Electro Convulsive Therapy(ECT)

Electro Convulsive Therapy(ECT)

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what is ECT

  • ECT is also known as electroshock therapy.
  • ECT is a physical therapy in which artificial or grand mal seizure is produced in patients by applying the electrode on the temporal region between the hemispheres of the brain.
  • ECT is the main and most common treatment for severe depression patients.

 

History of ECT

  • ECT was introduced by the cerletti and Bini in 1938.
  • American psychiatric association provides rights for ECT.
  • In 1976, consent started before ECT.
  • Consent for ECT should be collected by the patient.
  • In 2005, WHO also recommended consent before ECT.
  • In 2010, the Parliament of India passed the act to collect consent before ECT.

Indication of ECT   

  • Major Severe depression of suicidal ideas.
  • Schizophrenia types – catatonic schizophrenia
  • Paranoid schizophrenia
  • Unresponsive schizophrenia.
  • Bipolar disorder.
  • Organic brain syndrome.
  • Delirium and profound mania.
  • Medical condition seizures.

Contraindication of ECT

  • Pregnancy, fracture patient.
  • Old age patient.
  • Myocardial infarction patient.
  • Retinal detachment.
  • Brain tumor.
  • Increased ICP (1st priority option).
  • Renal and lungs disorder.
  • Hypertension.
  • Note – ECT is contraindicated in pregnancy only in 1st trimester.

 

Amount of current in ECT

  • 70 – 130 volt.
  • If seizures are not produced or patients take lithium therapy, it can be extended up to 150 volt.
  • Time duration of ECT = 0.6 – 1 second.
  • Extended up to 1.2 seconds.

 

Method and techniques of ECT

  1. Direct method – 

  • The direct method applies without sedation or anesthesia.
  • Only use the atropine sulfate.

 

  1. Indirect method – 
  • the indirect method also known as – modified ECT.
  • The indirect method is the commonest in clinical practice.
  • Anesthesia and sedation used during ECT with other associated drugs are –
  • Atropine sulfate
  • Thiopentane sodium
  • Succinylcholine
  • O2 inhalation.

 

Drugs during ECT

  1. Atropine sulfate – Administer 30 minutes from ECT.
  • Atropine sulfate is used in ECT to prevent bradycardia.
  1. Thiopentone sodium – Thiopentane sodium used to provide the anaesthesia during ECT.
  • Control the intensity of seizure.
  1. Succinylcholine – Used as a muscle relaxant.
  • During ECT succinylcholine prevents the risk of fracture.

Learning trick for – sequence of drug administration during ECT

आज तुम सब को हवा में उड़ा दूँगा ।

आज     = atropine sulfate

तुम       =  thiopentone sodium

सबको   = succinylcholine

हवा      =  O2 administer.

 

Types of ECT

  1. Unilateral ECT

  • In unilateral ECT, electrodes are placed on a single side.

Eg. – Right side is for a right-handed person and the left side for a left-handed person.

  • Unilateral ECT is less effective and less confusing and less complicated.

 

  1. Bilateral ECT – 

  • Bilateral ECT is most commonly used in clinical practice.
  • Electrodes are placed on both sides of the temporal region.
  • Side of bilateral ECT – Bi frontal
  •  Bi temporal region
  • Bilateral ECT is most effective but more confusing or more complicated.

 

Note – Position, where electrodes are placed unilateral.

ECT = D-Elias position.

Frequency of ECT

In depression = Total ECT is 6 – 8 times.

In schizophrenia = Total ECT is 8 – 12 times.

In chronic schizophrenia = Total ECT 20 – 25 times.

 

Note – 3 times alternative days in a week.

(Only 3 ECT in a week)

 

Nursing role in preparation ECT

  • Nurses collect lab investigations and reports. Eg. – X-ray, ECG, and blood reports.
  • Select the consent of the patient.
  • Physical examination of the patient before the ECT.
  • The empty bowel and bladder of the patient are done.
  • Inform the family member of the procedure.
  • Remove all artificial dentures, metallic jewelry, and articles of lipstick and nail paints.
  • Loose cloth provided to patients.
  • Vital sign examination.
  • Shampoo to the hair, tie to the women’s hair.
  • A nurse administered pre- ECT medication.

 

Nursing role during ECT

  • Nurses provide the supine position and apply pillows under the lumbar curve to prevent the risk of fracture in the 3rd, 4th, and 5th lumbar vertebra.
  • Anaesthetic medication is to be administered.
  • Restrain both legs, to prevent the risk of femur fracture.
  • Provide mouth gag to prevent tongue bites.
  • Hyperextension of the head with support to the chin is to be done.
  • Vital sign examination and maintaining an airway.
  • Observe tonic and clonic phases during ECT.
  • Observe the intensity of seizures.

 

Nursing role after ECT

  • A nurse opened the restrain.
  • Place the patient in a lateral or side-lying position.
  • Assess the vital sign.
  • Nurses physically observe the patient for injury or any complications.
  • Give a sip of water to check the gag reflex.
  • Ambulation to the patient to observe the injury of fracture.

 

Complications of ECT

  • Retrograde amnesia – unable to recall past memory.
  • Most common complication.
  • Respiratory distress.
  • Aspiration.
  • Mandible/jaw fracture (most common fracture after ECT).

Read also.

Psychotherapy Definition

Key points

  • Which type of therapy is used in the ECT – Physical Therapy?
  •  Electroshock therapy was introduced by – Carletti and Bini in 1938.
  • WHO recommended consent before ECT – in 2005.
  • ECT Consent was taken from the – Patient.
  • ECT Consent act was passed by the Parliament of India in – 2010.
  • ECT is the most effective management in which disease conditions – Severe depression and suicidal ideas.
  • Which type of Schizophrenia where ECT is less effective – Paranoid Schizophrenia.
  • Which type of Schizophrenia, where ECT is more effective – Catatonic Schizophrenia.
  • what is ect power?- 70 – 130 volt.
  • The most common ECT method used in clinical practice? – indirect Method.
  • Another name for indirect ECT methods? – Modified ECT.
  • Which drug to use to prevent bradycardia in ECT? – Atropine Sulphate.
  • Which drug can cause respiratory problems during ECT? – Succinylcholine.
  • The most common type of ECT in clinical practice? – Bilateral ECT.
  • Advantages of unilateral ECT? – Less complication and Less confusion.
  • Do nurses provide which position during ECT electrodes are placed in unilateral ECT? – D-Elias position.
  • Depression patients require a total ECT ?- of 6 – 8 times.
  • ECT Consent should be collected by? – Patient.
  • Position of a patient, during ECT therapy? – Supine Position.
  • What is the important nursing action during ECT? – Observe the intensity of seizures.
  • Control the intensity of seizures during ECT by the – Thiopentane sodium.
  • The most common complication occurs after ECT therapy. – Retrograde amnesia.
  • Most common fractures occur after the ECT therapy. – Mandible/jaw fracture.
  • What is the complication of ECT attained by nurses according to priority? – Respiratory distress.
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