The document discusses the history and development of electroconvulsive therapy (ECT). It notes that ECT was first used in the 1500s using camphor, was modernized in the 1930s using camphor for catatonic schizophrenia, and the first official ECT treatment was in 1938 in Rome. It then describes the concept, definition, purpose, methods, mechanisms of action, types, applications of electrodes, techniques, ECT team, indications, contraindications, side effects, frequency, and the roles of psychiatric nurses in the ECT procedure.

1. By
Br. Alok Kumar
M.Sc MHN

2.  Milestones in the history
of convulsive therapy
dating back to the 1500s
when the Swiss physician
Paracelsus (1493-1541)
used camphor to treat
mental illness

3.  In 1934 Ladislaus
Meduna begins the
modern era of
convulsive therapy
using intramuscular
injection of camphor
for catatonic
schizophrenia.

4.  The first ECT treatment was performed in April, 1938
by Italian psychiatrists Ugo Cerletti and Lucio Bini in
Rome

5.  In 1950 Von
Medona modified
the ECT procedure
from that time
onwards modified
ECT technique is
implemented and
considered as
unique psychiatric
treatment

7. CONCEPT OF ECT
 Electroconvulsive Therapy is a painless form of electric
therapy. It is called as physical/ somatic therapy.
 Patient is anaesthetized or sometimes without an
aesthesis electric current is applied for a fraction of a
second with the help of electrodes placed on the
temporal region.
 Due to this electric current convulsion or seizure (like
Grand Mal Epilepsy) are produced.

8. DEFINITION
 ‘Artificial induction of a grandmal seizure(tonic
phase:10-15sec; clonic phase:30-60sec) through the
application of electrical current to the brain , the
stimulus is applied through electrodes which are
placed either bilaterally in the frontal- temporal region
or unilaterally on the non –dominant side’

9. PURPOSE OF ECT
When drugs are not available or not
providing to be very effective for the
patient.
For the quick recovery of the patient.
When patient needs to get back to
work quickly.

10. METHOD
70-120 volts of
alternating
current
(50cycles)
passed for 0.3-
1.5 sec through
electrodes.

11. 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 biochemical theory.
 A number of researchers have demonstrated that
electrical stimulation results in significant increases in
the circulating levels of several neurotransmitters.

12. MECHANISM OF ACTION
 These neurotransmitters include serotonin, nor-
epinephrine, and dopamine, the same biogenic amines
that are affected by antidepressant drugs.
 Additional evidence suggests that ECT may also result
in increases in glutamate and gamma-amino butyric
acid (GABA).
 The results of studies relating to the mechanism
underlying the effectiveness of ECT are still ongoing
and continue to be controversial

13. TYPES
 Direct ECT
 Absence of anaesthesia
 Absence of muscle relaxation drugs.
 Modified ECT
 Drugs induced muscle relaxation and general
anaesthesia may or may not be used.

14. APPLICATIONS OF ELECTRODES
 In bilateral ECT, electrodes are placed above the
midpoint, on a line joining the tragus of the ear and
the lateral canthus of the eye.
 In unilateral ECT, electrode is placed on non-
dominant side (one side) of the head.

15. TECHNIQUE
Injection thiopentone sodium
(anaesthetic agent )3-5mg/kg body
weight through I.V
Muscle relaxants like injections
succinyl scoline 1mg/kg body
weight through I.V

16. TECHNIQUE
 Injection atropine 1/100 grams subcutaneously or
intra muscularly before electric current stimuli will
be passed
 70-120 volts of 50 cycles of alternating current
passed for 0.3-1.5 second through electrodes.
 If needed artificial respiration has to be given until
client breathes normally

17. ECT TEAM
Psychiatric
Nurse
Nursing aid

18. INDICATIONS
 Depression
 Stuporous conditions
 Endogenous depression
 Psychotic depression
 Reaction depression which is not responding to the
other therapies like psychotherapy , casework drugs
 Atypical depression
 Melancholia

19. INDICATIONS
 Severe Psychosis
 Severe attack of mania
 Destructive , assaultive behaviour
 Delirium
 Schizophrenia
 Catatonic and paranoid type
 Other type of schizophrenia, not responding to other
treatments
 Organic psychosis
 Senile and pre-senile dementia.

20. CONTRAINDICATIONS:
 Absolute
 Clients with increased
intracranial pressure

21. CONTRAINDICATIONS:
 Relative
 Cerebral disorders, e.g. Aneurysm, haemorrhage
 Brain tumour
 CVS disease like MI, CHF
 Retinal detachment
 Severe systematic diseases involving lungs. Kidney,
heart
 First trimester of pregnancy
 Osteomalacia
 Fractures.

22. SIDE EFFECTS/COMPLICATIONS
 Amnesia for recent events
 Confusional psychosis
 Memory impairment
 Restlessness
 Anxiety
 Confusion
 Drowsiness
 Poor concentration
 Aches: body ache, painful
masticatory movements
 Tongue bite , apnoea
 Cardiac arrest
 Joint dislocation, e.g.
Tempero-mandibular,
shoulder
 Unsteady gait
 Dryness of the mouth
 Palpitations
 Nausea , vomiting.

23. FREQUENCY OF ECT
 No fixed regimen
 Based on client’s conditions frequency of treatment
varies, e.g. in severe excitement cases ECT is given2-3
times/day; followed by alternate days ; weekly twice or
ones a week till the completion of remission of
symptoms and up to improvement.
 In schizophrenia clients;12-15 ECTs may be required
 MDP cases 6-8ECTs may be needed

24. ROLE OF PSYCHIATRIC NURSE IN
ECT PROCEDURE
 Pre ECT care
 The client is instructed to be accompanied by the
relative/friends for ECT procedure
 An informed consent is taken to overcome the fear ,
confusion , and anxieties associated with procedure
 Nurse should explain the risks and complications
related to procedures
 The client is given nothing by mouth (NBM)/Nil per
orally (NPO) for 6-8hrs before treatment.

25. ROLE OF PSYCHIATRIC NURSE IN
ECT PROCEDURE
 To collect the detail history of the client and recorded
it ,e.g. medial psychiatric , allergies
 Through physical examination is absolute necessary
 Complete neurological check up is carried out
 Fundus examinations of the eye
 Chest X-ray is taken
 Blood , urine analysis are done

26. ROLE OF PSYCHIATRIC NURSE IN
ECT PROCEDURE
 Check and record the vital signs
 Withhold night doses of drugs like diazepam,
barbiturates, anticonvulsants which increase the
threshold of seizure
 Withhold morning drugs(oral medications)
 Advise head-shampooing as application of hair oil can
result impedance of passage of electricity to the brain

27. ROLE OF PSYCHIATRIC NURSE IN
ECT PROCEDURE
 Remove the object like jewel, metallic objects ,
prosthesis , dentures contact lens
 Physical restraints may be necessary in acute case to
prevent powerful body jerky movements/ injury/fall
during procedure
 Tongue depressor or mouth gag is placed within the
mouth to prevent tongue bite or lip bite
 Injection atropine 1/100 grams or 0.6mg subcutaneous
or I.M is administered before ECT.

28. Intra Procedure Care
 Place the client in supine position over the hard bed(as
it facilities the control of body movements)
 Stay with client to overcome the anxiety and fear
 Assist in administering (J.M) the anaesthetic agent
injection pentathol sodium 100-200 mg dissolved in
distilled water and injection succinyl scoline 30-
60mg(I.V)

29.  Maintain patent airway
 Muscle relaxants will paralyse all the muscles
including respiratory muscles , hence ventilator
support has to be kept ready
 Bladder and bowel are emptied before ECT

30.  Monitor and record the voltage , intensity
duration of electricity stimuli, seizure pattern
condition of the client and medicines
administered
 Check the vital signs; if required o2 has to be
supplemented

31. Post Procedure Care
 Client must be shifted to post- procedure room after
the procedure
 Check the vital signs every 15 minutes until client’s
conditions stabilizes
 If client become aggressive/ confused administer 8-
10ml of injection paraldehyde or 50-100mg of
choropromazine or diazepam 5-10mmg I.V to control
clients behaviour

32.  If any respiratory difficulty , continue o2
supplementation till spontaneous respiration starts
 Use side –rail cot to prevent fall or injury
 Be with the client; if not possible allowed aid or
attender to be with client until recovery
 After recovery , reorient the client
 Relevant findings are documented.

33. ASSIGNMENT
 Write you role in ECT before & after the therapy.
 Write you role in ECT during the therapy.

34. BIBLIOGRAPHY
 Mary C. Townsend, “ Psychiatric Mental health Nursing,
concepts of care in evidence-based practice” , Ch-21, ,1st
Indian edition , Jaypee Brothers Medical Publishers (P)
Ltd. New Delhi 2012, Pg 344-350.
 Sreevani R. “A Guide To Mental Health & Psychiatric
Nursing”, Ch 5 3rd Edition, , Jaypee Brothers Medical
Publishers (P) Ltd. New Delhi 2010, Pg 129-131.
 Neeraja KP, “Essentials of mental health and psychiatric
Nursing”, vol.1, Ch-7 1st edition 2008, , Jaypee Brothers
Medical Publishers (P) Ltd. New Delhi 2008,Pg 224-227.
 Ahuja Niraja. “ Short Textbook of Psychiatry”,Ch 16 7th
edition,; Jaypee Brothers Medical Publishers (P) Ltd. New
Delhi 2011, Pg 199-203.