Electroconvulsive therapy ppt

PSYCHIATRIC MENTAL HEALTH NURSING
Electro Convulsive Therapy ppt
Dr. Rahul Sharma

1. Electroconvulsive Therapy
Dr. Rahul Sharma
Associate Professor
H.O.D. of Mental Health Nursing
Ph. D Coordinator
Seedling School of Nursing,
Jaipur National University, Jaipur

3. Introduction
•ThefirstECTtreatmentwasperformedin
April1938byItalianpsychiatristUgo
CerlettiandLuciobini.
•In1950,VonMedonamodifiedtheECT
procedureanditsimplementationis
consideredasuniquepsychiatric
treatment.

4. Definition
•Theinduction/generation/productionof
grandmalseizure,generalizedseizure
throughtheapplicationofelectriccurrent
tothebrain.
Electroconvulsivetherapy(ECT)isamedical
treatmentmostcommonlyusedinpatientswith
severemajordepressionorbipolardisorderthat
hasnotrespondedtoothertreatments.

5. Application of Electrodes

6. Thestimulusisappliedthroughelectrodes
whichareplacedeitherunilaterallyor
bilaterally.
1.Unilaterally-placedonlyononesideofthe
HeadorNonDominantside.
2.Bilaterally-inthefrontotemporalregionor
placed2.5–04cmabovethemidpointof
theearorlinejoiningthetragusofearand
lateralcanthusoftheeye.

7. Electric current Appliance method
•70-120voltofalternatingcurrentpassedfor0.3
–1.5secondsthroughelectrodes.
•ACTION
•TheexactmechanismbywhichtheECTaffect
thetherapeuticresponseisunknown.
•Onehypothesisindicatingtheectpossiblyaffect
theCatecholamine(Adrenalglandproduced
hormone=adrenalineandnonadrenaline)
pathwaybetweendiencephalons,limbicsystem
andhypothalamus

9. Techniques
•Injection–Thiopentanesodiumanaesthetic
agent)(3-5mg/kgbodywt.)throughIV.
•MusclerelaxantlikeinjSuccinylcholine(1mg/kg
bodywt.)throughIV.
•Injection–Atropine(1/100gms)subcutaneous
orIMbeforeelectriccurrentstimuliwillbe
passed.
•Ifneeded,artificialrespirationhastobegiven
untilclientbreathingnormally.

10. ECT TEAM
•Anaesthesiologist
•Psychiatrist
•Psychiatric nurse
•Nursing aid (assistant)

11. Indications
•Major Depression
• a. suicidal tendency
b. psychotic depression
c. stuporous condition (confused
person)
d. melancholia
e. contraindicated drugs
f. resistant drugs

12. •2. Mania
ECT is also indicated in treatment of acute
mania, episodes of bipolar disorder. At present it
is rarely used
3. Schizophrenia
It is used in patients with condition of
schizophrenia.
4. Other Conditions
ECT has also been tried with clients experiencing
various neurosis, OCD and personality disorder.

13. Contraindications
•Increased ICP( from brain tumour, CVA, or other
cardiovascular lesions)
•Cerebral diseases Aneurysm, Haemorrhage)
•Cardiovascular system disease like MI, CHF etc
•Severe disease ( lungs, kidney, heart)
•1
st
trimester of pregnancy
•Fracture
•Retinal detachment
•Fracture
•Pneumonia
•osteomalacia

14. Side effects
•Memory loss
•Memory disturbance
•Dislocation or fracture
•Mouth dryness
•Nausea
•Tongue bite
•Poor concentration
•Confusion
•Palpitation

15. Cont..
•Body and headache
•Cardiac arrest
•Restlessness
•Anxiety

16. Treatment
1. PRE ECT ROOM
•Comfortable waiting room with adequate sitting facilities for both
client and family
2. ECT ROOM
•Well equipped with necessary machine facilities like:-
•ECT machine
•Anaesthetise application
•Suction apparatus
•Defibrillator
•Tongue depression
•O2 cylinder
•CPR apparatus
•Mouth gauge
•Emergency drugs

17. 3. POST RECOVERY ROOM
• 6-8 bed
• Suction apparatus
• Ventilator Assistance
• Emergency drugs

18. Frequency of ECT
•No fixed regimen
•Based on client condition
•In severe excitement cases,ECT is given 2-3
times/week
•In schizophrenia, 12-15 ECT maybe required
•MDP(Mood , depression personality disorder)
cases 6-8 ECT may be needed.
•Total no. 6-10 , upto 25 may be preferred as
indicated.

20. Role of psychiatric nurse in ECT
•Pre ECT Care
•Theclientisinstructedabouttheectprocedurebytherelativeor
friend.
•Aninformedconsentistakentoovercomethefear,confusion&
anxietyassociatedwiththeprocedure.
•Nurseshouldexplaintherisk&complicationr/ttoprocedure
•Collectthedetailedhistoryofthept.&recordallexams–medical,
psychiatry&allergic.
•Physicalexaminationisnecessary,completeneurologicalcheckup
iscarriedout.
•Fundusoftheeyeexamination
•Chestx-rayistaken
•Blood,urineanalysisisdone
•Checkandrecordthevitalsigns.

21. •Withholdanynightdosesofdiazepam,barbiturates,
anticonvulsants,whichincreasethethresholdofseizure.
•Adviceheadshampooapplication,oilcanresultin
impedanceofpassageofelectricitytobrain.
•Removetheobjectslikejewellery,metallicobject,
contactlens,prosthesesetc.
•Physicalrestraintsmaybenecessaryinacutecasesto
preventpowerfuljerkymovements,injury,fallduring
procedure
•Tonguedepressorormouthgaugeisplacedwithinthe
mouthtopreventtonguebiteorlipbite.
•BeforeECT,inj,AtropineadministeredbeforeECT.
•Pt.shouldbeonNBM.

22. Intra procedure ECT care
•Placetheclientinsupinepositionoverthehardbed
•Staywiththept.toovercomeanxietyandfear.
•Assistinadministrationofanaestheticagents(thiopnetane
sodium),succinylcholine,dissolvedindistilledwater(IV).
•MaintainPt.airway.
•Musclerelaxantswillparalyzeallthemuscleincludingmuscle,
ventilativesupporthastobekeptready.
•UrinarybladderandbowelmustbeemptybeforeECT
•Monitorandrecordthevoltage(70-120volt/),intensityandduration
ofelectricalstimuli,seizurepattern&conditionoftheclient.
•Checkthevitalsign,ifrequiredoxygenhastbesupplied
•Cleantheareawithcottonswabandcheckforgrandmulseizure.

23. Post procedure ECT care
•ClientmustbeshiftedtothepostproceduresoonafterECT
procedure
•Checkthevitalsignafterevery15min.untilclientconditionisstable
•Ifclientbecomesaggressive,confused,excited,violent,administer
8-10mlinj.ofparaldehyde,5-10mgofdiazepamIVtocontrolthe
client
•Ifanyrespiratorydifficultyiscontinuedoxygensupplementisused.
•Usedsidegrills,cottopreventinjury.
•Ifpt.complainsofheadache,musclesaoleness,analgesicssuch
asPCMshouldbegiven.
•Afterrecovery,reorienttheclient.
•Relevantfindingsaredocumented.