Electroconvulsive therapy.ppt in mental health nursing

ECT

1. ECT

2. Electroconvulsive therapy
Introduction
ECT is a type of somatic treatment, first
introduced by bini and cereliti in april 1938.
Definition
ECT is the artificial induction of grandmal
seizure through the application of electrical
current to the brain.

3. Parameters of electrical current
applied
•Standard dose according to APA 1978
•VOLTAGE -70-120 VOLTS
•DURATION – 0.7- 1.5 SECONDS

4. MECHANISM OF ACTION
•One hypothesis states that ECT possibly
affects the catecholamine pathways
between diencephalons and limbic system
also involving the hypothalamus.

5. Types of ECT
•DIRECT ECT
ECT is given in the absence of anesthesia
and muscular relaxation.this is not a
commonly used method now.
•MODIFIED ECT
ECT is modified by drug induced muscular
relaxation and general anesthesia.

6. Frequency and total number of
ECT
•3 times per week indicated
•Total number;
6 to 10; up to 25 may be preferred as
indicated

7. Application of electrodes
•Bilateral ECT
each electrodes is placed 2.5-4cm [1-1.5
inch] above the midpoint on a line joining
the tragus of the year and the lateral
canthus of the eye.
•Unilateral ECT
electrodes are placed only on one side of
head.usually non- dominent side

8. Indications
•Major depression
•Severe catatonia
•Severe psychosis
•Organic mental disorder

9. Contra indications
•Absolute
raised ICP [intracranial pressure]
•Relative
cerebral hemorrhage
brain tumor
acute MI
congestive heart failure
pneumonia
retinal detachment

10. Complications of ECT
•Life threatening complications of ECT are
rare.
•ECT does not cause any brain damage
•Fractures can sometimes occur in elderly
patients

11. Side effects of ECT
•Memory impairment
•Drowsiness, confusion, restlessness
•Poor concentration anxiety
•Headache, weakness
•Dryness of mouth, palpitations, nausea,
vomiting
•Tongue bite

12. ECT team
•Psychiatrist
•Anesthesiologist
•Trained nurses

13. Treatment facilities
•There should be a 3 rooms
1] a pleasant comfortable waiting room [pre ECT
room]
2] ECT room
ECT machine ,anesthetic appliance, suction
apparatus, face masks, O2 sylinders, curved
tongue depressors, emergency drugs.
3] well equipped recovery room

14. Role
•Pre-treatment evaluation
- detailed medical and psychiatric history
- an informed consent should be taken
- vital signs
- patient should be on empty stomach for 4-6 hours
-withhold night doses of drugs
- withhold oral medications in the morning
- head shampooing in the morning
-remove jewellary, contact lens, metalic objects and tight
cloths.
-administration of 0.6mg atropine IM 30 mts before ECT.

15. •During procedure
- place the patient in comfortably on the
ECT table in supine position.
- assist in administering the anesthetic
agent [thiopental sodium] and muscle
relaxant [succynylcholine]
- since muscle relaxants paralyzes all
muscles including respiratory muscles, so
airway should be ensured and ventilator
support should be started

16. •Mouth gag should be inserted
•The placed of electrodes placement
should be cleaned with normal saline or
25% bicarbonate solution
•Monitor voltage, intensity and duration of
electrical stimulas
•During scizures monitor vital signs, ECG,
EEG, o2 saturation

17. Post procedure care
•Monitor vital signs
•Continue o2 till spontaneous respiration
starts
•Take safety precautions to prevent
injury[side lying position and suctioning to
prevent aspiration of secretions, use of
side rails to prevent falls]
•Reorient the patient after recovery
•Recording and documentation.