Ect topic which was expressed by ashish dadheech
•Download as PPT, PDF•
3 likes•285 views
electro convulsive therapy which is mostly used in psychiatric nursing for providing effective care and treatment to mental ill client in some kind of certain indication of depression,mania and schizophrenia
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Ect topic which was expressed by ashish dadheech
Similar to Ect topic which was expressed by ashish dadheech (20)
Recently uploaded
Recently uploaded (20)
Ect topic which was expressed by ashish dadheech
- 1. ELECTROCONVULSIV E THERAPY ASHISH DADHEECH MSC NURSING FINAL YEAR (M.H.N.)PSYCHIATRIC NURSING BHILWARA ,RAJASTHAN
- 2. History of ECT • Von Meduna (1934)- Autopsies of patients w/ Seizure disorders and of patients w/ Schizophrenia. • Difference in Glial cell proliferation
- 4. Insulin Shock Therapy • In the 1930’s , Dr Sakel developed Insulin Shock Therapy
- 5. Cerletti and Bini (1934): Electricity Initially done without muscle blocker or anesthetic
- 6. Early ECT • Assylums • Few effective medications • Many often severe side effects • 1950’s- ether, and curare extract developed (Abram Bennett- a psychiatrist helped develop a method for extracting curare). • In 1950’s antidepressant and antipsychotic meds introduced- significantly decreased
- 7. Electrophysiological Principles • Ohm’s Law: I=E/R (I=current, E=voltage, and R=resistance) • Dose of electricity in ECT= 100-500 milliCoulombs • Brain has low impedance (resistance), skull has very high impedance. Only 20% of applied charge actually enters the brain. • Seizure involves propagation of action potentials in a large percentage of neurons.
- 8. Mechanism of Action • Neurotransmitter levels all increased in CSF after seizure. Results in down regulation of Beta adrenergic receptors. • During seizure- PET studies show an increase in BBB permeability and in cerebral blood flow and metabolism. • After seizure, blood flow and metabolism is decreased especially in the frontal lobes. Research shows this correlated w/
- 9. Indications • Major Depression w/ or w/o psychotic features • Bipolar disorder - manic or depressed phase • Acute or Catatonic Schizophrenia • Some studies have shown efficacy in treating OCD, Delirium, NMS, Chronic pain syndromes, and intractable seizure disorders
- 10. Major Depression • Efficacy vs antidepressants • When is it a first line treatment consideration? • Length of Antidepressant effect • Maintenance ECT
- 11. Bipolar Mania • Efficacy vs Lithium • Indications for First Line Treatment: • -Recent Myocardial Infarction w/ Acute Mania • -Pregnancy w/ Acute mania
- 12. Pre ECT Workup • Physical Exam • Head CT • CXR • CBC, Basic Chem • EKG • ? Spinal Films
- 13. Contraindications? • No Absolute Contraindications • Relative Contraindications: Recent MI, Berry Aneurysm, Brain Mass, Increased Intracranial Pressure
- 14. Treatments • Premedicate w/ Glycopyrrolate, consider short acting Beta blocker • Patient not intubated • Bite block • Cuff leg to monitor sz • EEG and EMG • Length of sz- 20 sec to 1 min.
- 15. Number and Spacing of ECT • 2-3x/wk- efficacy vs less memory impairment • 5-12 sessions/ treatment (although up to 20 is possible) • Point of maximum improvement- no more improvement after 2 further treatments.
- 16. Adverse Effects • Mortality rate: .002% per treatment session, .01% per patient. • Sore Muscles • Head ache • Short term confusion/ delirium • Memory
- 17. Transcranial Magnetic Stimulation (TMS) • Rt Frontal lobe- TMS pulses suppress activity and causes happiness and increased energy • Left Frontal lobe- TMS pulses suppress activity and leads to sadness • 4/250 had seizure • 10Hz stimulation 20x/day, 11/17 patients w/ Major Depression showed significant improvement.
- 18. TMS continued • So far positive effects have not lasted as long as positive effects from ECT • Handful of case reports show efficacy w/ anxiety disorders.