NATIONAL INSTITUTE OF NURSING, SANGRUR

Mental Health Nursing

PRESENTATION
ON
“ELECTROCONVULSIVE THERAPY”

SUBMITTED TO: SUBMITTED BY:

Ms. Manpreet Kaur [Link] Kaur
Associate Professor [Link] (N) 1st Year
Mental Health Nursing Mental Health Nursing
 ELECTROCONVULSIVE THERAPY

IDENTIFICATION DATA

Name of the presentee- Navjot Kaur

Subject- Mental health Nursing

Topic- Electroconvulsive Therapy

Venue-

Language- English, Punjabi

Duration- 35- 45 minutes

Name of Evaluator-

Previous Knowledge: Students are aware about electroconvulsive therapy

Method of Teaching: Lecture-cum-Discussion

Media of Instruction: Blackboard, Flashcard,brochure,pamphletss and power point

presentation

General objectives:

At the end of teaching the group will be get knowledge about electroconvulsive Specific
therapy.
objectives:

At the end of teaching the group will be able to:-

o define electroconvulsive therapy

o discuss the types of ECT
o mechanism of action of ECT
o indications and contraindications of ECT
o role of nurse in ECT

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 TEACHI
SPECIFI NG
SR. A.V.
C TIM LEARNI EVALUATI
NO CONTENT MATTER AID
OBJECT E NG ON
. S
IVES ACTIVTI
ES
1. To 1mnt Myself, Navjot Kaur, I To build Rapport
introduce am pusuing masters in rapport estsblished
self mental health nursing with the
from National College of group.
Nursing,Sangrur.
2. To 1mnt I am here to teach you To
announce about the topic- introduce
the topic Electroconvulsive the topic.
therapy
3. To 3mnt INTRODUCTION Lecture- Blac
introduce  Most of people cum- kboa
the topic (educated and discussion rd
non-educated) PPT
think that life
inside mental
illness hospitals is
horror and scary.
 It is the effect of
media that shows
psychotic patients
in disgusting
appearance and
doing
unbelievable acts
 It also shows the
role of
electroconvulsive
therapy in a scary
scenario ,
-when two or
more huge male
nurses pull the
patient
- then connect him to an
electrical device , while
he is fully awake which
make him scream with a
loud voice
-cry and then lose his
consciousness because of
the severe pain he got.

Electroconvulsive therapy
(ECT), also known as

3
 electroshock, is a well-
established, albeit
controversial
psychiatric treatment in
which seizures are
electrically induced in
anesthetized patients for
therapeutic effect.

4. To discuss 1mnt  ECT first Lecture- Pow Who

the history appearance was by cum- er introduced the
of the scientist, discussion poin use of ECT?
electrocon Meduna in 1935 t
vulsive when he notice pres
therapy that most of entat
schizophrenic ion
symptoms are
temporary
disappear after a
normal
convulsion.
 He induced a
seizure with an
injection of
campor-in-oil in a
patient with
catatonic
schizophrenia,
 Cerletti and Bini
introduced the use
of "electric
shock" to induce
seizures in 1938,
and soon this
method became
the
standard.

5. To define 3mnt DEFINITIONS Lecture- PPt What is the

ECT  Artificial cum- definition of
induction of a discussion ECT?
grandmal seizure
(tonic phase 10-
15sec, clonic
phase: 30-60 sec.)
through the
application of
electrical
current to the
brain, the stimulus

4
 is applied through
electrodes which
are placed either
bilaterally in the
fronto-temporal
region or
unilaterally on the
non-dominant
side.”
 ECT is a
physical/somatic
therapy in which
the help of two
electrodes, current
is passed through
the temporal
region in between
the two
hemispheres of the
brain, to produce a
grand mal type of
seizure.
 It is a treatment in
which a grandmal
seizure is
artificially
induced in an
anaesthetized
patient by passing
on electrical
current through
electrodes applied
to the patients
head.
6. To discuss 1mnt PARAMETERS Lecture flash What are the
the • VOLTAGE- 70- cum card parameters of
parameter 120 Volts discussion s ECT?
sof ECT • Duration - 0.7-1 .5 method
sec

7. To discuss 3mnt MECHANISM OF Lecture- blac Enlist the

the ACTION cum- kboa mechanism of
mechanis • Neuro-transmitter discussion rd action for
m of theory ECT.
action • Neuro-endocrine PPT
theory
• Anti-convulsant
theory
• Brain damage
theory

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 • Psychological
theory
Neurotransmitter
theory.
ECT works like anti-
depressant medication,
changing the way brain
receptors receive
important mood-related
chemicals.
Anti-convulsant theory.
ECT-induced seizures
teach the brain to resist
seizures. This effort to
inhibit seizures dampens
abnormally active
brain circuits,
estabilishing mood.
Neuroendocrine theory.
The seizure causes the
hypothalamus to release
chemicals that cause
changes throughout the
body. The seizure may
release a neuropeptide
that regulates mood.
Brain damage
[Link] damages
the brain, causing
memory loss and
disorientation that creates
an illusion that problems
are gone, and euphoria,
which is a frequently
observed result of brain
injury. Both are
temporary.
Psychological theory.
Depressed people often
feel guilty, and ECT
satisfies their need for
punishment.
Alternatively, the
dramatic nature of ECT
and the nursing care
afterwards makes patients
feel they are being taken
seriously – the placebo
effect.

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8. To discuss 3mnt TYPES OF ECT Lecture- PPT What are the
the types A) According to cum- different
of ECT technique: discussion sources of
▫ Direct ECT recruitment?
Inthis,ECTisgivenintheab
senceof
anesthesiaandmuscularrel
axation.
Thisisnotacommonlyused
method now.
▫ Modified ECT
Electrodesareplacedonthe
sideofa
patient’sheadjustabovethe
temples.
Thepatientisgivenanesthet
icinjections
andamusclerelaxanttostop
muscle
andamusclerelaxanttostop
muscle
contractionsthatcanleadto
broken bones.
Asmallelectriccurrentispa
ssedthrough thebrain.
B) According to
placement of electrodes
▫ Bilateral
Most common, most
effective and most
cognitive dysfunction.
Each electrode placed
2.5–4 cm(1-1.5inches)on
the mid-point on a line
joining the tragus of the
ear and the lateral canthus
of the eye.
▫ Unilateral
Less cognitive effect, may
be clinically less
effective.
Electrodes are placed
only on one side of head
usually non-dominant
side.

9. To discuss 2mnt ELECTRODE Lecture- Blac How are

the PLACEMENT cum- k electrodes
electrode Each electrode is placed discussion boar placed?

7
 placement 2.5 -4 cm(1- 1.5 inches) d
on the midpoint on a line
joining the tragus of the
ear and the lateral canthus
of the eye

10. To discuss 2mnt INDICATIONS Lecture- Leaf Describe the

the • Severe depression cum- lets indications of
indication a. Severe episodes. discussion ECT
s of ECT b. Need for rapid
antidepressant response
(e.g. due to failure to eat
or drink in depressive
stupor; high suicide risk).
c. Failure of drug
treatments.
Patients who are unable to
tolerate side-effects of
drug treatment (e.g.
puerperal depressive
disorder).
e. Previous history of
good response to ECT.
f. Patient preference.
g. Suicidal ideas
h. Mania That hasn’t
improved with
medications
-Severe Catatonia
-Schizophrenia
Psychosis
When medications are
insufficient or symptoms
are severe
All of the above disorders
during pregnancy.

11. To discuss 2mnt CONTRAINDICATION Lecture- PPT Describe the

the S cum- contraindicati
contraindi • Absolute discussion ons for ECT
cations Increased ICP
• Relative
Cardiovascular (Coronary
artery disease, HTN,
aneurysms, arrhythmias)
Cerebrovascular effects
(Recent strokes, space
occupying lesions,
aneurysms)
Severe pulmonary

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 diseases (T.B,
Pneumonia, Asthma)

12. To discuss 2mnt COURSE OF ECT Lecture Chal What is the

the course • ECT is usually cum k course of
of ECT given 3 times a discussion boar ECT?
week, reduced to d
twice a week or
once a week once
symptoms begin
to respond. This
limits cognitive
problems.
• There is no
evidence that a
greater frequency
enhance treatment
response.
• The frequency of
treatment can be
reduced if the
patient shows a
severe confusional
state.
• With an extremely
agitated, psychotic
or suicidal patient
it may be useful to
give the first few
treatments on a
daily basis.
• ECT does not
prevent relapse.
So maintenance
treatment should
be with drug and
psychotherapy.

13. To discuss 1mnt ECT TEAM Lecture- Flas Enlist the ECT
the ECT • Psychiatrist cum- h team.
team • Anesthetist discussion card
• Trained Nurses s
• Nursing aids
• ECT assistant

14. To discuss 2mnt MEDICATIONS USED Lecture PPT What are the
the IN ECT cum medications
medicatio • [Link] discussion used for ECT?
ns used in 0.6mg method
ECT • [Link] 25-40

9
 mg
• Sodium Pendothal
150-250 mg
 A pretreatment
medication such
as atropin sulfate,
glycopyrolate is
administered IM
30 minutes before
treatment, (to
decrease secretion
and counteract the
effect of vagal
stimulation
induced by ECT.
 A short acting
anesthesia (the
patient should be
unconscious when
the ECT is given)
 Muscle relaxant
(to prevent muscle
contraction during
the seizure
reduction of
possibility of
fracture or
dislocated bone
 Pure oxygen
before and after
treatment.

15. To enlist 2mnt ARTICLES NEEDED Lecture PPT Enlist the

the FOR ECT cum articles
articles • Anaesthesia discussion required for
required applicant ECT.
for ECT • Suction apparatus
• Face mask
• O2 cylinder
• Tongue depressant
• Mouth gag
• Resuscitation
apparatus
• Full set of
emergency drug
• Defibrillator
• ECT drug
• Well-equipped
recovery room

10
15. To discuss 3mnt Observation of Lecture- ppt What is the
the production of seizure cum- duration of
Observati  The production of discussion tonic phase?
on of grand mal seizure
production is necessary for
of seizure direct and
modified ECT.
 In direct ECT, the
Tonic phase that is
muscle
contractions last
for 10 seconds
 The clonic phase
that is movement
or convulsion lasts
for 25 to 30
seconds
 Then the patient
goes into the
relaxation phase
 With the use of
anaesthesia in
modified ECT,
mild grimace or
blepharo-spasm,
(a tonic spasm of
the eyelid
muscles) is
observed when the
current is applied.
 There is a slow
planter flexion
(reverse Babinski)
during the tonic
phase and there
are fine
movements of the
toes during the
clonic phase.

16. To discuss 2mnt Side effects Enlist the

the side • Deaths during side-effects of
effects of ECT are due to ECT
ECT general
anaesthesia.
• Headache and
body ache
• Memory
disturbance than

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 bilateral ECTs
• Confusion
• Vomiting due to
increased ICP
• Memory lost from
a day or a month
due to hypoxia of
the brain
• Thoracic spine or
long bones
fracture
• Dislocation of
shoulder joint and
wrist
• Arrhythmia,
aspiration,
pneumonia, status
epilepticus
• Muscle pain,
nausea

17. To explain 5mnt ROLE OF A NURSE Lecture- Ppt Describe the

the role of • Pre-ECT care cum- role of nurse
nurse • Intra-procedure discussion
care
• Post-procedure
care
PRE ECT
• Informed consent
• Fully explain the
risks and benefits
of procedure and
answer questions
from patients or
relatives.
• Information
sheets.
• Reduce patient’s
anxiety and help
establish good
relationship
(nurse-patient,
doctor-patient).
• Administration of
drugs. Check
patient record
• Explain
procedure.
• Keep patient on
NPO 6-8hours

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 before ECT.
• Discourage
smoking just
before ECT.
• Remove artificial
dentures and
articles.
• Vital signs
• Ensure emergency
articles are
accessible.
• Emotional
support.
• Transfer patient to
ECT room with
necessary records.
DURING ECT
• Reassurance &
support.
• Place patient in
supine position.
• Necessary drug
administration.
• Mouth gag.
• Apply upward
pressure to
mandible.
• Oxygen
administration.
• Clean the scalp
with normal
saline.
• Prevent fall,
fracture,
dislocation
• Remove the
mouth gag after
seizure occurred
• Remove the oral
secretions & apply
O2 mask
POST ECT CARE
• Shift client post–
procedure room.
• Check vital signs
every15min.
• Administer drugs
if patient is
aggressive/violate
d/ confused.

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 • If respiratory
difficulty continue
oxygen.
• Provide side rails.
• Be with the
patient.
• Documentation.
• Reorient the client
after recovery.

18. To 1mnt  To define ECT Lecture PPT

summariz  To discuss the cum
e the topic types of ECT discussion
 To discuss the
mechanism of
action
 To discuss the
indications and
contraindications
of ECT
 To discuss the
course of ECT
 To discuss
observation during
ECT
 To discuss the role
of nurse
19. To enlist 1mnt Bibliography
the  Townsend Marry C.
references Psychiatric Mental
Health Nursing.
Fifth edition; FA
Davis company
publishers
 Sreevani R. A guide
to Mental health and
psychiatric Nursing,
second edition,
published by jaypee
publishers
 BimlaKapoor, a
textbook of
psychiatric, third
edition; jaypee
publishers
 [Link]
 https://
[Link]/
wiki/
electroconvulsiveth
erapy

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20. To 1mnt  Define ECT Questions
recaptuliz  Enlist the types of asked from the
e the topic ECT group.
 Enlist the
mechanism of
action for ECT
 What are the
Indications of
ECT?
 What are the Side-
effects of ECT?
 What is the
duration of ECT?

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