ) above the midpoint on a line joining the tragus of the ear and the lateral canthus of the eye Unilateral ECT :- electrode are placed only on one side of head , usually non – dominant side ( rt - side of head in a Rt handed individual) unilateral ECT is safer with much fewer side effects, particularly those of memory impairment

12. PRE ECT MEDICATION Anaesthetic agent:- Thiopental. :- 1.5 – 2.5 mg /kg body wt Propofol . :- 0.75-1.5mg /kg body wt Inj thiopentone Na :- 3-5 mg /kg body wt through IV Muscle relaxant Succinylchlorids neurotransmitters blocker :- 0.75 /kg body wt - used to prevent bone fractures and physical injury related to motor acivity Antichlokinergic agent :- Atropine :- 0.6-1mg Glucipyrolate :- 0.5 mg

13. SEQUENCE OF ADMINISTRATION OF MEDICATION IN ECT Atropine . Thiopental Succinylchloride

14. TYPE OF SEIZURE PRODUCED Grand mal seizure Tonic phase. :- lasting for 10-15sec Clonic phase :- lasting for 30-60 sec

15. INDICATIONS IF ECT Major depressive disorder Psychotic depression Endogenous depression Bipolar disorder Rapid cycling bipolar disorder Schizophrenia Acute schizophrenia Proninant catatonic Mania

16. CONTRAINDICATIONS Absolute Raised ICP Relative Cerebral aneurysm Cerebral hemorrhage Brain tumor Acute mocardial infraction Congestive heart failure

17. COMPLICATIONS OF ECT Brief period of disorientation Postiatak delirium Anterograde and retrograde amnesia Memory impairment Impairment in attention

18. ADVERSE EFFECTS Memory impairment Restlesness Anxiety Confusion Drowsiness Poor concentration Tongue bites Dyspnea Cardiac arrest Joint dislocation

19. ECT TEAM Psychiatrist Nurses Nursing aid

20. TREATMENT FACILITIES Pre ECT room Comfortable waiting room with adequate seating facilities both for client and for attender ECT room Well equipped with saphisticated mechinery facilities like ECT machine Anesthetic apparatus Accessibility to defibrillator O2 cylinder Mouth gag Emergency drug Curved tongue depressor Rescictation apparatus Post recovery room 6-8 beds Suction apparatus Ventilator Emergency drug

21. NURSING CARE IN ECT ECT is treated like a Minor surgical procedure that requires preoperative preparation and postoperative care Providing education and emotional support Pre ECT Planing and assessment Intra ECT Preparing and monitoring

22. Post operative Care and evaluation Documentation

23. 1. client education before ect Explain the procedure to the patient / care giver) gardian and obtain an informed consent Respimd to patients concerns and feeling Explain to the patient the necessary tasks associated with ECT Inform risk and benefits f ECT

24. PRE ECT PLANING AND ASSESSMENT Check patients identity Keep patients NOP for minimum 6-8 hour before ect The patient hair should be clean and dry Remove hair pins, bracelet,body piercing Encourage patients to pass urine before the treatment Remove prosthesses,dentures , glasses, heavy aid, contact lenses etc Withhold night dose of drug like diazepam, barbiturate standard practice should be practiced regarding general anesthesia care Administer atropine IM 30min before procedure Assess vital sign

25. INTRA ECT PREPARINING AND MONITORING Place patient in ECT tabke in supine position Stay with the patient to allay anxiety and fear Apply ECG electrode, BP cuff and pulse oximeter Administrator short acting anesthetic agent and muscular relaxant Prepare scalp and stimulus ECT electrode ( unilateral or bilateral) and apply paate to electrode Apply jelly to the electrode Support the shoulder and arms of the patient and restraint the tight with the help of a sheet Hyperextension of the head with support to the chin and administrater oxygen Do suction if necessary

26. POST ECT Care and evaluation Observe and record the vital parameters Place patient in side side lying position and clean the secretion Transfer the patient from recovery Room record vital sign in every 15 min for 30 min Allow patient to sleep for 30min -1 hr Reassure the client and reorient to the ward Allow patient to have tea or any drink Record the procedure,

27. DOCUMENTATION Document using flow sheet or progress notes Record patient viral sign and responses during the treatment sequence Documnent medication, seizure response Asses and documents the patients physical and mental status and any behaviour change or lack of such changes