electro convulsive therapy is imparting or introducing the electrical seizures in to the brain. the seizures will be introducing bilaterally that is frontal temporal region and dominant side of the brain. ect is the only therapy which was practiced in the ancient times .after that medicines have come. now it has wide variety of tequniques which is very common and came in to practice . this ect will be done under anesthesia and with out anesthesia. unilateral and bilateral ECT IS PRESENT .most commonly unilateral ect being practiced. The sitting of the ect may be up to 25 .every 3 sittings will be present once in a month . NURSES responsibility is to educate the patient regarding treatment and indications and it's side effects .family also have to include while this education process. ect means introducing the artificial grand mal seizures in to the brain. ancient times even before ect psychiatric patients treated by the electrical eels. That passes a 1000 volts . there are pre ect procedure intra ect procedure post ect procedure. Nurses must take part in these all 3 roles.

1. ELECTRO
CONVULSIVE
THERAPY
Topic :Electro convulsive therapy
Unit :X
Venue :3rd year classroom
Presented By:Ms.Anusha
Subject :Mental health nursing

2. INTRODUCTION
 Electro convulsive therapy [CT] is a type of somatic treatment ,first
introducdd by bini amd cerletti in April 1938.from 1980 onwards ECT
is being considered as a unique psychiatric treatment.
 Electro covulsive therapy is the artificial induction of a grandmal
seizures through the application of electrical seizure through the
application of electrical cirrent to the brain.
 The stimulus is applied through electrodes that are placed either
bilaterally in the fronto-temporal region ,or unilaterally on the non-
dominanat side (right side of head in a right handed individual)

3. DEFINITION

4. DEFINITION

5. HISTORICAL PERSPECTIVES

7. PARAMETERS OF ELECTRICAL
CURRENT APPLIED
Standard dose according to american
psychiatric association,1978
Voltage -70- 120 volts
Duration -0.7 -1.5 seconds

8. TYPES OF SEIZURE PRODUCED
 GRANDMAL SEIZURE-
 Tonic phase lasting for 10-15
seconds
 CLONIC :
 This phase lasting for 30-60
seconds

10. MECHANISM OF ACTION
 The exact mechanism of action is not known.one
hypothesis states that ECT possibly affects the
catacholamine pathways between diencephalon
(from where seizure generalization occur) and
limbic sysyem (which may be responsible for
mood disorders) also involving the hypothalamus

11. TYPES OF ECT
 DIRECT ECT
In this ,ECT is
given in the absence of
anesthesia and muscular
relaxation .this is not a
commonly used method
now
 MODIFIED ECT
Here ECT is
modified by drug induced
muscular relaxation and
general anesthesia

12. FREQUENCY AND TOTAL NUMBER
OF ECT
 FREQUENCY :
Three times per week or as indicated
 TOTAL NUMBER ;
6 TO 10 ;up to 25 be preffered as indicated

13. Application of electrodes

14. APPLICATION OF ELECTRODES
BILATERAL ECT
 Each electrode is placed
2.5 -4 cm (1 -1 ½) inch
above the mid point on
a line joining the tragus
of the ear and the
lateral canthus of the
eye
UNILATERAL ECT
 Electrodes are placed only on one
side of head ,usually non –
dominant side (right side of head
in a rigjt –handed indibidual )
 Unilateral ECT Is safer ,with much
fewr side effects ,particularly
those of memory impairement

15. INDICATIONS

16. Major depression

17. SEVERE CATATONIA

18. SEVERE PSYCHOSIS

19. ORGANIC MENTAL DISORDER

20. Other indications

21. CONTRAINDICATIONS

22. CONTRAINDICATIONS
ABSOLUTE
RELATIVE

23. • Absolute
raised intracranial pressure

24. RELATIVE
 Cerebral aneurysm

25. Cerebral hemorrhage

26. Brain tumor

27. Acute myocardial infarction

28. Congestive heart failure

29. Pneumonia

30. Aortic aneurysm

31. Retinal detachment

32. COMPLICATIONS
 Life threatening complicatioms of ect are
rare.ECT does not cause any brain damage.
Fractures can sometimes occur in elderly
patients with osteoporosis.in patients with a
history of heart disease,dysarythmias and
respiratory arrest may occur

33. SIDE EFFECTS OF ECT
 Memory impairement
 Drowsiness,confusion and restlessness
 Poor concentration ,anxiety
 Headache ,weakness /fatigue,backache,muscle
aches
 Dryness of mouth,palpitations
,nausea,vomiting
 Unsteady gait
 Tongue bite and incontinence

34. ECT TEAM

35. ECT team
Psychiatrist ,
anesthesiologist ,
trained nurses and
aids should be involved in the
administration of ECT

36. TREATMENT
FACILITIES

37. Three rooms
Pre ECT room
A pleasant ,comfortable
waiting room
ECT room
• Which should be eqipped with
machine and accessories ,
• an anesthetic appliance
• ,cylinders with adjustable flowvalves ,
• curved tongue depressors
• ,mouth gags,
• resuscitation apparatus and
• emergency drugs there should be
immeadiate access to a defibrillator
Recovery room
A well eqipped
recovery room

38. ROLE OF THE NURSE
 Pre –treatment evaluation
 Intra –procedure care
 Post-procedure care

39. Pre treatment evaluation
Medical and psychiatric history ,(history of
allergies)
Family and patient knowledge
(indications,contraindications)
Informed consent
Vital signs
Empty stomach (4-6 hurs prior)

40. • With hold night dose drugs( diazepam,barbiturates
and anticonvulsants
• Withhold oral morning medications
• Head shampooing
• Any jewellary,dentures,prosthesis,contact
lense,metallic objects ,tight clothing (avoid)
• Empty bladder ,bowel before ECT
• Administration of 0.6 mg ,atropine IM or SC 30 min
before or IV just before ECT

41. Intra-procedure care
 ECT table in supine position
 Stay with patient
 Assistin administring anesthetic agent( thiopental
sodium 3-5 mg /kg body weight) and muscle relaxant
(1mg /kg body weight of succynylcholine)
 Patent airway
 Mouth gag should be inserted (prevent tonuge bite)

42. Continue....
 The places of electrode placement must be cleaned
with normal saline or 25 % bicorbonate solution ,or a
conducting gel applied
 Monitor electrical stimulus (voltage ,intensity,and
duratio)
 Monitor seizure activity by cuff method
 100% oxygen
 During seizure monitor vital signs ,ECG ,oxygen
saturation ,EEG etc
 Record the findings and medicines given in the
patient’s chart

43. Post –procedure care
 Monitor vital signs
 Continue oxygen till spontaneous respiration starts
 Assess post –ictal confusion and restlessness
 Safety precautions to prevent injury (side lying position,
suctioning, side rails..)
 If still post –ictal confusion and restlessness, IV diazepam
may be administered
 Reorient the patient after recovery and stay with him until
fully oriented
 Document any findings as relavant in the patient’s record.

44. Summary
 Introduction
 Definition
 Types
 Mechanism of action
 Frequency and total number of ECT
 Applications of electrodes
 Indications
 Contraindications,side effects,ECT team, treatment
facilities
 Role of nurse

45. Conclusion
 Ect is a grandmal seizures that are produced
by electrical activity to treat mental disorders

46. ANY QUESTIONS?

47. THNAK YOU
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