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Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT), introduced in 1938, is a psychiatric treatment involving induced grand mal seizures through electrical stimulation of the brain. It can be administered bilaterally or unilaterally, with specific parameters for voltage and frequency, and is indicated for major depression and severe psychosis among other disorders. While ECT is generally effective, it has contraindications and potential side effects, requiring thorough pre-treatment evaluation and careful monitoring during and after the procedure.
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ECT is a somatic treatment, introduced in 1938, considered unique for psychiatric conditions.
ECT involves inducing seizures with electrical current; parameters include 70-120 volts, 0.7-1.5 seconds duration.
ECT's exact mechanism is unclear; it includes Direct and Modified ECT, with the latter using anesthesia.
Bilateral and unilateral placements are used in ECT, with unilateral being safer and causing fewer memory issues.
ECT is indicated for major depression, severe catatonia, psychosis, and some organic mental disorders.
Common side effects include headache, memory loss, confusion, and muscle aches post-treatment.
Drugs like succinylcholine, thiopentone sodium, and atropine are used to facilitate ECT.
Nursing roles include pre-treatment evaluation, intra-procedure care, and monitoring vital signs post-ECT.
Post-ECT care involves monitoring vital signs, ensuring safety, and managing potential complications.
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Electroconvulsive therapy (ECT)
- 1. BY MR. KALYAN KUMARMSC(N) ELECTRO CONVULSIVE THERAPY (ECT)
- 2. Introduction ▪ Electroconvulsive therapyis a type of somatic treatment, first introduced by Bini and cerletti in April 1938. From 1980 onwards ECT is being considered as a unique psychiatric treatment. ECT also known as electroshock therapy or Shock Therapy.
- 3. ▪ Electroconvulsive therapyis the artificial induction of Grandmal seizure through the application of electrical current to the brain. The stimulus is applied through the electrodes that are placed either bilaterally or unilaterally on the non-dominant side.
- 4. Parameters of electricalcurrent applied ▪ Voltage 70 - 120 volts ▪ Duration 0.7-1.5 seconds ▪ Frequency 3 times per week or as indicated ▪ Total number 6-10; upto 25 may be preferred as indicated.
- 5. Mechanism of action ▪The exact mechanism of action is not known. ECT possibly effects the catecholamine Pathways between diencephalon and limbic system also involving the hypothalamus.
- 6. Types of ECT ▪Direct ECT: It is given in the absence of anaesthesia and muscular relaxation. This is not a commonly used method now. ▪ Modified ECT: It is modified by drug induced muscle relaxation and general anaesthesia.
- 7. Applicationof electrodes ▪ BilateralECT: Each electrode is placed 2.5- 4 cm above the midpoint, on a line joining the tragus of the ear and the lateral canthus of the eye.
- 8. ▪ Unilateral ECT:Electrodes are placed only on one side of the head, usually non dominant side unilateral ECT is safer, with much fewer Side Effects particularly those of memory 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 ▪ AcuteMyocardial Infarction ▪ BrainTumor ▪ 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.Succinylcholine 0.5 mg/kg (Muscle relaxant) ▪ Injection. Thiopentone sodium 3 mg/kg (Anesthetic) ▪ Injection. Atropine 3 mg/kg (To reduce Respiratory secretions)
- 15. Nursing responsibilities PRE-TREATMENT EVALUATION ▪Detailed Medical and psychiatric history including history of allergies ▪ Assessment of patients and families knowledge of indications, Side Effects, therapeutic effects and risk associated with ECT. ▪ Assess vital sings ▪ Obtain informed consent.
- 16. ▪ NBM for4-6 hours prior to ECT. ▪ Withhold oral medication in the morning ▪ Any jewellery, prosthesis and contact lens, metabolic objects and tight clothing should be removed from the patient's body.
- 17. Intra procedure care ▪Place the patient comfortably on the ECT table in supine position ▪ Stay with the patient to allay anxiety and fear. ▪ Mouth gag should be inserted to prevent possible tongue bite ▪ The place of electrode placement should be cleaned with normal saline ▪ Monitor voltage, intensity and duration of electrical stimulus. ▪ 100% oxygen should be provided ▪ Record the findings and medicines given in the patient chart.
- 18. Post procedure care ▪Monitor vital signs ▪ Continue oxygenation till spontaneous respiration starts ▪ Take safety precautions to prevent injury( use of side rails to prevent Falls, side-lying position and suctioning to prevent aspiration of secretions).
- 19. ▪ If thereis severe post-ictal confusion and restlessness IV Diazepam may be administered ▪ Document any findings as relevant, in the patient's record.
- 20.