ECT

Brief History

Von Meduna-In 1934,used 25% camphor oil intramuscularly to produce convulsions.Later he used pentylene tetrazol for the same purpose

In 1938, Cerletti and Bini used Electroconvulsive Therapy

Cerletti

In 1970s-Wide spread of criticism occurred against ECT. Following this many modification made in ECT technique

In 1974, American Psychiatric Associations Council on Research and Development appointed a Task Force on ECT

In 1976- The APA Task Force gave its report which provided clear guidelines for use of ECT and declared it to be safe and effective method of treatment when used by professional trained in the technique. In 1990- The APA Task Force Report on ECT redefined the indications, gave guidelines for obtaining consent and set standards for training, treatment.

ECT

ECT is the treatment in which a grand mal seizure is artificially induced in an anesthetized patient by passing an electrical current through electrodes applied to the patients head for therapeutic purposes.

Indications
1.Major severe depression
i)With suicidal risk ii)With stupor iii)With melancholia iv)With psychotic features v)With poor intake of food and fluids

vi)With unsatisfactory response to drug therapy

vii) Where drugs are contraindicated or have serious side effects viii)Where speedier recovery is needed

2.Severe catatonia i)With stupor ii)With poor intake of food and fluids iii)With unsatisfactory response to drug therapy iv) Where drugs are contraindicated or have serious side effects vi) Where speedier recovery is needed

3.Severe psychosis(schizophrenia or mania) i)With risk of suicide, homicide or danger of physical assault ii)With unsatisfactory response to drug therapy iii)Where drugs are contraindicated

iv)With very prominent depressive features(Schizo-affective disorder)

4.Organic mental disorders

i)Organic hallucinosis ii)Organic delusional disorder iii)Delirium

5.Medical disorders i)Organic catatonia ii)Intractable seizure disorder iii)N.M.S

iv)Parkinsonism

Mechanism of action

Neurotransmitter theory Neurotrophic factor theory Anticonvulsant theory:

Contraindications
a.Absolute -Raised ICP
b.Relative -Cerebral aneurysm -Cerebral hemorrhage -Brain tumor -Acute MI -CHF -Retinal detachment

Types Direct ECT Absence of anaesthesia Absence of muscle relaxation drugs. Modified ECT ECT is modified by drug induced muscular relaxation and general anesthesia

Method 70-120 volt of alternating current passed for 0.7-1.5 sec through electrodes.

Application of Electrodes

Bilateral ECT

In unilateral ECT

Frequency and total number of ECT

3 times per week or as indicated Total number:6 to 10; up to 25 may be preferred

Side Effects
1.Side-effects associated with general anesthesia 2.Memory disturbances 3.Cofusion

4. Otherside-effects

ECT team

Psychiatrist, anaesthesiologist, trained nurses and aides

Treatment facilities
Pre-ECT room -A pleasant comfortable waiting room

ECT room

Recovery room

Technique

Duration of effect

Role of the nurse in ECT

Pre-Treatment Evaluation Intraprocedure care Post procedure care

Conclusion