Electroconvulsive Therapy
Psychiatric- SOMATIC
Modality
Electroconvulsive therapy is increasingly being delivered on an outpatient basis and being
administered to seniors as treatment for depression
Hoag, H. CMAJ 2008;178:1264-1266
Copyright ©2008 Canadian Medical Association or its licensors
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
ELECTROCONVULSIVE THERAPY
The administration of a muscle
relaxant minimizes seizure activity,
preventing damage to long bones and
cervical vertebrae
ELECTROCONVULSIVE THERAPY
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
ELECTROCONVULSIVE THERAPY
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
ELECTROCONVULSIVE THERAPY
At-risk clients include:
2. Those with recent myocardial
infarction
3. cerebral vascular accident
4. cerebral vascular
malformation
5. clients with intracranial mass
lesions
ELECTROCONVULSIVE THERAPY
Contraindications:
2. Angina pectoris
3. Congestive heart failure
4. Severe pulmonary disease
5. Fractures
7. 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-procedure
Pre-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
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
