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

 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

 The administration of a muscle

relaxant minimizes seizure activity,
preventing damage to long bones and
cervical vertebrae
 ELECTROCONVULSIVE THERAPY

 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

 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

7. 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
 ECT
 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 brady-
arrhythmias
 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
Potential side-effects
 Confusion
 Disorientation
 Short term memory loss- which
may last up to 6 months
 Fractures
 Arrhythmias