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ECT Therapy for Depression Relief
- 1. Electroconvulsive Therapy - is passing an electrical current through electrodes that are attached to the temples. TREAMENT MODALITIES
- 2. ELECTROCONVULSIVE THERAPY consists of inducing a grand mal (tonic- clonic) seizure by passing an electrical current through electrodes that are attached to the temples
- 3. Copyright ©2008 Canadian Medical Association or its licensors Hoag, H. CMAJ 2008;178:1264-1266 Electroconvulsive therapy is increasingly being delivered on an outpatient basis and being administered to seniors as treatment for depression
- 4. ELECTROCONVULSIVE THERAPY administration of a muscle relaxant ex. Succinylcholine (Anectine), minimizes seizure activity, preventing damage to long bones and cervical vertebrae
- 5. 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 Usual relief is seen after 2-3 ECTs
- 6. ELECTROCONVULSIVE THERAPY At-risk clients include: 1. Post MI 2. Pregnant women *The resultant seizure from ECT can cause transient increases in blood pressure, myocardial oxygen consumption, heart rate, and intracranial pressure.
- 7. Uses of ECT Clients with major depressive and bipolar depressive disorders psychotic symptoms are present such as delusions of guilt, somatic delusions, and delusions of infidelity
- 8. Uses of ECT Manic clients whose conditions are resistant to lithium and antipsychotic medications 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.
- 9. Uses of ECT 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
- 10. ECT: 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
- 11. ECT: 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
- 12. ECT: 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 bradyarrhythmias
- 13. ECT: DURING 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 administered_ Succinylcholine
- 14. ECT: DURING 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
- 15. ECT: 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
- 16. ECT: 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
- 17. Potential side-effects Confusion Disorientation Short term memory loss- which may last up to 6 months Fractures Arrhythmias