* ECT

Dr Ayedh Talha
* ECT is a form of brain stimulation in which
induction of a seizure occurs when an applied
electrical stimulus creates an electrical field

*. ECT
* 1.constant-current, constant-voltage, and
constant-energy devices
* constant current is on the order of 0.5 to 1 A
* Dose is manipulated by varying the time of
exposure to a fixed current
* 2.brief-pulse devices
* typical device generates a sine wave stimulus
and has a range of 70 to 170 V

* Devices Used to Deliver ECT

* ultrabrief pulse devices
* On average:
* 70-170 v is the voltage used
* .5 – 1 A is the ususal current
* 500-600 mc is the used charge

*
* downregulate β-adrenergic receptors
* leads to increased density of 5-HT2 receptors
* increased dopaminergic functioning,
particularly D1- and D3-receptor function
* mixed GABAergic activity
* upregulation of adenosine receptors
* brain-derived neurotrophic factor and nerve
growth factor are both increased

* Mechanisms of Action
* marked neural plasticity in some brain areas—for example,
hippocampus
* second messenger systems
* genetic expression
* transcription regulation
* large increases in global cerebral blood flow (CBF) and
cerebral metabolic rate (CMR)
* Neuroplasticity:structural for microscopic changes , synaptic
plasticity in hippocampus

*
* Major depression, both unipolar and bipolar
Psychotic depression in particular
* Mania, including mixed episodes
* Schizophrenia with acute exacerbation
      Catatonic subtype particularly
      Schizoaffective disorder
* Parkinson's disease
* Neuroleptic malignant disorder

*Indications
* Rapid definitive response required on medical or psychiatric
grounds
* Risks of alternative treatments outweigh benefits
* Past history of poor response to psychotropics or good
response to ECT
*    Patient preference
* Failure to respond to pharmacotherapy in the current episode

*Clinical indications
* Intolerance of pharmacotherapy in the current episode
*    Rapid definitive response necessitated by deterioration of
the patient's condition

*
* Establish relative indications for ECT
* Assessment of target symptoms
* Baseline cognitive evaluation
* Focused medical history
* Focused surgical/anesthetic history
* Complete physical examination
* Standard initial studies
* Consultation with cardiology service

* Pretreatment Evaluation
* Informed consent
* Discussion of the procedure

*
*
* Typically, ECT is given two to three times
weekly on nonconsecutive days
* Twice-weekly treatment is equally effective
* Daily treatment is used in the most urgent
situations, such as severe mania
* The number of treatment sessions in a course
of ECT should be individualized
* the average is from 6 to 12 sessions

* Treatment Course
* Continuation treatment, is standard practice
for the major syndromes
* Continuation treatment with medications is the
predominant practice
* Continuation ECT tapered to 1/mo. For 2 mo.
After remission(once a week, or every 2 weeks,
for 4 months or more)

* Continuation Treatment
* Early:
* transient loss of short-ter memory
* or retrograde amnesia( usually resolves
completely (64%),
* headache (48%, if recurrent, use simple
analgesics),
* temporary confusion (27%), nausea/vomiting
(9%), clumsiness (5%), muscular aches

* Side-effects
* Late:
* Loss of long-term memory(rare)
* Mortality:
* No greater than for general anesthesia in minor
surgery (1:10,000) and is usually due to cardiac
complications in patients with known cardiac
disease.

*
* There are no absolute contraindications
* Relative:
* recent MI,
* cardiac arrythmias,
* other unstable cardiac conditions,
* severe pulmonary disease,
* recent cerebral infarction (especially hemorrhagic),
* increased intracranial pressure,
* Contraindications
* retinal detachment,
* unstable vascular aneurysm or malformation,
* pheochromocytoma,
* osteoporosis,
* recent fractures, and temporomandibular joint
problems.

*
*Benzodiazepines/barbiturates(raise threshold)
*Best avoided during ECT, or reduced
*Anticonvulsants
*Continue, but higher ECT stimulus needed.
*.Antipsychotics(lower seizure threshold)
*Continue if clinically indicated.
*Increased risk of hypotension and post-ECT
confusion.
*Clozapine should be suspended 24hrs before
ECT.

*Psychiatric drugs and

ECT
*Antidepressants
*TCAs, SSRIs, MAOIs—continue if
clinically indicated. Increased risk of
hypotension and post-ECT confusion
(especially TCAs).
*Moclobemide should be suspended
24hrs before ECT.
*Lithium
*Best avoided as may increase cognitive
side-effects and increase likelihood of
neurotoxic effects of lithium.
THANK YOU