this may be helpful for nursing students

2. Mr. N.Loganathan M.Sc (N),
Lecturer,
Dept of psychiatric nursing,
COMS-TH.

3. Electroconvulsive therapy (ECT), also
known as
is a well established, albeitis a well established, albeit
controversial psychiatric treatment in which
seizures are electrically induced in
anesthetized patients for therapeutic effects.

4. ECT was first introduced by Italian psychiatrist Ugo
Cerletti and Lucio Bini in April 1938.
Insulin coma therapy and pharmacoconvulsive
therapy were replaced by ECT.
Insulin coma therapy was introduced by the
German psychiatrist Manfred Sakel in 1933.German psychiatrist Manfred Sakel in 1933.
Pharmacoconvulsive therapy was introduced in
Budapest in 1934 by Ladislas Meduna.
In 1974, the APA’s council on research and
development appointed a task force on ECT.
The APA task force on ECT, in 1976, gave its report
which provided clear guidelines for use of ECT.

5. 1. “ Artificial induction of a grand mal seizure (tonic
phase 10-15 sec, clonic phase 30-60 sec) through
the application of electrical current to the brain, the
stimulus is applied through electrodes which are
placed either bilaterally in fronto-temporal region orplaced either bilaterally in fronto-temporal region or
unilaterally on the non dominant side.”
or
2. ECT is a physical/somatic therapy in which the help
of two electrodes, current is passed through the
temporal region in between the two hemispheres of
the brain, to produce a grand mal type of seizure.

6. : 70-120 volts
(The usual amount of current
passed in ECT is 200-1600mA)passed in ECT is 200-1600mA)
: 0.7-1.5 sec

7. ECT relief very severe depressive illnesses when
other treatments have failed.
ECT has saved patient’s live because 15% of
people with severe depression will killpeople with severe depression will kill
themselves.
ECT works faster than all antidepressants drugs.

8. Major Depression w/ or w/o psychotic features.
Bipolar disorder - manic or depressed phase.
Acute or Catatonic Schizophrenia.
Some studies have shown efficacy in treatingSome studies have shown efficacy in treating
OCD, Delirium, Chronic pain syndromes, and
intractable seizure disorders.

9. Absolute
Increased ICP
Relative
1. Cardiovascular problems
Coronary artery disease, HTN, Aneurysms,Coronary artery disease, HTN, Aneurysms,
Arrhythmias
2. Cerebro vascular effects
Recent strokes, Space occupying lesions,
Aneurysms
3. Severe pulmonary disease
TB, Pneumonia, Asthma

10. The exact mechanism of action is notnot knownknown.
One hypothesishypothesis statesstates that ECT possibly
affectsaffectsaffectsaffects thethethethe catecholaminecatecholaminecatecholaminecatecholamine pathwayspathwayspathwayspathways betweenaffectsaffectsaffectsaffects thethethethe catecholaminecatecholaminecatecholaminecatecholamine pathwayspathwayspathwayspathways between
diencephalon (from where seizure generalization
occurs) and limbic systems (which may be
responsible for mood disorders), also involving
the hypothalamus.

12. DIRECT ECT
In this, ECT is given in the absence of
anesthesia and muscular relaxation.
This is not a commonly used method
now.now.

13. Electrodes are placed on the side of a
patient’s head just above the temples.
The patient is given anesthetic injections
and a muscle relaxant to stop muscleand a muscle relaxant to stop muscle
contractions that can lead to broken
bones.
A small electric current is passed through
the brain.

14. Bilateral
Most common, most effective
and most cognitive
dysfunction.dysfunction.
Each electrode placed 2.5 – 4
cm (1-1.5 inches) on the
midpoint on a line joining the
tragus of the ear and the
lateral canthus of the eye.

15. Unilateral
less cognitive effect,
may be clinically less
effective.
Electrodes are placed
only on one side of
head usually non
dominant side.

17. ECT is usually given 3 times a week, reduced to
twice a week or once a week once symptoms begin to
respond. This limits cognitive problems.
Treatment of depression usually consists of 6-12
treatments.treatments.
Psychosis and mania upto (or sometimes more than)
20 treatments.
Catatonia usually resolves in 3-5 treatments.

18. Psychiatrist
Anesthetist
Trained nurses
Nursing aidsNursing aids
ECT assistant

19. Inj. Atropine (0.6mg to 1mg)
Inj. Succinylecholine (1mg/kg/b.wt)
Inj. Sodium thiopendothal (3-5mg/kg/b.wt)

20. A pretreatment medication such as atropine
sulfate, glycopyrolate is administered
IM 30 min before treatment, (to decrease
secretion and counteract the effect of vagal
stimulation induced by ECT).
A short acting anesthesia (the patient should beA short acting anesthesia (the patient should be
unconscious when the ECT is given).
Muscle relaxant (to prevent muscle contraction
during the seizure reduction of possibility of
fracture or dislocated bone).
Pure oxygen before and after treatment

21. 3 rooms
1. Waiting room
2. ECT room2. ECT room
3. Recovery room

25. Articles for anesthesia
Suction apparatus
Face mask
Oxygen cylinder
Tongue depressor
Mouth gag
Resuscitation apparatus
Full set of emergency drugs, ECT drugs
Defibrillator

26. Description of the procedure.
Explain why the procedure is
recommended.
Alternative treatmentAlternative treatment
Benefits may be transient
Behavioral restrictions
Voluntary treatment
Implies consent for emergency treatment
Risks major and minor

27. Time 10-15mit (or more time preparation and
recovery)
Intravenous (IV) catheter
Oxygen mask may be givenOxygen mask may be given
Electrodes are placed on the head either
unilateral or bilateral
Anesthetic is injected into IV
Unconscious and unaware of procedure
Muscle relaxant is injected into IV
Prevent violent convulsions

28. BP cuff placed around forearm or ankle.
To Prevents muscle relaxant from
paralyzing, so doctor can confirm seizure
with movement of hand/foot.
Electric current is sent through electrodes
to brain.to brain.
Seizure lasts 30-60 seconds.
Few min later, anesthetic and muscle
relaxant wear off.

29. • Pre ECT care
• Intra procedure care
• Post procedure care

30. Informed consent
Fully explain the risks and benefits of procedure
and answer questions from patients or relatives.
Information sheets.Information sheets.
Reduce patients anxiety and help establish good
relationship (nurse-patient, doctor-patient).
Administration of drugs.
Check patient record.

31. Cont…
Explain procedure.
Keep patient on NPO 6-8 hours before ECT.
Discourage smoking just before ECT.
Remove artificial dentures and articles.
Vital signs.Vital signs.
Ensure emergency articles are accessible.
Emotional support.
Transfer patient to ECT room with necessary
records.

32. Checks patients identity.
Check patient is NPO and has emptied their bowels and
bladder prior to coming to treatment room.
Check patient is not wearing restrictive clothing and
jewellery/dentures have been removed.jewellery/dentures have been removed.
Consult ECT record of previous treatments(including
anesthetic problems).
Ensure consent form is signed appropriately.
Check no medication that might increase or reduce
seizure threshold has been recently given.
Check ECT machine is functioning correctly.

33. Reassurance & support.
Place patient in supine position.
Necessary drug administration.
Mouth gag.Mouth gag.
Apply upward pressure to mandible.
Oxygen administration.
Clean the scalp with normal saline.
Prevent fall, fracture, dislocation
Remove the mouth gag after seizure occurred
Suck the oral secretion & apply O2 mask

35. Shift client post – procedure room.
Check vital signs every 15 min.
Administer drugs if patient is aggressive / violated /
confused.confused.
If respiratory difficulty continue oxygen.
Provide side rails.
Be with the patient.
Documentation.
Reorient the client after recovery.

36. ImpairmentImpairmentImpairmentImpairment ofofofof cognitioncognitioncognitioncognition
Period of confusion immediately after ECT
May not know where you are or why you are
there
Generally lasts few minutes to several hours
MemoryMemoryMemoryMemory losslosslossloss
May forget weeks/months before treatment, during
treatment or after treatment has stopped
Usually improves within couple of months
Permanent in relatively rare cases

37. MedicalMedicalMedicalMedical complicationscomplicationscomplicationscomplications
Heart problems
Small risk of death
PhysicalPhysicalPhysicalPhysical symptomssymptomssymptomssymptoms
NauseaNausea
Vomiting
Headache
Muscle ache
Jaw pain

38. People with serious mental illness who are at risk
of self harm or are thought to be risk to other
people can be sectioned under the mental health
act.act.
This means they can be taken to a place of
safety, usually a secure psychiatric unit, and given
treatment against their will.
They may not consent to the treatment they are
given and may be held against their will.