Electroconvulsive Therapy (ECT)

ECT was introduced in 1937 by Ugo Cerletti and Lucio Beni. On the basis of their clinical experience with epileptic clients who demonstrated an absence of schizophrenic behavior and with the theory that seizure activity prevented schizophrenic behavior. They developed a method of inducing a grand mal seizure in schizophrenic patients. Later on the use of ECT was extended to people of all ages with various mental disorders. ECT is the introduction of electric current through one or two electrodes attached to the temples to deliver electrical impulses to the brain. This will result to a tonic seizure of 5 to 15 seconds after 70 to 130 volt current applied in 0.1 to 0.5 seconds up to maximum of 2 seconds. The most common frequency of treatment is 6 12 treatments for affective disorders and up to 30 treatments for schizophrenia. ECT is usually given three times a week every other day, although it can be given more frequently.

INDICATIONS :
Depressed clients who do not respond to antidepressants Depressed clients who experience intolerable side effects at therapeutic dose (particularly true to older adults) Clients who are actively suicidal may be given ECT if there is concern for their safety while waiting for the full effects of antidepressant medication Clients usually are given a series of 6 to 15 treatments scheduled 3 times a week. Generally 6 treatments is needed to see sustained improvement in depressive symptoms. Maximum benefit is achieved in 12 to 15 treatments.

PREPARATION OF CLIENT:
The client is NPO after midnight Remove any fingernail polish Remove dentures Let the patient void prior to the procedure An IV is started for the administration of medication Approximately 30 minutes before the procedure, atropine sulfate ( 0.6 1.0 mg) is administered IM to block vagal stimulating effects of ECT and decrease oropharyngeal secretions. Extremely anxious clients may receive an anti-anxiety agent such as diazepam (valium) within 1 hour of ECT. The client then receives a short acting anesthetic (Methohexital or Thiopenthal) so he is not awake during the procedure.

 Next the client receives succinylcholine ( Anectine ) that relaxes all muscles to reduce greatly the outward signs of the seizure (clonic and tonic muscle contractions).

ADVERSE EFFECTS OF ECT:

Temporary memory loss usually appear after the 4th treatment. Usually returns within 1 to 6 months following treatment Confusion/ disorientation Headache Nausea & vomiting

NURSES RESPONSIBILITY :
Explain the procedure Assuring the client that no pain will be experienced Avoid the word shock, use the word treatment instead Stay with the client and state that he or she will not be left alone Check the baseline vital signs Place emergency equipment in the treatment room Have signed consent on the chart Monitor vital signs after the grand-mal seizure Assessed for the return of gag reflex and the respiratory function Turn the patient on his side to prevent aspiration of saliva Ventilation and monitoring continues until the client has recovered Re orient the client as to place, time, and person as soon as he is awake. Document all treatments given After the patient has rested, let him have a shower and start his usual activities.