ELECTROCONVULS

IVE THERAPY
NUHA AYISHA NV
 INDICATIONS
 PRE TREATMET EVALUATION
 CONTRA INDICATIONS
 TECHNIQUE
 MECH OF ACTION
 DURATION OF THEAPY
 SIDE EFFECTS
 ECT uses electric current to create generalised cerebral seizure in a pt under GA

 1934-camphor oil i.m

 A/w stigma
INDICATIONS
 1)Major severe depression

with suicidal risk (most imp)

with stupor, poor intake of food & fluids, melancholia, psychotic features,
refractory drug therapy
 2)Severe catatonia (non organic)

 3)Severe psychoses

with risk of suicide,homicide,physical assault

with refractory drug therapy, with very prominent depressive features (schizo
affective d/o)
 SUGGESTIVE INDICATIONS( 1990 APA)

 1)Organic mental d/o--- organic mood syndrome,organic hallucinosis,organic delusional d/o

 2)Medical d/o---- NMS, organic catatonia

 Safer profile in elderly, pregnant, breastfeeding and debilitated pts than drug therapy
PRE TREATMENT
EVALUATION
 Written informed consent

 Detailed medical and psychiatric h/o

 General & systemic examination

 Routine lab investigations

 EXAMINATION OF FUNDUS
CONTRA INDICATIONS
 ABSOLUTE--- Raised ICT

Pheochromocytoma

 RELATIVE---

1)Recent MI, Conduction defects

2)Severe HTN
3)CVA
4)Severe pulmonary disease
5)Retinal detachment
6)High risk pregnancy
TECHNIQUE
 Administered by a team of anaesthetist,psychiatrist & nurse

 DIRECT ECT--- OBSOLETE

 MODIFIED ECT---drug induced ms relaxation & GA

 NPO

 BLADDER & BOWEL EMPTYING

 Vitals,EEG,ECG,EMG MONITORS

 GA  Atropine

Anaesthetic agent-propofol/thiopentone/METHOHEXITAL
Ms relaxant-Succinyl choline
Preoxygenation with 100%O2
Hyperventialtion with bag valve mask (to increase sz intensity by hypocarbia)
 Mouth gag
 Pressure over mandible
 Placement of electrodes—

1)BILATERAL ECT- std form

each electrode placed 1-11/2” above midpoint on line joining
tragus and lateral canthus of eye
APA task force-Superior
2)UNILATERAL ECT- on non dominant side
Safer with fewer S/E
 Therapeutic adequacy is measured by occurrence of a GTCS for not less than 25-30 seconds

 1)EEG recording
 2)Occluding circulation of an extremity with BP cuff
 3)plantar exyension and eyelid contractions

ADEQUACY: Most guidelines- Sz activity by EEG -25 s

2004-Bilateral generalised sz is impnnot duration

 Usual dose: 90-150V for 0.1-1.0 s

Current:200-1600 mA
 Brief pulse wave 30-100 pulses/sec

more efficacious & safer

 Stimulus dose

1)Calculation of sz threshold
2)Calculation of rx stimulus-1.5 times

 After sz care
DURATION
 Depends on individual cases

 Usually 6-10 is sufficient.Upto 15 treatments can be given

 Not >3 ECT/wk

 Benefit lasts only till ECT is given—drug therapy before and after ECTs
MOA
 Exact-unclear
 Affect catecholamine pathway btw diancephelon and limbic system
 Down regulation of beta 1 receptors in cortex & hippocampus
SIDE EFFECTS
 A/w GA
 Memory disturbances :mild , recovery within 1-6 m

Unilateral<Bilateral
 Confusion
 Others--- Headache, prolonged Apnea, prolonged Sz, Cardiovascular Dysfn, Emergent Mania,
Ms Aches ,Apprehension