medical students

1. ELECTROCONVULSIVE
THERAPY
• Electroconvulsive Therapy ;
• The induction of a grand mal (generalized)
seizure through the application of electrical
current to the brain.
• The stimulus is applied through electrodes
that are placed either bilaterally in the
frontotemporal region or unilaterally on the
same side as the dominant hand.

2. Mechanism of action
• The exact mechanism by which ECT effects a therapeutic
response is unknown.
• Several theories exist, but the one to which the most
credibility has been given is the biochem- ical theory.
• A number of researchers have demonstrated that electric
stimulation results in significant increases in the circulating
levels of several neurotransmitters (Wahlund & von Rosen,
2003). These neurotransmitters include serotonin,
norepinephrine, and dopamine, the same biogenic amines
that are affected by antidepressant drugs.
• Additional evidence suggests that ECT may also result in
increases in glutamate levels.

3. admin of ECT
• Unconciousness is induced using a barbiturate such as
methohexital.
• Succinylcholine is then given to paralyze the skeletal
muscles thus preventing violent contractions induced
by the seizures.
• One limb is tied with a torniquet b4 the succinylcholine
is administered. The limb is used to monitor muscle
mvt induced by electrical current applied to the brain
• Breathing tube is inserted and the tongue secured.
• Current is then applied while brain activity is being
monitored by an EEG.

4. • INDICATIONS
• Major Depression
• ECT has been shown to be effective in the
treatment of severe depression.
• It appears to be particularly effective in
depressed clients who are also experiencing
psychotic symptoms.
• ECT is not often used as the treatment of choice
for depressive disorders but is considered only
after a trial of therapy with antidepressant
medication has proved ineffective.

5. • Mania
• ECT is also indicated in the treatment of acute
manic episodes of bipolar affective disorder .
• At present, it is rarely used for this purpose,
having been superceded by the widespread use
of antipsychotic drugs and/or lithium.
• However, it has been shown to be effective in the
treatment of manic clients who do not tolerate or
fail to respond to lithium or other drug
treatment, or when life is threatened by
dangerous behavior or exhaustion.

6. • Schizophrenia
• ECT can induce a remission in some clients
who present with acute schizophrenia.
• It does not appear to be of value to
individuals with chronic schizophrenic illness.

7. • CONTRAINDICATIONS
• The only absolute contraindication for ECT is
elevated ICP.causes include: trauma,
• It is associated with a physiological rise in
cerebrospinal fluid pressure during the
treatment, resulting in increased intracranial
pressure that could lead to brain stem
herniation (Marangell et al., 2003).

8. • Other factors that place clients at risk for ECT
include severe osteoporosis, acute and chronic
pulmonary disorders, and high-risk or
complicated pregnancy

9. Risks
• major risks of ECT include
• mortality;
• permanent memory loss,
• Brain damage
•

10. Roles of a nurse
• Prior to ECT
• ASSESSMENT
• A complete physical examination must be completed by the
appropriate medical professional prior to the initiation of
ECT.
• This evaluation should include a thorough assess- ment of
cardiovascular and pulmonary status as well as laboratory
blood and urine studies.
• A skeletal history and radiographic assessment should also
be considered.
• The nurse may be responsible for ensuring that informed
consent has been obtained from the client.

11. ● The client’s mood and level of interaction with
others
Evidence of suicidal ideation, plan, and means
● Level of anxiety and fears associated with
receiving ECT
● Thought and communication patterns

12. • During the treatment procedure;
• Ensure patency of airway.
• Provide suctioning if needed.
• Assist anesthesiologist with oxygenation as required.
• Observe readouts on machines monitoring vital signs
and cardiac functioning.
• Provide support to the client’s arms and legs during
the seizure.
• Observe and record the type and amount of
movement induced by the seizure.

13. Roles of the nurse
• After the procedure
• oxygenate the client with pure oxygen until
sponta- neous respirations return.
• Most clients awaken within 10 or 15 minutes
of the treatment. obtain vitals after client
awakes.

14. Wat??
• Amount of current used?
• Current amount, 800milliampres
• Volts used, 70 to 150v {only 12.6volts r
needed to start a car}
• Duration ,1to 6 seconds
• Therapy first tested by 2 italian physicians in
1930s on a 39yr old unidentifiable homeless
man.