kat'zC.
Bengan,RN
OUTLINE
History and use
The mechanism of ECT
Side effects and risks
Pro's and Cons
Nursing Care (Pre-, Intra-, Post-ECT)
DEFINITION
Administration of electric
current to the brain
through electrodes placed
on the head in order to
induce seizure activity in
the brain, used in the
treatment of certain mental
disorders, especially
severe depression.
Also called electroshock,
electroshock therapy.
American Heritage Dictionary (online)
OVERVIEW
Extremely safe and effective medical
treatment (6-12 sessions)
a small amount of electricity (70-120
volts) is applied to the temporal,
producing a seizure in the brain.
The procedure is painless
Has an extremely high success rate for
the treatment of major depressive
disorder, catatonia, mania and
various psychotic symptoms.
HISTORY
HIPPOCRATES
- saw that insane patients
showed
reduced symptoms after
suffering
from convulsions
brought on by
malaria.
There is an account in 47
AD, of a physician using an
electric eel to cure
headaches of the Roman
Emperor Claudius.
In the 1500s
A Jesuit missionary wrote of Ethiopians
using electricity to expel devils.
Paracelsus, a Swiss physician, used
camphor to produce seizures to cure
insanity.
kat'[Link],RN
In the 1700s
Individuals treated with hellebore went into
convulsions and coma and were cured of
mania and raving madness.
In 1792 John Birch used electric shocks to
the head to cure patients.
Hellebo
re
flower
In the 1800s there were
reports of insanity being
cured with electric
shock.
In 1927 insulin coma therapy was
invented by Manfred Sakel. It involved
giving insulin in order to lower levels of
glucose, producing coma and
convulsions.
Mathematician John Nash (A Beautiful
Mind) was given this treatment in the
1960s.
Manfred
Sakel
In 1932 Ladislaus Von
Meduna used camphor
to treat schizophrenia.
He later used metrazol
since it was faster.
In 1937 two neurologists studying epilepsy, Ugo
Cerletti and Lucio Bini, decided to use electric
shock to induce seizure without the side effects
of metrazol.
The idea to apply shock therapy to humans came
to Cerletti when he saw pigs being shocked into
a coma before being slaughtered.
kat'[Link],RN
First ECT device was developed
by Italian medical scientists in
1938.
In 1938 the first
Electroconvulsive
Therapy
treatment was
tested on a
schizophrenic in
Rome. He had
a full recovery.
In 1940 the first
Electroconvulsive
Therapy
treatment was
given in the
United States.
Modern ECT methods monitor
various physiological measures
heart rate (ECG), neural activity
(EEG), muscular activity (EMG),
blood pressure and blood-oxygen
tensionto assess the patients
status during treatment.
In conjunction with other
therapeutic advances
anesthesia, muscle relaxants,
physiologically efficient electrical
currents and continuous
oxygenationthe negative effects
of ECT have been markedly
reduced.
kat'[Link],RN
Neurotransmitter
Theory
Brain damage
Theory
kat'[Link],RN
Neurotransmitter Theory
This explanation is
based on evidence
that the electricity
sensitizes serotonin
receptors
Supporters also state
that ECT desensitizes
receptors that help
reabsorb dopamine
and norepinephrine,
causing them to stay
in the synapse
kat'[Link],RN
Brain Damage Theory
Memory loss and
disorientation lead to the
illusion of problems being
gone
The bioethics of ECT
- is this a safe,
effective procedure
or should it be
banned?
What is the sense of ruining
my head and erasing my
memory...and putting me
out of business? It was a
brilliant cure...but we lost
the patient.
"ECT has a higher success rate for severe
depression than any other form of treatment.
-Dr. Dimitris Popolos
Since the 1960s, the methods of ECT have changed
somewhat and it seems to be safer. It is known to
produce some memory loss, but seems to be the most
effective treatment for people with severe depression.
It is estimated that in the united states, 100,000 people per
year undergo ECT treatments and that there are about 1,300
treatments per week.
NURSING MANAGEMENT
PRE-PROCEDURE
Oxygen
Mouth guard
Consent
NPO
Void first
Vital signs
Pre-Meds
succinylcholine
(Anectine)
methohexital Na
(Brevital)
atrophine sulfate
Proper positioning of
patient
NURSING MANAGEMENT
NURSING MANAGEMENT
POST-PROCEDURE
Reorient the client to TIME,
PLACE, and PERSON
Vital signs
Stay with the client during
period of confusion
Tapos na po!
Oye! Oye!