Electroconvulsive Therapy

Introduction

 Electroconvulsive therapy
(ECT) is the induction of
grandmal seizure through
the application of electrical
current to the brain.
 ECT was developed in
1938 by Italian
Psychiatrists Ugo Cerletti
and Lucino Bini in Rome
 Introduction

 It is a relatively safe and effective procedure that is only

performed under the supervision of trained healthcare
professionals.

 In some illnesses, ECT can be up to 90 percent effective in

reducing the severity of symptoms.
 According to the American Psychiatric Association, 80% of
people with severe depression saw their symptoms improved
significantly after ECT. This is 20% higher than the average
success rate for most antidepressant medications.
 Introduction

 Myth: ECT does not work.

Fact: ECT is considered one of the safest and most effective medical
treatments for severe depression and can improve the symptoms of
several other mental illnesses.
 Myth: ECT is painful.
Fact: ECT is not painful because the person is given a general
anesthetic and muscle relaxant before the treatment.
 Myth: ECT is dangerous.
Fact: ECT is no more dangerous than any other medical procedure that
uses a general anesthetic, and ECT has a low risk of complications .
 How Does it Work?
 Electrode pads are placed on the person’s head at precise
locations.

 They are either placed on both sides of the brain, called

bilateral ECT, or on one side, called unilateral ECT(
shown to have less memory loss compared to bilateral).

 Once the anesthetic and muscle relaxant is

administered, the doctor presses a button on the ECT
machine to deliver the electrical current to the brain.
Electrode placement: frontotemporal
region bilaterally or unilateral(D'Elia
position)
 How Does it Work?

 This causes a short, controlled set of electrical currents to pass

through the electrodes into the person’s brain.

 This lasts only a few seconds. An electroencephalogram

(EEG) records the person’s brain activity.

 The EEG will show a sudden increase in activity as soon as

the treatment begins.
 Indication of ECT

• Severe depression.
• With psychotic symptoms, psychomotor retardation, neurovegetative changes such as
disturbances in sleep, appetite and energy.
• Depression with melancholic symptoms, where antidepressants are not effective.
• Mania
• not responding to lithium and life is threatened by dangerous behavior or exhaustion

• Schizophrenia
• with catatonia or affective symptoms
• Others:
• OCD &Personality disorders rarely
 ECT to be used with caution in

1. pregnancy:

• ECT is considered a low-risk and effective treatment in all

stages of pregnancy.

• Anaesthesia consultation should be obtained because of

potential differences in technique, monitoring, and
positioning.
Elderly Patients:

Aside from physiological considerations

during, and immediately after anesthesia,
being elderly in it self confers no specific
risk for ECT.
 Contraindication

Relative
contraindications
Absolute Cardiovascular problem within 3-6
month
Contraindication
CVA

Increase in intra Cerebral aneurysm

cranial pressure osteoporosis

Pulmonary disease
 Mechanism of Action
• The mechanism of action is unknown.
• Several theories exist but the most common is the
biochemical theory. which indicates that the electrical
stimulation result in significant increase of circulation of
neurotransmitters include:
• Serotonin, Nor- Epinephrine& Dopamine
• ECT may also result in increase in glutamate and GABA
• ECT causes modulation of white matter microstructure in
pathways connecting frontal and limbic areas, which are
altered in major depression.
 people who are treated with
ECT may begin to feel
better within one week of
beginning their treatment.
 Side Effect

• Temporary loss of memory and confusion.

• The initial confusion associated with ECT are usually

temporary approximately 30 min.
 Side Effect

• Studies indicate mortality rate about 2 per 100,000.

• The cause of death in ECT is related to cardiovascular

complications such as MI, VF, stroke, arrest, or aortic aneurysm.

• Brain damage in ECT remain a concern for some studies in which

the excessive electrical dosage and the seizure may produce muscle
paralysis and brain hypoxia.
• Permanent memory loss, rarely
 Medication used with ECT

 Atropine/glycopyrolate: which use to decrease secretion

(prevent aspiration) and the effect of vagal stimulation.
Should be given 30 min prior ECT

 Propofol (Diprivan)/thiopental sodium/ methohexital: Short

acting of anesthesia to prevent pain.

 Succinylcholine: Muscle relaxant is used to prevent muscle

contraction during seizure and to prevent bone fracture or
dislocation of bones.
 Patient Preparation
• Before ECT
• Ensure that the physician has obtained an informed consent and a signed form is
available on the system or in the chart.
• Ensure that the most recent lab reports (CBC, Urinalysis ) and results of ECG and
X ray are available.
• Record the vital signs one hr. before the procedure.
• Have the client void
• Remove dentures, eye glasses contact lenses, jwellery and hairpins
• Change into hospital gown or loose gown
• Administer pretreatment medication if prescribed. (atropine or glycopyrolate if
given early give IM 30mts before.
 Before ECT continued

• Stay with the client to allay fears and anxiety.

• Maintain a positive attitude about the procedure, and encourage the
client to verbalize the feelings.
• Consideration should be given at all times to the patient's dignity,
comfort and safety.
• Patient's initial weight has been recorded on the ECT Checklist.
• client's have remained (NPO) 6-8 hrs prior to the procedure.
 Before ECT continued

• Anti- convulsive medication should be held

• Make sure pre anesthesia check up is done
• Baseline memory should be assessed.
• Current and past use of medication.
• Level of anxiety and fear related to the procedure.
• History of allergies
• Ability to carryout ADL
Intervention during treatment
• supine position
• ensure patency of airway, provide suctioning if needed
• Assist with oxygenation
• Monitor V/S, SPO2,
• Provide support to the client’s arms and legs during seizure
• Observe and record the type and amount of movement
induced by the seizure and seizure duration
• Close observation and continue to oxygenate until spontaneous
respirations begin.
 Post- treatment intervention
• Monitor V/S every 15 min for the first hour
• Position the client on side to prevent aspiration
• Orient client to time and place
• Describe what had happened
• Provide reassurance about confusion and memory loss will subside
• Allow the client to verbalize fear
• Stay with the client until he or she is fully awake.
• Provide client with highly structured routine activities to minimize
confusion.
Documentation
• Vital signs
• Orientation
• Memory
• Gag reflux returned
• Detailed description of
behavioural changes
• Medications
• Any side effect
 Possible nursing diagnoses
• Anxiety related to impending therapy
• Deficient knowledge related to necessity for and side effects or risks of ECT
• Risk for injury related to risks associated with ECT
• Risk for aspiration related to altered level of consciousness immediately
following treatment
• Decreased cardiac output related to vagal stimulation occurring during ECT
• Impaired memory/acute confusion related to side effects of ECT.
• Self care deficit related to incapacitation during post ictal stage
• Risk for activity intolerance related to post ECT confusion and memory loss.