Electroconvulsive Therapy

Electroconvulsive Therapy

Psychiatric- SOMATIC Modality

Copyright ©2008 Canadian Medical Association or its licensors

Hoag, H. CMAJ 2008;178:1264-1266

Electroconvulsive therapy is increasingly being delivered on an outpatient basis and being administered to seniors as treatment for depression

ELECTROCONVULSIVE THERAPY

An effective treatment for depression that consists of inducing a grand mal (tonic-clonic) seizure by passing an electrical current through electrodes that are attached to the temples


The administration of a muscle relaxant minimizes seizure activity, preventing damage to long bones and cervical vertebrae


The usual course is 6 to 12 treatments given two to three times per week

Maintenance ECT once a month may help to decrease the relapse rate for the client with recurrent depression


ECT is not a permanent cure Not necessarily effective in clients

with personality disorders,

those with drug dependence, or those with depression secondary to situational or social difficulties


At-risk clients include:1. Those with recent myocardial

infarction2. cerebral vascular accident3. cerebral vascular

malformation4. clients with intracranial mass

lesions


Contraindications: 1. Angina pectoris2. Congestive heart failure3. Severe pulmonary disease4. Fractures

5. Glaucoma

PREGNANCY

ECT

Uses Clients with major depressive

and bipolar depressive disorders, especially when psychotic symptoms are present such as delusions of guilt, somatic delusions, and delusions of infidelity

ECT

Uses Manic clients whose conditions are

resistant to lithium and antipsychotic medications and clients who are rapid cyclers (a client with a bipolar disorder who has many episodes of mood swings close together)

Clients with schizophrenia (especially catatonia), those with schizoaffective syndromes, and psychotic clients.

ECT

Indications for use When antidepressant medications

have no effect When there is a need for a rapid

definitive response, such as when a client is suicidal or homicidal

The client is in extreme agitation or stupor

ECT

Indications for use The risks of other treatments

outweigh the risk of ECT The client has a history of

poor medication response, a history of good ECT response, or both

The client prefers it

ECT

The usual course is 6-12 treatments in 2-3x per week

MAINTENANCE ECT once a month

Usual relief is seen after 2-3 ECTs

If after 12 treatments, no relief is seen, ECT in=s not anymore recommended

ECT: Pre-procedure

Pre-procedure Explain the procedure

to the client Encourage the client to

discuss feelings, including myths regarding ECT

Teach the client and family what to expect

Informed consent must be obtained when voluntary clients are being treated

ECT: Pre-procedure

Pre-procedure For involuntary clients, when

informed consent cannot be obtained, permission may be obtained from the next of kin, although in some states the permission for ECT must be obtained from the court

NPO after midnight or at least 4-8 hours prior to treatment

ECT: Pre-procedurePre-procedure Baseline vital signs are taken The client is requested to void Hairpins, contact lenses, and

dentures are removed

Administer preoperative medication if prescribed; glycopyrrolate (Robinul) or atropine sulfate may be prescribed to prevent aspiration and brady-arrhythmias

ECT: DURING procedure

Intra-procedure The nurse must obtain an IV line BP and Vitals taken ECG and EEG electrodes are

attached to the body SHORT acting anesthetics are

administered: Methohexital, Thiopental

Muscle relaxant is administered_ Succinylcholine

ECT: DURING procedure

Intra-procedure Oxygen is given by mask Tongue guard may be

placed on the mouth 110-150 volts of electricity

is delivered for 0.5 to 2 seconds to initiate a tonic clonic seizure, usually lasting for 1-minute

ECT: POST procedure

POST procedure Continue monitoring of vital signs Patient is usually brought to the

recovery room where emergency drugs and equipments are available

RE-ORIENT the client when he is awake

Provide reassurance that the amnesia is ONLY temporary

ECT: POST procedure

POST procedure The patient is returned to the room

after all vitals are stable Mental status examination NPO temporarily and introduce foods

once GAG reflex will return

Potential side-effects

Confusion Disorientation Short term memory loss- which may

last up to 6 months Fractures Arrhythmias

Electroconvulsive Therapy

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Transcript of Electroconvulsive Therapy