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Electro Convulsive Therapy

Introduction

ECT is also known as electroshock therapy.

ECT is a physical therapy in which artificial or grand mal seizure is produced in patients by
applyinthe electrode on the temporal region between the hemispheres of the brain.

ECT is the main and most common treatment for severe depression patients.

ECTHistory

ECT was introduced by the cerletti and Bini in 1938.

American psychiatric association provides rights for ECT.

In 1976, consent started before ECT.

Consent for ECT should be collected by patient.

In 2005, WHO also recommended for consent before ECT.

In 2010, Parliament of India passed the act to collect the consent before ECT.

Indication of ECT
Major Severe depression of suicidal ideas.

Schizophrenia types - catatonic schizophrenia

Paranoid schizophrenia

Unresponsive schizophrenia.

Bipolar disorder.

Organic brain syndrome.

Delirium and profound mania.

Medical condition seizures.

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Contraindication of ECT

Pregnancy, fracture patient.

Old age patient.

Myocardial infarction patient.

Retinal detachment.

Brain tumour.

Increased ICP (1st priority option).

Renal and lungs disorder.

Hypertension.

Note - ECT is contraindicated in pregnancy only in 1st trimester.

Amount of current

70 - 130 volt.

If seizures are not produced or patients take lithium therapy, it can be extended up to 150 volt.

Time duration of ECT = 0.6 - 1 second.

Extended up to 1.2 second.

Method and techniques of ECT

Direct method - Direct method apply without sedation or anaesthesia.

Only use the atropine sulphate.

Indirect method - indirect method also known as - modified ECT.

Indirect method is commonest in clinical practice.

Anaesthesia and sedation used during ECT with other associated drugs are -

Atropine sulphate

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Thiopentane sodium

Succinylcholine

O2 inhalation.

Drugs during ECT

Atropine sulphate - Administer 30 minutes from ECT.

Atropine sulphate is used in ECT to prevent bradycardia.

Thiopentone sodium - Thiopentane sodium used to provide the anaesthesia during ECT.

Control the intensity of seizure.

Succinylcholine - Used as a muscle relaxant.

During ECT succinylcholine prevents the risk of fracture.

Learning trick for - sequence of drug administration during ECT

आज तुम सब को हवा में उडा दूँ गा ।

आज = atropine sulphate
तुम = thiopentone sodium
सबको = succinylcholine
हवा = O2 administer.

Types of ECT

Unilateral ECT - In unilateral ECT, electrodes are placed on a single sided.

Eg. - Right side for right handed person and left side for left handed person.

Unilateral ECT is less effective and less confusing and less complicated.

Bilateral ECT -

Bilateral ECT is most commonly used in clinical practice.

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Electrodes are placed on both sides of the temporal region.

Side of bilateral ECT - Bi frontal

Bi temporal region

Bilateral ECT is most effective but more confusions or more complications.

Note - Position, where electrodes are placed in unilateral.

ECT = D-Elias position.

Frequency of ECT -
In depression = Total ECT is 6 - 8 times.
In schizophrenia = Total ECT is 8 - 12 times.
In chronic schizophrenia = Total ECT 20 - 25 times.
Note - 3 times alternative days in a week.
(Only 3 ECT in a week)

Nursing role in preparation ECT

Nurses collect the lab investigations and reports. Eg. - X-ray, ECG and blood reports.

Select the consent by patient.

Physical examination of the patient before the ECT.

Empty bowel and bladder of patient is done.

Inform the family member for the procedure.

Remove all artificial dentures, metallic jewellery and articles lipstick and nail paints.

Loose cloth provided to patients.

Vital sign examination.

Shampoo to the hair, tie to the women's hair.

Nurse administered pre- ECT medication.

Nursing role during ECT

Nurses provide the supine position and apply pillows under lumbar curve to prevent risk of fracture
in 3rd, 4th, and 5th lumbar vertebra.

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Anaesthetic medication is to be administered.

Restrain both legs, to prevent risk of femur fracture.

Provide mouth gag to prevent tongue bite.

Hyperextension of the head with support to the chin to be done.

Vital sign examination and maintain airway.

Observe tonic and clonic phase during ECT.

Observe the intensity of seizures.

Nursing role after ECT

Nurse opened the restrain.

Place the patient in a lateral or side lying position.

Assess the vital sign.

Nurses physically observe the patient for injury or any complications.

Give a sip of water to check the gag reflex.

Ambulation to the patient to observe the injury of fracture.

Complications of ECT

Retrograde amnesia - unable to recall past memory.

Most common complication.

Respiratory distress.

Aspiration.

Mandible / jaw fracture (most common fracture after ECT).

Key points

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Which type of therapy used in the ECT - Physical Therapy.

Electroshock therapy was introduced by - Carletti and Bini 1938.

WHO recommended for consent before ECT - in 2005.

ECT Consent taken from the - Patient.

ECT Consent act was passed by Parliament of India in - 2010.

ECT is the most effective management in which disease condition - Severe depression and suicidal
ideas.

Which type of Schizophrenia where ECT is less effective - Paranoid Schizophrenia.

Which type of Schizophrenia, where ECT is more effective - Catatonic Schizophrenia.

Amount of current during - 70 - 130 volt.

Most common ECT method is used in clinical practice - Indirect Method.

Other name of indirect ECT method - Modified ECT.

Which drug to use to prevent bradycardia in ECT - Atropine Sulphate.

Which drug can cause respiratory problems during ECT - Succinylcholine.

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Most common type of ECT in clinical practice - Bilateral ECT.

Advantage of unilateral ECT - Less complication and Less confusion.

Nurses provide which position during ECT electrode are placed in unilateral ECT - D-Elias
position.

Depression patients require total ECT - 6 - 8 times.

ECT Consent should be collected by - Patient.

Position of patient, during ECT therapy – Supine Position.

What is the important nursing action during ECT - Observe the intensity of seizures.

Control the intensity of seizures during ECT by the - Thiopentane sodium.

Most common complication occurs after ECT therapy - Retrograde amnesia.

Most common fractures occur after the ECT therapy - Mandible / jaw fracture.

What is the complication of ECT attain by nurse according to priority - Respiratory distress.

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