Electroconvulsive Therapy

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

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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

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

ELECTROCONVULSIVE THERAPY

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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

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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

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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

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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 bradyarrhythmias

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

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Confusion Disorientation Short term memory loss- which may last up to 6 months Fractures Arrhythmias