Ect- an Introduction to Nursing Students

ECT An Introduction to Nursing Students

    □ ECT remains an important, effective & safe treatment for a variety of Neuropsychiatry disorders.
    ❖ 1500 – Paracelsus induced seizures by camphor (By mouth to treat psychiatric illness)
    ❖ 1934 – Meduna used injections of camphor to induce seizure in treating catatonic symptoms.
    ❖ 1938 – Cerletti and Bini used electrical shock to induce seizure for the treatment of psychosis.
Direct ECT:

Electrical shock given to a conscious patient.

Modified ECT:

ECT with Anesthesia and muscle relaxant.

Mechanism of Action :

Specific mechanism is unknown.
  1. Neurophysiology: Metabolism of glucose & oxygen and permeability of BBB increases.
  2. Neurochemical: Changes in neurotransmitters like Nor epinephrine, serotonin, Dopamine, GABA, opioids etc.
  3. Neuroplasticity: In animals synaptic plasticity is observed.
Frequency of ECT’s :
    ✓ Generally – 3 times a week on nonconsecutive days.
    ✓ Daily: Used in most urgent situations like SUICIDE, Severe mania.
    ✓ Once a week: For continuation ECT
Number of Sessions
    ✓ Should be individualized as requirement
    ✓ Average 6 – 12 sessions

Indications :
    o Major:- SUICIDE patient
    o   Major Depressive disorder.
    o Mania – severe & Rapid cyclers
    o schizophrenia.
    o Others:- OCD – catatonia – Delirium Narcoleptic malignant syndrome
        ▪ Intractable seizures.

    o Contraindication: Raised intracranial pressure.

Pretreatment evaluation:
Psychiatric Assessment:
    • Establish the indication for ECT
    • Explore post treatment with ECT
    • Behavioral Assessment
    • Cognitive evaluation for orientation, memory.

Consent :
    ❖ Written informed consent must be obtained.

    ❖ Discuss the benefits & risks.

    ❖ Consent may be withdrawn during the course of ECT.

    ❖ If patient cannot give consent, then family members consent can be taken.

ECT Procedure :
Pre – ECT...