Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment for certain mental illnesses. During this therapy, electrical currents are sent through the brain to induce a seizure.

The procedure has been shown to help people with clinical depression. It’s most often used to treat people who don’t respond to medication.

1. BY
MR. KALYAN KUMAR MSC(N)
ELECTRO CONVULSIVE
THERAPY (ECT)

2. Introduction
▪Electroconvulsivetherapyisatypeofsomatic
treatment,firstintroducedbyBiniandcerlettiin
April1938.From1980onwardsECTisbeing
consideredasauniquepsychiatrictreatment.ECT
alsoknownaselectroshocktherapyorShock
Therapy.

3. ▪Electroconvulsivetherapyistheartificial
inductionofGrandmalseizurethroughthe
applicationofelectricalcurrenttothebrain.The
stimulusisappliedthroughtheelectrodesthatare
placedeitherbilaterallyorunilaterallyonthe
non-dominantside.

4. Parameters of electrical current applied
▪Voltage70-120volts
▪Duration0.7-1.5seconds
▪Frequency3timesperweekorasindicated
▪Totalnumber6-10;upto25maybepreferredas
indicated.

5. Mechanism of action
▪Theexactmechanismofactionisnotknown.ECT
possiblyeffectsthecatecholaminePathways
betweendiencephalonandlimbicsystemalso
involvingthehypothalamus.

6. Types of ECT
▪DirectECT:Itisgivenintheabsenceof
anaesthesiaandmuscularrelaxation.Thisisnota
commonlyusedmethodnow.
▪ModifiedECT:Itismodifiedbydruginduced
musclerelaxationandgeneralanaesthesia.

7. Application of electrodes
▪BilateralECT:Eachelectrodeisplaced2.5-4cm
abovethemidpoint,onalinejoiningthetragus
oftheearandthelateralcanthusoftheeye.

8. ▪UnilateralECT:Electrodesareplacedonlyon
onesideofthehead,usuallynondominantside
unilateralECTissafer,withmuchfewerSide
Effectsparticularlythoseofmemory
impairment.

9. Indications
▪Major depression
▪Severe catatonia
▪Organic mental disorders
▪Severe psychosis (Schizophrenia or Mania)

10. Contraindications
▪Raised ICP ( Intracranial pressure)
▪Congestive heart failure
▪Cerebral haemorrhage
▪Retinal detachment

11. ▪Pneumonia
▪Acute Myocardial Infarction
▪Brain Tumor
▪Cerebral aneurysm

12. Side effects
▪Headache
▪Short term memory loss
▪Confusion, anxiety
▪Dryness of mouth
▪Palpitations

13. ▪Nausea, vomiting
▪Drowsiness
▪Tongue bite
▪Muscle aches
▪Restlessness

14. Drugs used
▪Injection.Succinylcholine0.5 mg/kg (Muscle
relaxant)
▪Injection. Thiopentonesodium 3 mg/kg
(Anesthetic)
▪Injection. Atropine3 mg/kg (To reduce
Respiratory secretions)

15. Nursing responsibilities
PRE-TREATMENTEVALUATION
▪DetailedMedicalandpsychiatrichistoryincluding
historyofallergies
▪Assessmentofpatientsandfamiliesknowledgeof
indications,SideEffects,therapeuticeffectsand
riskassociatedwithECT.
▪Assessvitalsings
▪Obtaininformedconsent.

16. ▪NBMfor4-6hourspriortoECT.
▪Withholdoralmedicationinthemorning
▪Anyjewellery,prosthesisandcontactlens,
metabolicobjectsandtightclothingshouldbe
removedfromthepatient'sbody.

17. Intra procedure care
▪PlacethepatientcomfortablyontheECTtablein
supineposition
▪Staywiththepatienttoallayanxietyandfear.
▪Mouthgagshouldbeinsertedtopreventpossible
tonguebite
▪Theplaceofelectrodeplacementshouldbecleaned
withnormalsaline
▪Monitorvoltage,intensityanddurationofelectrical
stimulus.
▪100%oxygenshouldbeprovided
▪Recordthefindingsandmedicinesgiveninthe
patientchart.

18. Post procedure care
▪Monitorvitalsigns
▪Continueoxygenationtillspontaneousrespiration
starts
▪Takesafetyprecautionstopreventinjury(useof
siderailstopreventFalls,side-lyingpositionand
suctioningtopreventaspirationofsecretions).

19. ▪Ifthereisseverepost-ictalconfusionand
restlessnessIVDiazepammaybeadministered
▪Documentanyfindingsasrelevant,inthe
patient'srecord.

20. ▪Summary
▪Conclusion