ELECTROCONVULSIVE
THERAPY
Short history of ECT Medications to be
Definition discontinued before
Indications ECT
Anaesthetic Agents
Situations that need
immediate use of used in ECT
Types of ECT
ECT
Forms of ECT
Contraindications Complications, risk
Course of treatment
and side effects of ECT
and administration
Management of the
The core ECT team client before, during
Items needed at the and after ECT
ECT room
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Italian Professor of neuropsychiatry
Ugo Cerletti, who had been using
electric shocks to produce seizures
in animal experiments, and his
colleague Lucio Bini developed the
idea of using electricity as a
substitute for metrazol in convulsive
therapy and, in 1937, experimented
for the first time on a person.
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ECT soon replaced metrazol therapy all
over the world because it was cheaper,
less frightening and more convenient.
ECT is the only form of shock treatment
still performed by modern medicine.
Today, an estimated 1 million people
worldwide receive ECT every year.
ECT is the first-line treatment for
patients who have not responded to
other interventions such as medication
and psychotherapy.
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Electroconvulsive therapy (ECT), also known
as electroshock treatment, is psychiatric
treatment in which seizures are electrically
induced in anesthetized patients for
therapeutic effect.
ECT is the introduction of a controlled grand
mal seizure by passing an electrical current
through the brain.
It is the use of electrically induced seizures
for the safe and effective treatment of severe
depression.
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ECT is a way by which a grand mal
seizure is artificially induced in an
anaesthetized patient by passing on
electrical current through electrodes
supplied to the patient’s temples.
The current is usually 70–120 volts
and it is administered for 11/2
seconds.
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NEUROTRANSMITTER THEORY – it
acts like the Tricyclic antidepressants
by increasing neurotransmitters in the
synaptic cleft.
ENDOCRINE THEORY – it helps the
release of pituitary hormones like
endorphins, TSH, ADH which make the
client happy.
ANTI-CONVULSANT THEORY – has an
anticonvulsant effect on the brain that
results in an antidepressant effect.
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Major depression Undifferentiated
Mania(often in schizophrenia
Bipolar Disorder) (accompanied by
Catatonia perplexity and
Postpartum psychosis prominent affective
Motor symptoms of symptoms)
Parkinson’s disease Phencyclidine delirium
Delirium tremens To improve tardive
Schizoaffective dyskinesia
disorder For patients who have
Acute exacerbations of failed a trial of drug
paranoid
treatment
schizophrenia
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Depressed patients at immediate risk of
suicide.
Weaked and malnourished patients who
might not survive long enough to experience
an adequate trial of antidepressant.
Patients whose general medical condition
prohibits the use of antidepressants.
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Epileptic Severe cardiac
Intracranial pressure conditions, e.g.,
Asthmatic CVA, myocardial
Fractures of the long infarctions, CHF, etc
bone Aortic or carotid
Children under 10 aneurysm
years of age Cerebral lesions
Respiratory Fissures on the skull
disorders, e.g., Poor liver or renal
pneumonia, TB, etc function
Severe hypertension
Retinal detachment
Tumours of the
nervous system
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Pregnant women and the elderly are far
more susceptible to untoward effects
from medication(s) than to untoward
effects from ECT.
Besides, ECT is considered a safe
treatment alternative in antepartum
psychosis and for the geriatric patients
(Hamilton, 1986) with mood disorders.
ECT is not contraindicated for pregnant
women and elderly patients.
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Conduct pelvic examination.
Ask client to stop nonessential
anticholinergic medication.
Conduct uterine tocodynamometry (i.e.
measuring the force and frequency of
uterine contractions).
Ensure intravenous hydration.
administer a nonparticulate antacid.
Elevate the pregnant woman's right hip.
Conduct external foetal cardiac monitoring.
Carry intubation.
Avoid excessive hyperventilation.
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The number and frequency of
therapy consists of 6–12 treatments,
and
It is administered 2 or 3 times a
week.
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The psychiatrist
The anaesthesiologist
The nurse
The medical/physician assistant,
where necessary
The patient
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ECT machine with Firm bed (with side rails)
electrodes
Electro-contact
Endotracheal tube
solution (bowl of
normal saline or gel) Mouth gag
Face masks
Muscle relaxants
Oxygen cylinder Tongue depressors
(spatula)
EEG/ECG machine Dissecting forceps, etc
Laryngoscope
Screens
Syringes and needles Ambubag
for drawing up and Defribillator
injecting drugs
Tourniquet Suction machine
TPR and BP tray with Resuscitating apparatus
all necessary Emergency drugs
equipment Sedatives
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Tricyclic Benzodiazepines –
Antidepressants – Increase seizure
They predispose threshold.
client to Anticonvulsants –
Arrhythmias. Lead to a greater
Lithium – It electrical stimulus
enhances post-ECT to induce seizure.
confusion.
Theophylline –
Lowers seizure
threshold.
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Atropine 0.5–0.6 mg, given 30 minutes
before the procedure. Atropine dry body
secretions and prevent aspiration.
I.V. Sodium Penthotal (Thiopentone) 150–
250 mg, to relax the muscles.
Scoline Suxamethonium, as muscle
relaxant.
Pure oxygen (100%) inhalant.
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1)BILATERAL ECT: Involves placing the
electrodes of the ECT machine
simultaneously at each temple of the
patient’s head. It means placing the
electrodes on each side of the head at
the region known as the temporal fossa.
The disadvantage of this type of ECT is
that it has cognitive side effects, such
as memory loss and confusion.
The advantage is that it is very good as it
has a better therapeutic effect.
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2) UNILATERAL ECT: Involves placing
both electrodes on the same side of the
head (the dominant hemisphere). In
this case, one electrode is placed
midline (the temporal position), and the
other over the non-dominant
hemisphere (the parietal area),
generally presumed to be the right.
The advantage of this type of ECT is that it
reduces problems of memory.
However, patients suffering from severe
depression do not benefit much from it.
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ECT can be administered in Two forms:
Straight/Direct: This is the unmodified
form of ECT where no anaesthetic agent
is given to the client and the electricity is
applied through the electrodes to the
head to induce the grand mal seizure.
Modified: The client is given an
anaesthetic agent before the application
of the electricity to induce the seizure.
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Memory loss
Confusion
Anoxia
Medical complications: Such as spasms of
the larynx (laryngospasm), circulatory
insufficiency, loss of tooth (if the tooth is
weak), fractures of the vertebra and
other bones of the body, severe
headache, nausea, transient bradycardia,
and prolonged apnoea can occur.
Death – not common.
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1. Preparation of the client/Pretreatment
Nursing Actions
2. The ECT procedure and management/Intra-
procedure care
3. Care of the client after therapy/Post-
treatment Nursing Actions
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THIS IS AN ASSIGNMENT AS PART OF
YOUR MIDSEMESTER EXAMS. IT SHOULD
BE WRITTEN IN YOUR PSYCHIATRIC
NOTE BOOKS AND SUBMITTED FOR
MARKING.
TEN PERCENT – BEFORE ECT.
TEN PERCENT – DURING ECT.
TEN PERCENT – AFTER ECT.
TOTAL MARKS OF THIRTY PERCENT
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THANK
YOU
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