Electroconvulsive Therapy is still being used. It is a procedure usually done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure.

1. ELECTROCONVULSIVE
THERAPY
PRESENTED BY:
MS. MONIKA KANWAR
NURSING TUTOR
M.Sc. (N) [MENTAL HEALTH NURSING]

2. INTRODUCTION
• Electroconvulsive therapy (ECT), also known as
electroshock or electroplexy therapy.
• Electroconvulsive therapy (ECT) was first described in
1938 as a treatment for schizophrenia, when it was
believed that people with epilepsy were rarely
schizophrenic, and it was thought that convulsions
could cure schizophrenia.

3. • Other somatic therapies had been tried before that
time, in a particular insulin coma therapy and
pharmacoconvulsive therapy.
• Von Meduna, in 1934, used 25% camphor oil
intramuscularly to produce convulsions for the first
time for therapeutic purposes. Later, he used
pentylenetetrazol (Metrazol) for the same purpose.
• ECT is actually more effective for mood disorders
than for schizophrenia (PAYNE & PRUDIC, 2009)

4. • Electroconvulsive therapy is a type of somatic
treatment, first introduced by BINI & CERLETTI in
April 1938.
• ECT has been used continuously for more than 50
years, longer than any other physical treatment
available for mental illness.

5. DEFINITION
Electroconvulsive therapy is the artificial induction of
grandmal seizure through the brain. The stimulus is
applied through electrodes that are placed either
bilaterally in the front temporal region, or unilaterally
on the non-dominant side.
OR
Electroconvulsive therapy is a treatment in which
grandmal seizure is artificially induced in an
anesthetized patient by passing an electrical current
through electrodes applied to patient’s head.
According to Mankad et al.

6. ARTICLES NEEDED FOR ECT
• Articles for anesthesia
• Suction apparatus
• Face mask
• Oxygen cylinder
• Tongue depressor
• Mouth gag
• Resuscitation apparatus
• Full set of emergency drugs, ECT drugs
• Defibrillator

7. PARAMETERS
Standard Dose According to American Psychiatric
Association, 1978
• VOLTAGE: 70-120 volts
(The usual amount of current passed in ECT is 200-
1600 Mah)
• DURATION: 0.7-1.5 sec.

8. TYPES OF SEIZURE PRODUCED:
• Grandmal seizure- Tonic phase lasting for 10-15
seconds
• Clonic phase lasting for 30-60 seconds
FREQUENCY & TOTAL NUMBER OF ECT:
• FREQUENCY: 3 times per week or as indicated
• TOTAL NUMBER: 6 to 10; up to 25 may be preferred
as indicated.

9. INDICATIONS
Primary indication for ECT is major depression
(WEINER & FALCONE, 2011)
1. 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.
2. SEVERE CATATONIA (Functional): With stupor;
poor intake of food & fluids, unsatisfactory response
to drugs or where drugs are contraindicated or have
serious side effects.

10. Cont…..
3. SEVERE PSYCHOSIS (Schizophrenia or mania):
With risk of suicide, homicide or danger of physical
assault; depressive features; unsatisfactory response
to drug therapy, or when drugs are contraindicated
or have serious side effects.
4. ORGANIC MENTAL DISORDERS:
• Organic mood disorders
• Organic psychosis

11. Cont…..
5. OTHER INDICATIONS:
ECT is preferred to antidepressant therapy in some
cases, such as for patients with cardiac disease;
when tricyclics are contraindicated because of the
potential for dysarrythmias & congestive heart
failure, & for pregnant women, in whom
antidepressants place the fetus at risk for
congestive defects.

12. TYPES OF ECT
1. DIRECT ECT:
In this, ECT is given in the
absence of anesthesia &
muscular relaxation. This
is not commonly used
method now.
2. MODIFIED ECT:
Here ECT is modified by drug
induced muscular relaxation
& general anesthesia

13. APPLICATION OF ELECTRODES
BITEMPORAL ECT/POSITION :
Each electrode is placed 2.5-4
cm above the midpoint, on a
line joining the tragus of the ear
& the lateral canthus of the eye.
UNILATERAL ECT/POSITION :
Electrodes are placed only on
one side of head, usually non-
dominant side
Unilateral ECT is safer, with
much fewer side-effects,
particularly those of memory
impairment.

14. Cont…..
BIFRONTALECT/POSITION:
In bifrontal position the
placement of an electrode on
each side of the head is more
frontal (5 cm from the
external canthus of eye) than
in standard bifrontal
placement.

15. Cont…..
• Alternative electrode placement are now routinely
used, including bifrontal and unilateral. Studies of
new form unilateral ECT, called Focal electrically
administered seizure therapy (FEAST) appears to
minimize cognitive effects of ECT even further
(PIERECE et al, 2008)

16. MECHANISM OF ACTION
• The exact mechanism of action is not known.
• One hypothesis states that ECT possibly affects the
catecholamine pathways between diencephalon (from
where seizure generalization occurs) & limbic system
(which may be responsible for mood disorders) also
involving the hypothalamus.

17. CONTD….
• According to Biochemical Theory, ECT increases
level of some neurotransmitter (Serotonin, nor-
epinephrine, dopamine) in some area of mind.

18. CONTRAINDICATIONS
• ABSOLUTE:
- Raised ICP
• RELATIVE:
⁻ Cerebral aneurysm
⁻ Cerebral hemorrhage
⁻ Brain tumor
⁻ Acute myocardial infarction
⁻ Congestive heart failure
⁻ Pneumonia
⁻ Retinal detachment

19. COMPLICATIONS
• Life-threatening complications of ECT are rare. ECT
does not cause any brain damage.
• Fractures can sometimes occur in elderly patients
with osteoporosis.
• In patients with a history of heart disease,
dysrhythmias and respiratory arrest may occur.

20. SIDE EFFECTS OF ECT
• Memory impairment
• Drowsiness, confusion & restlessness
• Poor concentration, anxiety
• Headache, weakness/fatigue, backache, muscleaches
• Dryness of mouth, palpitations, nausea, vomiting
• Unsteady gait
• Tongue bite & incontinence

21. ECT TEAM
• Psychiatrist
• Anesthesiologist
• Trained nurses
• Nursing aids
• ECT assistant

22. TREATMENT FACILITIES
There should be a suite of three rooms:
• A pleasant, comfortable waiting room (Pre ECT
room)
• ECT room, which should be equipped with ECT
machine & accessories, an anesthetic appliance,
suction apparatus, face masks, oxygen cylinders with
adjustable flow valves, curved tongue depressors,
mouth gags, resuscitation apparatus & emergency
drugs. There should be immediate access to
defibrillator.
• A well-equipped recovery room.

23. PREPARATION FOR
ELECTROCONVULSIVE THERAPY
1. WAITING ROOM OR SETTING ROOM:
In this room, patient is asked to wait or take rest before
Electroconvulsive therapy. Room should be calm
with dim lights, light colour of the walls.
• Put some flower to give pleasant feelings to the
patient.
• There should be some magazines to read, so that the
patient can divert his mind and reduce anxiety.

24. Cont….
• Lavotry (Toilet) should be attached because the
patient needs to empty his bladder & bowel before
getting Electroconvulsive Therapy.
• The nurse should always be available in the room so
that patient & Relative can clarify their doubts, pre-
anesthetic drugs should be kept ready

25. Cont….
2. TREATMENT ROOM/ ECT ROOM: In this
treatment room the nurse needs to do the following
preparation of articles for the comfort of patient.
• The room should be near to the waiting room, for
privacy a bedside screen should be present.

26. Cont….
ARTICLES FOR PREPARATION OF PATIENT:
• Small pillows to put under the patient waist to
prevent injury.
• Mouth gag to prevent injury to the tongue during
convulsions and to keep the airway patent.
• Tongue spatula, endotracheal tube & sterile catheter
for suction
• Oxygen cylinder & ambu bag to give oxygen
immediately after the therapy to give artificial
respiration if require.

27. Cont….
ARTICLES FOR THE PROCEDURE:
• A trolly with an E.C.T. machine in working order, Check
all the electric plug point.
• Jelly or Normal Saline for putting an electrode, as
Normal Saline is a good conductor of electricity and
facilitates in passing current.
• Emergency drugs & resuscitation tray, mouth wipes, B.P.
apparatus, sterile syringe, spirit swabs and adequate light.
• Doctor should be present in the E.C.T room.

28. Cont….
3. RECOVERY ROOM/ AFTER CARE ROOM:
• When the patient respond to a painful stimuli,
he/she is transferred to the recovery room.
• Observation of vital signs such as Temperature,
Pulse, Respiration and Blood pressure.
• Toilet facilities should be available in the recovery
room.

29. Cont….
• E.C.T. Equipment should always be available in the
psychiatric ward or unit to meet emergency situations.
• Once the patient becomes oriented he/she can be
transferred to his/her ward.
• Electroconvulsive involves significant responsibility
of the nursing personnel.
−The patient care before giving E.C.T.
−The patient care during E.C.T
−The patient care after giving E.C.T.

30. NURSING
RESPONSIBILITIES
Before E.C.T.:
• Detailed medical and psychiatric history including any
allergic history
• Assessment of knowledge of patient and family
• Take written consent for ECT
- Informed Consent: Consent given by a well-advised and
mentally competent patient to be treated by the care
provider or randomized into a research study.
- Substituted Consent: Consent given by legal guardian, if
patient is not capable of giving their own consent.
• Explain risks & benefits
• Answer all the questions
• Reduce patient anxiety & help in establishing good
relationship

31. Cont…..
• Assess vital signs
• Patient should be on empty stomach for 4-6 hours prior to
E.C.T.
• Withhold night doses of drugs which increase seizure
threshold.
• Withhold oral medications in morning.
• Do head shampooing in the morning (As oil is a bad
conductor of electricity)
• Remove, jewellery, prosthesis, dentures, contact lens,
metallic objects & tight clothing's.
• Empty bowel & bladder just before ECT.
• Administer 0.6 mg of Atropine I.M. or SC 30 minutes before
ECT, or I.V. just before ECT (To decrease pharyngeal
secretions and counteract the effect of bradycardia.)

32. Cont…..
During E.C.T.:
• Place the patient on ECT table in supine position.
• Stay with the patient to allay anxiety & fear.
• Assist in administering anesthetic agent (thiopental
sodium 3-5 mg/kg body weight/0.25-0.50 gm) for short
term anesthetic effect immediately before ECT.
• Assist in administering muscle relaxant
(Succynylcholine1mg/kg body weight/ 30-50 mgs) to
prevent fracture and dislocation
• Since the muscle relaxant paralyzes all muscles, patient
airway should be ensured & ventilatory support should be
started.
• Mouth gag should be inserted to prevent possible tongue
bite.

33. Cont…..
• Electrode should be cleaned with
normal saline or 25% bicarbonate
solution, or conducting gel applied.
• Monitor voltage, intensity &
duration of electrical stimulus
given.
• Monitor seizure activity using cuff
method.
• 100% oxygen should be provided
• During seizure monitor vital signs,
ECG, Oxygen saturation, EEG, etc.
• Record the findings & medicines
given in the patient’s chart.

34. Cont…..
After E.C.T.:
• Place the patient in side lying position on railing cot to
avoid aspiration of secretion.
• Monitor vital signs
• Continue oxygenation till spontaneous respiration starts
• Assess for post- ictal confusion and restlessness
• Take safety precautions to prevent injury.
• Administer I.V. diazepam in case of severe post-ictal
confusion & restlessness.
• Reorient the patient & stay with him/her until fully
oriented.
• Document any findings as relevant in patient’s record.

35. SUMMARIZATION
• Introduction
• Definition
• Articles
• Parameters
• Types of seizure produced
• Frequency & total number of ECT
• Indications
• Types of ECT
• Application of Electrodes
• Mechanism of action
• Contraindications
• Side effects of ECT
• ECT team
• Treatment facility
• Preparation for electroconvulsive therapy
• Nursing Responsibilities