Somatic Therapies

Somatic Therapies
 The treatment approach that use physiologic or
physical interventions to effect behavioral
change.
 Type of Somatic Therapy
 Electroconvulsive Therapy (Electro Shock
Therapy/ Shock Therapy)
 - introduced in 1938 by Ugo Cerletti and
Luciano Bini ( Cerlettis assistant)
 - It is introduction of electric current
passed through the brain for 0.2-0.8 seconds,
causing a seizure, resulting in full grand mal
convulsion
 Preparation for ECT

 The patient must have a pretreatment evaluation,

including physical examination, laboratory work
( blood count, blood chemistries, urinalysis)
 A consent form must be signed.
 If possible, the routine use of benzodiazepines or
barbiturates for nighttime sedation should be
eliminated because of their ability to raise the seizure
threshold
 Trained electrotherapist and anesthesiologist should
be available
 Nursing Responsibilities before ECT

 NPO for 6-8 hours before ECT, except for cardiac,

Anti HPN, and other medications
 Atropine should be given one hour before the
procedure (oral or IV) to reduce secretions and
subsequent risk for aspirations
 Cx. Should ask to urinate before the treatment
( seizure induced incontinence )
 Remove hairpins, contact lenses, hearing aid, and
dentures
 take VS
 Procedure during ECT

 IV line is inserted
 Electrodes are attached to the proper place on the head
 METHOHEXITAL (Brevital) short acting barbiturate is given
IV for anesthesia
 SUCCYNYLCHOLINE (Anectine) is a neuromuscular
blocking agent causing paralysis not sedation
 Ventilates the Cx. 100% 02 immediately before the treatment
 Monitor Cx. For heart rate and rhythm, blood pressure, and
EEG
 Ventilation and Monitoring continue until the patient recovers
 Nursing Responsibilities after ECT

 The nurse or anesthesiologist mechanically ventilates

the patient with 100% 02 until the patient can breathe
unassisted
 Monitor for respiratory problems
 ECT causes confusion and disorientation; reorient
Cx. To time, place, person
 Administer benzodiazepines, as needed
 Observe properly, provide time to relax the client
before standing
 Document
 Indications

Major Depression
Severe Mania not controlled by medications
Post partum psychosis after no response to
antidepressant
Schizophrenia (catatonic) when non responsive to
medications
Movement disorders refractory to treatment
(parkinson’s disorder, tardive, etc.)
 Disadvantage
 -Temporary Relief
 -Memory loss
 -Hypertension, Arrhythmias, alterations of
cardiac output, and change in -cerebrovascular
dynamics
 Advantage
 -Safe and effective than other antidepressants
to some other case
 PSYCHOSURGERY (LOBOTOMY)
-introduced in 1935, by Antonio Egas
Moniz, a neurosurgeon from Portugal
-Walter Freeman, neurologist and James
Watts, neurosurgeon introduced the surgery to
USA
-It is a surgical procedure that destroys
brain tissue for the purpose of relieving
intractable mental disorders not amendable to
therapies
Indications
-OCD
-Aggressiveness related to mental disorders
 BRIGHT LIGHT THERAPY (BLT)

 -formerly called phototherapy

 -exposes patient to intense light (5000 lux
hours) each day
 Indications
 -SAD
 -Bulimia
 -Sleep maintenance insomia
 -nonseasonal depression
 TRANSCRANIAL MAGNETIC STIMUATION
(TMS) OR REPETITIVE TRANSCRANIAL
MAGNETIC STIMUATION (rTMS)

 -produces a magnetic field over the brain,

influencing brain activity, also increase the
release of neurotransmitters and/or down
regulates beta-adrenergic receptors
 Indications
 -depressive disorders
 -other disorders