2. Electro convulsive therapy is also known as electroshock, is well
established controversial psychiatric treatment in which seizures are
electrically induced in anaesthized patients for therapeutic effect.
In april 1938, carletti and bini (neuropsychiatrists) introduced ECT
technique.
In 1950, von medona modified ECT procedure
INTRODUCTION
3. Electroconvulsive therapy is artificial induction of a grandmal
seizure through the application of electric current to the brain, the
stimulus is applied through electrodes which are placed either
bilaterally in the fronto-temporal region or unilaterally on the non-
dominant side
OR
ECT consists of passing electric
current through brain’s temporal lobe
to produce seizures after which brain
activity comes to normal
DEFINITION
5. It is normally offered when
Several medication tried but not helped
Side effects of antidepressants are too severe
find ECT effective in past
Patient has suicidal attempts
Patient does not eat or drink anything
PREFERENCE OF ECT OVER OTHER
TREATMENTS
7. 1. Rapid intra cranial pressure
2. Space occupying lesion in frontal cortex
3. Subarachnoid hemorrhage
ABSOLUTE
8. 1. Acute myocardial infarction
2. History of cerebral infarction
3. Fractures, fever
4. Cardiac arrhythmias
5. Hypertension
6. Pneumonia
7. Bronchial asthma
8. Aneurysm
9. Bleeding disorders
NOTE- ECT in pregnancy[2trimester] and old age are not
contraindicated.
RELATIVE
9. The technique used for ECT administration are of two types:-
1. Direct ECT:-
It is given in the absence of muscle relaxant and general
anesthesia.
Only atropine sulphate is administered I/V or S/C or I/M half
an hour before treatment (it prolongs the period of
disorientation after seizures and inhibits vomiting)
Minor tranquillizer like COLMPOSE is also used.
Grandmal seizures is induced by passing electric current
through the temporal lobe.
TECHNIQUE
10. ECT is modified with the use of anesthesia, muscle relaxant and
oxygenation.
The use of anesthesia is must to decrease anxiety and to
achieve maximum effect. It is used to modify force of
convulsion and to avoid complications like bone fracture. It is
used in patients who are recovering from heart conditions.
MODIFIED ECT
11. DRUGS USED IN ECT
DRUG DOSE ACTION
ATROPINE 0.6-1mg/kg Anticholinergic
PROPOFOL 0.75mg/kg Anaesthetic agent
THIOPENTAL 150-250 mg Anaesthetic agent
SUCCINYL CHOLINE 0.5-1.5mg/kg Muscle relaxant
PHENOBARBITAL 50-100mg Sedative
12. It is given IV before the treatment or given S/C or I/M 30
min before treatment.
It is given to decrease oral secretions and to prevent vagal
stimulation during ECT which causes cardiac arrest
ATROPINE
13. Propofol and thiopentone
Thiopentone decreases the duration of seizures.
Preparation of thiopentone:- Dissolve 20ml NS in a vial of
500mg, it will be 25mg/ml and then draw in 10 ml syringe, and
give 2.5mg/kg.
ANESTHETIC AGENTS
14. Succinylcholine is a depolarizing blocking agent, it’s administration is
followed by muscle fasciculation which starts from above to
downwards, when the fine twitching movements disappear it is a time
of muscle relaxation. It reduces intense muscle contraction associated
with ECT
MUSCLE RELAXANTS
15. A B.P cuff is applied on one upper extremity and then succinyl-
choline is administered and then electric shock is given,
the seizure appears in
that extremity from upward
to downward.
A mouth gag is inserted in between teeth to prevent tongue bite
during the convulsion and pressure applied on mandible.
MUSCLE FASCICULATION
16. The electrodes (U shaped in most equipment) is moistened
with saline or 25% bicarbonate and are applied on head.
According to application of electrodes it is of two types:-
Bilateral ECT
Unilateral ECT
PLACEMENT OF ELECTRODES
17. Most commonly used
Involves the placement of electrodes on bitemporal region
An imaginery line is drawn from outer canthus of eye to
the tragus of ear.
Midpoint of imaginery line is
located and electrode placed
(2.2 -4)cm above the
midpoint.
BILATERAL ECT
18.
19. Electrodes are placed on one side of the head usually on the
non dominating side
Unilateral ECT is better with lesser side effects particularly
those of memory impairment
UNILATERAL ECT
20. AMOUNT OF ELECTRICITY USED IN ECT
Voltage 70-150 volts Mean= 110 volts
Current 200-1600 mA Mean = 1000 mA
Duration 0.1- 1 sec Mean = 0.6 sec
21. In Tonic phase
Bleparospasm- a tonic spasm of eyelid muscles is
observed when current is applied.
Mild grimace
In Clonic phase
Babinski reflex-slow planter flexion during tonic
phase and fine movements of toes in clonic phase
Planter flexion
REFLEXES
23. Depression:- Patient show response after few ECT and peak
response after 10-12 ECT.
In Bipolar disorders(manic type) Schizoaffective or
catatonic schizophrenia peak response is shown after 5-10 ECT.
In chronically ill schizophrenia peak response is shown after20-25
treatment.
ECT is given 3 times a week the frequency of treatment can
be reduced if patient show a severe confusional state, in suicidal
cases it can be given on daily bases.
NUMBER AND FREQUENCY
24. Affect on cognition and memory:-
1. Amnesia
Retrograde
Anterograde
2. Memory loss and confusion
3. Learning capacity improves though there is
impairment in retention of memory
COMPLICATIONS
25. Fractures and dislocations
Headache
Fear due to unpleasant experience
Backache
Injury to mouth and tongue
COMPLICATIONS
32. Explanation of procedure
Informed consent
Detailed medical and psychiatric
history
General and systemic physical
examination
Routine laboratory investigations (Hb, ESR,urine
routine, ECG, chest X ray)
Others like EEG and plasma pseudo cholinesterase (for
those who receive succinyl-choline)
PRE- TREATMENT EVALUATION
33. It is important that patient should not hear or see
anything before or after treatment.
In hospital setting where ECT is given
nurse should do set up which includes:-
Waiting room
Treatment room
Recovery room or after care room
ROLE OF NURSE
34. Room should be calm with dim lights and light color
of walls.
Put some flowers to give pleasant feeling to patient.
There should be magazine
so that patient can divert his
mind and reduce anxiety.
Lavatory should be attached because patient needs
to empty his bowel and bladder before treatment.
Nurse should be available to clear the doubts
regarding ECT.
WAITING ROOM
35. It should have low level bed with railings for comfort
of patient, railing should be well padded to avoid
injury to patient during convulsions.
o Articles required for ECT are:-
ECT machine-check all the plugs are in working
condition
NS to clean temporal region and also to dip
electrodes
Endotracheal tube
Sterile suction catheters
Mouth wipes and cotton balls
Emergency drugs
TREATMENT ROOM/ECT ROOM
36. Sterile syringes 2cc,
5cc,10cc
Sterile spirit swabs
In lower shelf of trolley
put AMBU bag
B.P apparatus
Mouth gag-to avoid injury in mouth
Tongue depressor
Small pillow to put under patient’s back
Kidney tray and paper bag
CONTD….
37. Once patient respond to painful stimuli he is
transferred to recovery room
A well padded floor bed should be kept ready
Observation and monitoring of vital-signs
Mouth wipe to clear secretions
Extra clothes if patient spoils with urine or stool
RECOVERY ROOM
38. •Nursing intervention before
•Giving ECT
Purpose
1.Check all the investigations
(Hb, urine for sugar and
Ketones)
2. Written consent from
relatives to be taken. They
should be explained in
detail, patient should not be
told as word current causes
fear.
•To select a patient for ECT
•Consent is taken for legal
protection. Explanation to
relatives will avoid them from
shock and fear of therapy.
39. 3. Patient should be kept
NPO(atleast 2 to 3 hrs)
4.Remove all metallic
articles (watch, bangles etc.)
5.Remove artificial dentures
6.Remove lipstick, nail polish
or any other make up.
To prevent vomiting and
aspiration after ECT.
To prevent electric current
passing through unwanted
areas.
To prevent it from dislodging
and blocking respiratory
tract.
To check for cyanosis.
40. 7. Loosen the tight clothes(
necktie in men, blouse in
women).
8. Replace long sedatives with
hypnotics
9.Encorage patient to empty
his/her bowel and bladder
10.Give pre-medication to
patient (atropine and calmpose
)
11.Take the stretcher of patient
to the waiting room
•To help in facilating respiration
and meet any emergency.
•To enhance the effect of ECT
•To reduce his/her
embarrassment after
treatment
•To reduce anxiety of patient
and enhance effectiveness
•Prepare patient
psychologically that he is
proceeding for procedure
41. Nursing Intervention
during ECT
Purpose
1. Patient is
transferred on a
trolley from the
waiting room to ECT
room and is placed
in well-padded
comfortable dorsal
position or supine
position, small pillow
is kept under lumbar
curve.
To prevent injury well-
padded bed is given and
ECT is given in supine
position.
42. 2. Give short acting anesthetic
agent i.e. thiopentone
2.5mg/kg and succinycholine
.75-1.5 mg/kg.
3.Well padded mouth gag or
tongue depressor is placed
between the teeth.
To reduce his anxiety and
cause less vigorous
convulsions and thereby to
prevent complications.
To prevent biting of tongue
and injury to lips.
.
43. 4.Support the shoulder
and arms tightly, restrain
the thigh with the help of
sheet.
5. Hyperextension of head
with support to chin by
the nurse.
To prevent fractures.
To prevent jaw dislocation
and for patent airway
44. 6. Give few breaths of oxygen
to patient.
7.Provide electrodes dipped in
saline water or jelly for
placing on temporal region.
8.Make an observation of
grandmal seizures. The initial
tonic stage which lasts for10-
15 sec followed by
convulsions lasting for 25 to
30 sec.
•To help the patient to
overcome phase of apnea
after convulsions.
•Concentrated saline is a
good conductor of electricity,
thereby facilities convulsions.
•To ensure that there are no
stuns or sub shocks and the
treatment is successful
45. 9.Do suction
immediately.
10.Restore respiration
by giving oxygen by
mask.
To keep airway patent
and prevent patient
from aspiration
pneumonia.
To prevent patient from
respiratory and cardiac
complications.
46. Nursing intervention
after ECT
Purpose
1.Observe and record
respiration, pulse and BP of
patient
2.Put the railings and place
patient on a side lying
position, wipe the secretions.
3.Transfer patient to recovery
room only when she answer
simple question “open your
mouth”
To prevent any respiratory
and cardiac complications
2.To prevent the patient
fall, and to prevent
aspiration of secretions.
To make sure that patient
has come out of
unconsciousness.
47. 4. Record vital signs every
15 min , once patient is
stable record every 30
min till he recovers
completely.
5. Allow patient to sleep for
30 min to 1 hour.
6. Reassure the patient.
7. Reorient patient to ward
toilet and nursing station
To make early nursing
diagnosis of patient going to
complications.
To help the patient to
overcome physical exhaustion.
It helps to overcome
maladaptive behavior.
To help patient to overcome
confusional state.
48. 8.Make a note of any injuries
or complaints of pain by the
patient-body pain headache.
9.Encourage patient to go for
shower bath and change
clothes.
10.Allow patient to take
clear tea followed by meals.
11.Conduct the MMSE
12.Help patient to carry out
daily activites
To detect any type of fracture
To give patient a sense of
well being and freshness.
To meet the nutritional need
as he has not taken anything
since morning
To check cognition
impairment.
It helps to resume patient to
his work.
50. RECAPITULATION
Q1.Define ECT.
Q2.What are the indications of ECT?
True or false
1. Succinylcholine is a anesthetic agent.
2. ECT can not be given in pregnancy.
3. Amount of current passed in ECT IS 200-1600mA.
