Electroconvulsive therapy

3. EKLAVYA UNIVERSITY, DAMOH,(M.P.)
Guided by..
Dr. Dinesh kushwaha
Co – guided by..
Miss raksha Rai
ma’am
Presented by..
.Mayank Rajak .Nikita Rajak
.Vishakha Kurmi .Ruchi patel
.Naina ahirwar .Megha balmik
.Tanuj choudhry .Shobhna Raj
.Neha choudhry
Department – School of Nursing and Paramedical science

4. TOPIC - ECT

5. INTRODUCTION ...
 It is first developed in the late 1930s, in Italy.
 Electroconvulsive therapy is a type of somatic
treatment, first introduced by LUCIO BINI and
UGO CERLETTI in 18 April 1938s .
 The first recorded treatment at McLean hospital
taking place in 1941s in Italy .
 From 1980s onwards ECT is being considered as a
unique psychiatric treatment.

6. Born-
September 26, 1877
Conegliano, Kingdom of
Italy
Died -
July 25, 1963 (aged 85)
Rome, Italy
Known for -
Inventing electroconvulsive
therapy
Scientific career -
Neurology, neuropsychiatry,
Psychiatry
UGO CERELETTI

7. Born- 1908
Died -1964
Age – 56
Occupation -
Psychiatrist,
professor
Education-
University of Rome
La Sapienza
LUCIO BINI

8. Can be seen –Museo di
Storia della
Medicina,University “La
Sapienza”, Rome
The first ECT Machine

9. The first patient was
treated on 18 April
1938s.
Patient age -39 year old
man
Found- Milan railway
station
Hallucinations

10. Definition...
Electroconvulsive therapy is a treatment that
involves sending an electric current through
your brain. This causes a brief surge of
electrical activity within your brain (also
known as a seizure). The aim is to relieve
severe symptoms of some mental health
problems.

11. Parameters of Electrical current
Applied ...
Standard dose according to American
Psychiatric Association,1978:
Voltage – 70 – 120 volts
 Duration – 0.7 – 1.5 seconds.

12. Types of Seizures Produced ...
Grandmal Seizure – tonic phase lasting
for 10 – 15 seconds
(loss of consciousness and violent muscle contraction)
Clonic phase lasting for 30 – 60 seconds

13. Mechanism of action ...
 The exact mechanism of action is not known .
SOME THEORY
 Neurotransmitter changes
 Neuroendocrine effects
 Brain damage theory
 Neuroplasticity

14. Neurotransmitter changes ...
 ECT works like anti-depressant medication. ECT is thought to
influence neurotransmitter levels, particularly serotonin,
norepinephrine, and dopamine, which play key roles in mood
regulation.

15. Neuroendocrine effects ...
The seizure causes the hypothalamus to release
chemicals that cause changes throughout the body.
The seizure may release a neuropeptide that regulates
mood.

16. Neuroplasticity...
 ECT is believed to induce changes in neuroplasticity, altering the
connections between neurons and promoting adaptive changes in the
brain.

17. Brain damage theory ...
 Shock damages the brain, causing memory loss and disorientation
that creates an illusion that problems are gone, and euphoria,
which is a frequently observed result of brain injury. Both are
temporary.

18. Types of ECT ...
Direct ECT –
 Anesthetic agents and muscle
relaxants are not used.
 Generalized convulsions produced
can result in fractures or teeth
dislocation.

19. Modified ECT -
 Anesthetic agents and muscle relaxants are used.
 Risk of fractures gets minimized.

20. Frequency and Total Number of ECT ...
Frequency –
 3 times per week or as indicated.
 Treatment of depression usually consists of 6-12
treatments.
 Catatonia usually resolves in 3-5 treatments.
 Total number –
 6 to 10; up to 25 in month may be preferred as
indicated

21. Application
Of
Electrodes

23. Electrodes...

24. Bilateral ECT ...
 : Each Electrode is placed 2.54 cm (11 inch) above the mid point
of the, on the line joining the tragus of the ear and the lateral
canthus of the eye.

26. Unilateral ECT...
 Electrodes are placed only one side of head, usually. Non
dominant side (Right side of head in a right-handed
individual).
 One electrode is placed at the top (vertex) of the head.
 Unilateral ECT is safer, with much fewer side-effects,
particularly those of memory impairments

28. INDICATIONS...

30. Major depression :
 With Suicidal risk, Stupor, Poor intake of food & fluids,
Melancholia with psychotic features, Unsatisfactory response to
drugs or where drugs are contraindicated or have serious side
effects

31. Severe catatonia (functional)
 Catatonia, a
neuropsychiatric syndrome
characterized by abnormal
movements, behaviors, and
withdrawal.

32. Severe psychosis..
 Schizophrenia
 Mania

33. Organic mental disorders:
A decrease in mental functioning that is not
the result of a psychiatric condition.
Organic mood disorder

34. Organic psychosis...
An organic psychosis is an abnormal mental state with a
known physical cause characterized by an altered
perception of reality.

35. CONTRAINDICATIONS...

37. Absolute ...
--Raised ICP (intracranial pressure )

38. • Relatives..
1. Cerebral aneurysm
2. Cerebral hemorrhage

39. 3. Brain tumor
4. Acute myocardial
infarction

40. 5. Congestive heart
failure
6. Pneumonia

41. 7. Aortic
aneurysm
8. Retinal
detachment

42. Complications of ECT...

43. 1. Life Threatening Complications of ECT
are rare.

44. 2. ECT does not cause any brain damage.

45. 4. Fractures can sometimes occur in elderly
patients with Osteoporosis.

46. 5. In Patients with a History of heart disease,
dysrhythmias and respiratory arrest may occur.

47. Side Effects of ECT ...

48. Memory Impairments
Drowsiness, Confusion and
Restlessness
Poor Concentration
Headache, Weakness Fatigue,
backache, Muscle ache, Anxiety
Dryness of Mouth, Palpitations,
Nausea, Vomiting
Unsteady Gait
Tongue Bite & Incontinence

49. ECT TEAM ...

50. 1.Psychiatrist
2.Anesthesiologist
3.Trained nurse

51. 4.Nursing aids 5.ECT Assistant

52. MEDICATION USED IN ECT...
Inj. Atropine 0.6mg
Inj. Scoline 25 – 40mg
Sodium Pendothal 125 - 250 mg

53. Treatment Facilities...
1. A pleasant, comfortable waiting room (pre- ECT
room)

54. 2.ECT Room

55. 3. Recovery room – well -equipped

56. ARTICLES NEEDED FOR ECT...
Articles for anesthesia
Suction Apparatus
Face mask
O2 cylinder
Tongue depressor
Mouth gag
Resuscitation apparatus
emergency drugs, ECT drugs
Defibrillator

57. Examination before ECT ...

58. 1. Psychiatric history, including past response to
ECT
2. Mental status examination, including a cognitive
examination
3. General medical history and examination to
identify medical risks of ECT focusing on
neurologic, cardiovascular, pulmonary systems,
and effects of previous anesthesia inductions
Cont...

59. ECT Machine ...

61. Pre-treatment Evaluation...
Detailed medical and psychiatric history, including
history of allergies.
Assessment of patients and families knowledge of
indications, side-effects, therapeutic effects and risks
associated with ECT.
An informed consent should be taken. Allay any
unfounded fears and anxieties regarding the procedure.
Assess baseline vital signs.
Patient should be on empty stomach for 4-6 hours prior
to ECT.

62. Withhold night doses of drugs which increase seizure
threshold like diazepam, barbiturates and anticonvulsants.
Withhold oral medications in the morning.
Head shampooing in the morning since oil causes
impedance of passage of electricity to brain.
Any jewellery, prosthesis, dentures, contact lens, metallic
objects and tight clothing should be removed from the
patient’s body.
Empty bladder and bowel just before ECT.
Cont...

63. Cont..
Administration of 0.6 mg atropine IM or SC 30
minutes before ECT, or IV just before ECT.

64. Intra-procedure Care...
Place the patient comfortably on the ECT table in supine
position.
Stay with the patient to allay anxiety and fear.
Assist in administering the anesthetic agent (thiopental
sodium 3-5 mg/kg body weight) and muscle relaxant
(1 mg/kg body weight of succinylcholine) .
Since the muscle relaxant paralyzes all muscles including
respiratory muscles patent airway should be ensured and
ventilatory support should be started.

65. Cont...
Mouth gag should be inserted to prevent possible tongue
bite.
The place(s) of electrode placement should be cleated with
normal saline of 25% bicarbonate solution, or conducting
gel applied.
Monitor voltage, intensity and duration of electrical
stimulus given.
Monitor seizure activity try using cuff method.
100 percent oxygen should he provided.

66. During seizure monitor vital signs, ECG, oxygen saturation
EEG, etc.
Record the findings and medicines given in the patient’s
chart.
Cont...

67. Post-procedure Care...
Monitor vital signs.
Continue oxygenation till spontaneous respiration starts.
Assess for post-ictal confusion and restlessness.
Take safety precautions to prevent injury (side-lying
position and suctioning to prevent aspiration of secretions,
use of side rails to prevent falls ) .
If there is severe post-ictal confusion and restlessness, IV
diazepam may be administered.

68. Cont...
Reorient the patient after recovery and stay with
him until fully oriented.
Document any findings as relevant in the patient’s
record.

69. Conclusion...
Electroconvulsive therapy (ECT) is a procedure, done
under general anesthesia, in which small electric
currents are passed through the brain, intentionally
triggering a brief seizure. ECT seems to cause changes
in brain chemistry that can quickly reverse symptoms
of certain mental health Like major depression
psychosis etc .