Subject : Mental Health Nursing
Topic : ELECTRO CONVULSIVE
THERAPY
Presented by:
Ms. Nagarathna
1st MSc Nursinng
Dept. of Psychiatric Nursing
SDUCON
Tamaka, KSolar.
Objective
• Define Electroconvulsive therapy.
• Appeciate the importance of empathy and emotional support to the
patient and family.
• Prepare the patint for pre-anasthetic check up
INTRODUCTION
• INTRODUCTION
• Electroconvulsive therapy (ECT), also known as electroshock or electroplexy
therapy.
• Electroconvulsive therapy (ECT) was first described in 1938 as a treatment for
schizophrenia, when it was believed that people with epilepsy were rarely
schizophrenic, and it was thought that convulsions could cure schizophrenia.
Electroconvulsive therapy is a type of
somatic treatment, first introduced by BINI
& CERLETTI in April 1938.
ECT has been used continuously for more
than 50 years, longer than any other
DEFINITION
• Electroconvulsive therapy is the artificial induction of grandmal seizure through the
brain. The stimulus is applied through electrodes that are placed either bilaterally in the
front temporal region, or unilaterally on the non-dominant side.
OR
• an Electroconvulsive therapy is a treatment in which grandmal seizure is artificially
induced in anesthetized patient by passing an electrical current through electrodes applied
to patient's head.
PARAMETERS
Standard Dose According to
American Psychiatric
Association, 1978
(The usual amount of
current passed in ECT is 0.8-
0.9 Ampere
Duration: 08 sec.
Types of Seizure
Grandmal seizure- Clonic phase
Tonic phase lasting lasting for 30-60
for 10-15 seconds seconds
FREQUENCY & TOTAL NUMBER OF
ECT
• FREQUENCY: 3 times per week or as indicated
• TOTAL NUMBER: 6 to 12 sesdsions for
depression anad patient with scizophrenia require
more treatment.
INDICATION poor intake of food & fluids,
melancholia with psychotic
features, unsatisfactory
MAJOR D2. SEVERE response to drugs o where
CATATONIA drugs are contraindicated or
(Functional):EPRESSION have serious sid effects.
With stupor; poor intake of
food & fluids, unsatisfactory
2. SEVERE CATATONIA
response to drugs or where
(Functional)
drugs are contraindicated or
have serious side effects.
With risk of suicide, homicide
or danger of physical assault;
SEVERE depressive features;
PSYCHOSIS(Schizophrenia or unsatisfactory response to
mania): drug therapy, or when drugs
are contraindicated or have
serious side effects.
Organic mood disorders
4. ORGANIC MENTAL
DISORDERS:
Organic psychosis
APPLICATION
UNILATERAL
Both electrodes BILATERAL
are placed on the Fronto temporal
non-dominant sites on each side
side( right side)
BIFRONTAL
Placed 5 cm vertically
above the out canthus
of each eye along an
imaginary vertical line
perpendicular to line.
Contraindication
a) Intracranial Pessure
b) Relative
• Crebral aneurysm
• Cerebral hemoprrahage
• Brain tumor
• Acute myocardial infarction
• Congestive heart failure
• Pneumonia
• Retinal detatchment
• High risk pregnacies
SIDE EFFECTS OF ECT
Memory impairment
Headache,
weakness/fatigue,
backache, muscleaches
Drowsiness, confusion &
restlessness
Dryness of mouth,
palpitations, nausea,
vomiting
Tongue bite &
incontinence
Poor concentration, anxiety
Unsteady gait
ECT TEAM
• Psychiatrist
• Anasthesiologist
• Trained nurses
• and aids
NURSES RESPONSIBILITY
• Electroconvulsive therapy is treated like a minor surgical procedure
that requires pre treatment, intra treatment and post-treatment
nursing care.
• Pre-treatment Evaluation
• Detailed medical and psychiatric history including history of allergies.
• Assessment of patients' and family's knowledge of indications, side-
effects, therapeutic effects and risks associated with ECT.
• Informed consent should be taken.
Mitigate any unfounded fears and anxieties regarding the procedure.
• Assess baseline vital signs.
• Patient should avoid food intake for at least 6 hours before treatment.
• Withhold night doses of drugs such as diazepam, barbiturates and
anticonvulsants which increase seizure threshold.
• Withhold oral medications in the morning
• Head shampooing in the morning since oil causes impedance of
passage of electricity to the brain.
• Any jewelry, prosthesis, dentures, contact lens, metallic objects and
tight clothing, hair clips, contact lenses and hearing aids should be
removed from the patient's body.
• Hair should be dry and Zlean (damp hair and presence of cream may
lead to short circuiting of the current over scalp).
• Empty bladder and bowel just before ECT.
• Administration of 0.6 mg atropine IM or SC 30 minutes before ECT or
IV just before ECT.
• Intranatal Procedure
• Place the patient comfortably on the ECT table in supine position.
• Stay with the patient to allay anxiety and fear.
• Assist in administering the anesthetic agent (thiopental sodium 3-5 mg/kg body weight)
and muscle relaxant (0.5-1 mg/kg body weight of succinylcholine).
• Since the muscle relaxant paralyzes all muscles including respiratory muscles, patent
airway should be ensured and ventilatory support started.
• Mouth gag should be inserted to prevent possible tongue bite.
• The place(s) of electrode placement should be cleaned with normal saline
or 25% bicarbonate solution, or a conducting gel applied.
• Monitor voltage, intensity and duration of electrical stimulus given.
• Monitor seizure activity using cuff method. 100% oxygen should be
provided.
• During seizure monitor vital signs, ECG, oxygen saturation, EEG, etc.
• Record the findings and medicines given in the patient's chart.
• Post Procedure Care
• Monitor vital signs.
• Continue oxygenation till spontaneous respiration starts.
• Assess for postictal confusion and restless-ness.
• Take safety precautions to prevent injury (side-lying
position and suctioning to prevent aspiration of secretions,
use of side rails to prevent falls).
• If there is severe postictal confusion and restlessness, IV diazepam )
may be adminis-tered.
• Close monitoring of cognitive deficits.
• Documentary findings as relevant in the patient's record.
• (See Appendix 15 for ECT History Collection Format