Today our topic of discussion is Procedure for Electroconvulsive Therapy.
Procedure for Electroconvulsive Therapy
Procedure (Fig. 32.2)
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 alteration 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 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 an 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).
Contraindications
There are no absolute contraindications to ECT, however relative contraindications are:
- Increased intracranial pressure
- Cerebrovascular 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 components
- Brain damage.
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