ECT involves inducing seizures through electrical stimulation of the brain under anesthesia to treat psychiatric conditions. It was introduced in 1938 and replaced previous somatic therapies. ECT works via its effects on brain catecholamine pathways and limbic systems. The procedure involves placing electrodes on the head and passing a brief electrical current while the patient is under anesthesia and muscle relaxation to induce a seizure. Potential risks include cognitive side effects and medical complications, though memory loss is usually temporary. Informed consent is required but involuntary treatment is allowed under certain legal circumstances.

1. GUIDED BY: PRESENTED BY:
Dr.Jesinda, Ph.D(N)., N.Dhivya Priya
HOD of Psychiatric Department, M.Sc(N)., II Year
SHNC, Madurai SHNC, Madurai

2. INTRODUCTION
Electroconvulsive therapy (ECT), also
known as Electroshock or Electroplexy is a
well established, albeit controversial
psychiatric treatment in which seizures are
electrically induced in anesthetized patients
for therapeutic effects.

3. ECT was first introduced by Italian psychiatrist
Ugo Cerletti and Lucio Bini in April 1938.
Insulin coma therapy and pharmacoconvulsive
therapy were replaced by ECT.
Insulin coma therapy was introduced by the
German psychiatrist Manfred Sakel in 1933.
Pharmacoconvulsive therapy was introduced in
Budapest in 1934 by Ladislas Meduna.
In 1974, the APA’s council on research
and development appointed a task force on ECT.
The APA task force on ECT, in 1976, gave its report
which provided clear guidelines for use of ECT.

4. 1.“ Artificial induction of a grand mal seizure
(tonic phase 10-15 sec, clonic phase 30-60 sec
through the application of electrical current
to the brain, the stimulus is applied through
electrodes which are placed either bilaterally in
fronto-temporal region or unilaterally on the
non dominant side.”
or
2.ECT is a physical/somatic therapy in which the
help of two electrodes, current is passed
through the temporal region in between the two
hemispheres of the brain, to produce a grand
mal type of seizure.
DEFINITION

5. : 70-120 volts of current
(The usual amount passed
in ECT is 200-1600mA)
: 0.7-1.5 sec

6. ECT relief very severe depressive illnesses
when other treatments have failed.
ECT has saved patient’s live because 15% of
people with severe depression will kill
themselves.
ECT works faster than all antidepressants
drugs.

7. -
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, Chronic pain
syndromes, and intractable seizure
disorders.

8. Absolute
Increased ICP
Relative
1. Cardiovascular
problems
Coronary artery Arrhythmias
disease, HTN, Aneurysms,
2. Cerebro vascular effects
Recentstrokes, Aneurysms Space occupying lesions,
3.Severepulmonarydisease
TB, Pneumonia, Asthma

9. The exact mechanism of action is notknown.
One hypothesis states that ECT possibly
affects the catecholamine pathways between
diencephalon (from where seizure
generalization occurs) and limbic systems
(which may be responsible for mood
disorders), also involving the hypothalamus.

11. DIRECT ECT
In this, ECT is given in the absence
of anesthesia and muscular
relaxation.
This is not a commonly
usedmethod now.

12. Electrodes are placed on the side of a
patient’s head just above the temples.
The patient is given anesthetic
injections and a muscle relaxant to
stop muscle contractions that can lead
to broken bones.
A small electric current is passed
through the brain.

13. Bilateral
Most common, most
effective and most
cognitive
dysfunction.
Each electrode placed 2.5 –
4 cm (1-1.5 inches) on the
midpoint on a line joining
the tragus of the ear and
the lateral canthus of the
eye.

14. Unilateral
may be clinically
less cognitive effect,
less
effective.
Electrodes are placed
only on one
head usually
side of
non
dominant side.

15. D D U

16. ECT is usually given 3 times a week, reduced
to twice a week or once a week once symptoms
begin to respond. This limits cognitive problems.
Treatmentof depressionusually consists of 6-12
treatments.
Psychosis and mania upto (or sometimes more
than) 20 treatments.
Catatonia usually resolves in 3-5 treatments.

17. Psychiatrist
Anesthetist
Trained
nurses
Nursing
aids ECT
assistant

18. Inj. Atropine (0.6mg to 1mg)
Inj. Succinylecholine (1mg/kg/b.wt)
Inj. Sodium thiopendothal (3-5mg/kg/b.wt)

19. A pretreatment medication such as atropine
sulfate, glycopyrolate is administered IM
30 min before treatment, (to decrease
secretion and counteract the effect of vagal
stimulation induced by ECT).
A short acting anesthesia (the patient should
be unconscious when the ECT is given).
Muscle relaxant (to prevent muscle contraction
during the seizure reduction of possibility of
fracture or dislocated bone).
Pure oxygen before and after treatment

20. 3 rooms
1. Waiting room
2. ECT room
3. Recovery room

24. Articles for anesthesia Suction
apparatus Face mask
Oxygen cylinder Tongue
depressor Mouth gag
Resuscitation apparatus
Fullset of emergency drugs,
ECTdrugs Defibrillator

25. Description of the procedure.
Explain why the procedure is
recommended.
➢Alternative treatment
➢Benefits may be transient
➢Behavioral restrictions
➢Voluntarytreatment
➢Implies consent for emergency
treatment
➢Risks major and minor

26. Time10-15mit (or more time preparation and
recovery)
Intravenous (IV) catheter Oxygen mask may be
given
Electrodes are placed on the head either
unilateral or bilateral
Anesthetic is injectedinto IV Unconscious and
unaware of procedure Muscle relaxant is injected
into IV Prevent violent convulsions

27. BP cuff placed around forearm or
ankle. To Prevents muscle relaxant
from paralyzing, so doctor can
confirm seizure with movement of
hand/foot.
Electric current is sent through
electrodes to brain.
Seizure lasts 30-60 seconds.
Few min later, anesthetic and muscle
relaxant wear off.

28. • Pre ECT care
• Intra procedure care
• Post procedure care

29. Informed consent
Fully explain therisks and benefits of procedure
and answer questions from patients or relatives.
Information sheets.
Reduce patients anxiety and help establish
good relationship (nurse-patient, doctor
patient).
Administration of drugs. Check patient record.

30. Cont…
Explainprocedure.
Keep patient on NPO 6-8hours before ECT.
Discourage smoking just before ECT. Remove
artificial dentures andarticles.
Vital signs.
Ensure emergency articles are accessible.
Emotional support.
Transfer patient to ECT room with necessary
records.

31. Checks patients identity.
Check patient is NPO and has emptied their bowels
and bladder prior to coming to treatment room.
Check patient is not wearing restrictive clothing and
treatments(including
jewellery/dentures have been
removed. Consult ECT record of
previous anesthetic problems).
or reduce
Ensureconsent form is signed appropriately. Check
no medication that might increase seizure
threshold has been recently given.
Check ECT machine is functioning correctly.

32. Reassurance & support.
Place patient in supine position.
Necessary drug administration.
Mouth gag.
Apply upward pressure to mandible.
Oxygen administration.
Clean the scalp with normal saline.
Prevent fall, fracture, dislocation
Remove the mouth gag after seizure
occurred Suck the oral secretion &
apply O2 mask

34. Shift client post – procedure room. Check vital
signs every 15 min.
Administer drugs if patient is aggressive/
violated/ confused.
If respiratory difficulty continue oxygen. Provide
side rails.
Be with the patient. Documentation.
Reorient the client after recovery.

35. Impairment of cognition
Period of confusion immediately after ECT May
not know where you are or why you are there
Generally lasts few minutes toseveral hours
Memory loss
May forget weeks/months before treatment,
during treatment or after treatment has
stopped
Usually improves within couple of months
Permanent in relatively rare cases

36. Medical complications
Heart problems Small
risk of death
Physical symptoms Nausea
Vomiting Headache
Muscle ache Jaw
pain

37. People with serious mental illness who are at
risk of self harm or are thought to be risk to
other people can be sectioned under the
mental health act.
This means they can be taken to a place of
safety, usually a secure psychiatric unit, and
given treatment against their will.
They may not consent to the treatment they
are given and may be held against their will.