ASSISTING WITH ELECTROCONVSULSIVE THERAPY – Definition, Indications, Contraindication, Articles, Procedure, Types and Risks Associated with ECT (Mental Health Nursing)
Electroconvulsive therapy (ECT) is a treatment in which a grand mal seizure is artificially induced through the application of an electric current to the brain while client is under general anesthesia. The current is applied through electrodes placed bilaterally on the frontal temporal region or unilaterally on the same side as the dominant hand. Most clients require six to ten treatments
History: the first electroconvulsive therapy was performed in 1938 in Rome by Italian psychiatrists Ugo Cerlette and Lucio Bini. Electroconvulsive therapy was widely accepted from around 1940-1955. This period was followed by a 20 year span during which ECT was considered objectionable. A second peak of acceptance began around 1975 and has been increasing to the present
DEFINITION
Electroconvulsive therapy is a physical therapy, in which there is an application of electrical current to the temporal region of the brain to produce a grand mal type of seizure, for bringing about therapeutic effects
INDICATIONS
- Major depression
- Involution melancholia
- Schizophrenia
- Mania
- Postpartum depression
CONTRAINDICATION
- Increased intracranial pressure
- Recent myocardial infarction
- Cerebral hemorrhage
- Glaucoma
- History of cardiovascular diseases
- Pregnancy
ARTICLES
- ECT machine, electrodes
- ECG monitor
- Pulse oximeter
- Suction apparatus
- Oxygen cylinder and ambu bag
- Mouth gag and tongue depressor
- Sterile syringe and needles
- IV stand
- Emergency drugs
- K-basin
- Jelly
MEDICATIONS DURING THE ECT PROCEDURES
- Anesthetic induction agents – methohexital, thiopental, propofol, etomidate, ketamine
- Neuromuscular blocking agents – succinylcholine, rocuronium, atracurium, mivacurium
- Antihypertensives – beta-blockers (atenolol, esmolol, and labetalol) , calcium channel blockers (nifedipine and nicardipine)
- Anticholinergic agents – glycopyrrolate, atropine
- Narcotics – fentanyl, remifentanil, alfentanil
PROCEDURE
Electroconvulsive therapy involves the passage of an electrical stimulus of 70-150 volts to the brain for 0.7-1.5 seconds to produce a grand mal seizure. Seizure induction is necessary to achieve the therapeutic effect, which is thought to be the result of an alternation in the post synaptic response to the neurotransmitters in the central nervous system
The client receives atropine sulfate subcutaneously before the procedure and at the beginning of the treatment an intravenous dose of sodium pentothal. Electrode jelly is applied bilaterally to the temples or unilaterally to the padded electrodes. An airway or soft mouth gag is put in the client’s mouth to prevent tongue bite. Succinyl choline is also administered. The resulting grand mal seizure closely closely resembles a tonic phase (tightening of muscles) for approximately 10 seconds and a clonic phase (rhythmic movements of the muscles) for 30 seconds. The movements are slight and often limited to plantar flexion of the feet, followed by rhythmic twitching of the toes. The seizure is accompanied by a short period of apnea and then stertorous (snoring like) respiration. Because the muscle relaxant paralyses the respiratory muscles as anesthetist is present to administer oxygen to the client and assist respiration by mechanical means, if necessary. Usually, the client sleeps for 5-10 minutes after seizure, slowly awakens and does not remember the treatment
INDICATIONS
- Treatment of intractable depression that is severe depression in which antidepressant medications have been ineffective or not tolerated well
- Treatment of manic episodes of bipolar disorders whereby therapy with lithium or other medications are ineffective or not tolerated well
- Shown to induce remission with clients who present with acute schizophrenia, but is of little value to treat chronic schizophrenia
- Catatonia responds well to ECT with improvement in motor symptoms (posturing, rigidity, catalepsy)
CONTRAINDCATIONS
There are no absolute contraindications to ECT, however relative contraindications are:
- Increased intracranial pressure
- Cerbrovascular accident
- Space occupying intracranial lesions
- Cervical injury or problem
- Head injuries
- Recent myocardial infarction
TYPES
- Modified: treatment approach whereby pretreatment medications are utilized to initiate treatment
- Unmodified: treatment without the aid of medication. A concern with this approach is the high morbidity associated with treatment, thus this method is no longer in use
RISKS ASSOCIATED WITH ECT
- Mortality: death is rare and usually is related to cardiovascular complications
- Cognitive impairment memory loss has both retrograde and anterograde component
- Brain damage
