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Introduction

The use of ECT still generates significant controversy. Electroconvulsive therapy (ECT) has been demonstrated to be an effective and safe treatment for many psychiatric disorders. ECT has been viewed as harmful by the general public and psychiatric patients. Despite such debate, approximately 100,000 patients annually receive ECT in the United States

Modern Electroconvulsive Therapy (ECT) Machines

Definition of E.C.T :
It is treatment modality in which electric current passed through
The brain for 0.5 to 2 seconds with an electric current of 70 to 150 micro volts, Causing grand mal epileptic seizer .

an

Phases of convulsion :
a.
b. c. d.

Epileptic cry : It literally sounds like a gradual scream/yell.


Tonic phase : characterized by muscle rigidity, eye fixed, pubic dilated, it last for few seconds. Colonic phase : Rhythmic contraction and relaxation of all body muscle especially face muscle. Relaxation phase :Muscles start to be relax .

Mechanism of action :
The exact mechanism of action of ECT is not fully known. ECT affects multiple central nervous system

components, including hormones, neuropeptides,


and neurotransmitters

Mechanism of action :
* Neurotransmitter theory It was suggested that E.C.T acts like tricycle antidepressants by enhancing deficient neurotransmission in monoaminergic system , especially it is thought to improve serotoninergic and adrenergic neurotransmission

Neuroendocrine theory : It suggests that E.C.T release prolactin, thyroid stimulating

hormones , pituitary hormones but the specific hormone


responsible for the therapeutic effect is not known .

Anti-convulsive theory :
It is suggested that E.C.T treatment exert a profound anti-convulsive effect on the brain that result in an Anti-depressant effect .

Frequency of treatment A series of about 6-15 treatments are scheduled three times a week. Six treatments are needed to observe a sustained improvement of depressive symptoms. Maximum effect or benefit is achieved in 12 to 15 treatments.

Types of E.C.T
I. According to techniques:
A. Modified E.C.T :
The patient given some form of medication before E.C.T : 1. Anticholinergic : atropine 0.5mg Intramuscular until pulse increased by 10% to decrease risk of arrhythmias ,cardiac arrest and aspiration.

2. Anesthesia :
The dosage should be adjusted to minimum effective

amount because higher dosage will increase the


seizure threshold and prolonged the period of apnea . 3. Muscle relaxants : succinylcholine or anectine.

B. Unmodified ECT :
ECT gives without anesthesia , but it has a disadvantage of
more adverse reaction .

II .According to site :
Bilateral and Unilateral ECT .

A. Bilateral ECT :
It is used for severely ill patient . Electrodes are placed bilateral in the two temporal

sites, but it has more cognitive side effect more


disorientation and more memory impairment .

B . Unilateral ECT :
It's more recently have been used , it has been reported that pt. have
fewer cognitive side effect and induce less disorientation , fewer memory impairment , and few pathological ECT changes .

It is given to the patient at right or left side according to the patient in


the non- dominant area .

Indications of ECT:
Major depression( Suicide ideation, refusal of food, not respond to treatment) Acute Mania ( Excitement ) patients who do not respond to another form of drugs. Schizophrenia especially catatonic stupor or excitements. Patients who cannot tolerate pharmacotherapy due to side effect. Patients with history of poor drug response. patients in whom treatment response is urgently needed, such as patients who are suicidal or those who are refusing food and are nutritionally compromised. ECT may be efficacious in patients with rapid cycling bipolar disorder ECT is effective for symptoms of acute schizophrenia but is not effective for chronic schizophrenia. ECT is not recommended for the treatment of obsessive-compulsive disorder (OCD) but may be considered for treating comorbid disorders such as major depressive disorder, mania, and schizophrenia in patients with OCD

Can

pregnant

women

undergo

ECT?

Pregnant clients can also undergo an electroconvulsive therapy. The treatment poses no harm or injury to the fetus. Thus, pregnant self-destructive women may undergo ECT to provide quick relief of depression and self-directed violence.

Generally, geriatric patients with depression have better outcomes with ECT than do younger patients Seizure threshold may rise with increasing age, and effective seizures may be hard to induce.

Side Effects
Cognitive adverse effects are the major limitations to the use of ECT. This effects are observed with a brief period of confusion, disorientation and impairments in attention, and memory. This effects reverse over time and modifications such as switching to unilateral ECT, lowering the stimulus dose, increasing the time interval between treatments, may decrease cognitive adverse effects. Anterograde and retrograde amnesia may result from ECT. After ECT, anterograde amnesia resolves rapidly(temporary) . With retrograde amnesia are greatest for events closest to the time of treatment. Postictal delirium may occur in a minority of patients/ Geriatric patients may be at a higher risk for persistent confusion and greater memory deficits during and after ECT. Systematic effect, Fatigue, Headache, muscles aches nausea, anorexia . Headache is common. It can be treated with medications such as aspirin,

Prolonged seizures and status epileptics may be more likely when patients receive medications that lower seizure threshold. Prolonged apnea is rare but may

occur .

complication
Fracture and dislocation Arrhythmia Tongue injury Aspiration

Contraindications and precautions


ECT stimulates a seizure episode to occur, however it does not cause a seizure disorder and patient with a seizure disorder may undergo the therapy. No absolute contraindications are noted with ECT but a few conditions have been associated with morbidity and mortality rate which includes the following: recent myocardial infraction sever hypertension presence of intracerebral mass recent cerebro-vascular accident (stroke)

Nursing Interventions
Preparation before ECT
Preparation of equipment

Treatment device and supplies including electrodes past and gel gauze pads alcohol saline suction device, Stretcher with firm matter with side rails Ventilator equipment, Intravenous and vein puncture

Preparation of patient
Psychological preparation Physical preparation

Complete blood count Electrocardiography Chest X ray Urine analysis Remove dentures metal hairpins shoes or slippers before treatment. The regular use of benzodiazepine for night time sedation should be eliminated because of its ability to raise the seizer threshold Atropine should be given as order one hour before treatment or intravenous Informed consent should be signed. NPO post-midnight. Remove fingernail polish. IV line initiation.

Patients in late pregnancy should lie on their left side during ECT to ensure adequate blood flow to the fetus. Psychotropic drugs, especially antidepressants and antipsychotics, may give rise to some concern in clinical practice because of their known ability to reduce seizure threshold and to provoke epileptic seizures

*During ECT
Accompanied the patients Explain the procedure Administration of short-acting anaesthetic. Administration of a sedative or muscle relaxant(succinylcholine). Atropine is also given to decrease bronchial secretions which could block the airways during seizures. Let the client void before the procedure. Place electrodes on the clients head on one side (unilateral) or both (bilateral). Brain monitoring through electroencephalogram (EEG). Air way is inserted into mouth Hold his arm at his sides to prevent uncontrolled thrashing. Electric impulses is given with up to 150 microvolt. .

After ECT
Positions
Oxygen administration with an Ambu-bag Assess client for the return of gag reflex. Ensure his safety. When the client is awake, reorient the client. Obtain vital signs. Allow the client to eat (with a positive gag reflex).

GOOD LUCK

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