the brief explanation regarding the electroconvulsive therapy for the student and teacher nurses. your valuable suggestions are welcome. please follow my youtube channel ' Bhuman ' for more exciting topics.

1. ELECTROCONVULSIVE
THERAPY
Mr. Sushil Sudarshan Humane MSN, RN
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2. Introduction to
concept
• Electroconvulsive therapy (ECT) is a procedure,
done under general anesthesia, in which small
electric currents are passed through the brain,
intentionally triggering a brief seizure.
• ECT seems to cause changes in brain chemistry
that can quickly reverse symptoms of certain
mental health conditions.
• ECT often works when other treatments are
unsuccessful and when the full course of
treatment is completed, but it may not work for
everyone.
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3. Types of ECT
• It can be direct or modified
• It can be bilateral, unilateral or bifrontal
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4. Indications for ECT
1) Depression
• Major severe depression especially with suicidal risk with
psychiatric features like delusions or hallucinations
• Depressive stupor
• Puerperal depression and postpartum psychosis
• Poor intake of food and fluids
• Where the speeder recovery needed
• In elderly patient
• First-trimester of pregnancy
• Depression with physical illness
• Schizo-affective depression
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5. Indications for ECT
• 2) Obsession or compulsion
• 3) Schizophrenia
• Catatonic schizophrenia and catatonic
stupor
• Acute schizophrenic episode
• Intolerance or
• Puerperal schizophrenia
• First trimester of pregnancy
• Schizophrenia with depression
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6. Indications for ECT
4) Mania
• Excreted of un-cooperation behavior
• Bipolar mood disorder with rapid cycle
• Bipolar and disorder with mixed behavior
• Mania in the first trimester of pregnancy
• 5)Postpartum psychosis
• 6) Schizoaffective disorder
• 7) Psychosis in the first trimester of pregnancy
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7. Contraindications
of ECT
• Increased intracranial pressure, including tumors,
hematomas, and subarachnoid hemorrhage
• Acute myocardial infarction
• Hypertension
• Cardiac disease, aneurysm, thrombophlebitis,
bleeding disorders or where there is increased risk
of embolism
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8. Contraindications
of ECT
• CVA
• Severe pulmonary disease such as pneumonia
and TB
• Others are fracture, dehydration, fever, glaucoma,
retinal detachment, CCF, and contraindicated for
anaesthesia
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9. Side effects
• Deaths during ECT are due to general anaesthesia.
• Headache and body ache
• Memory disturbance than bilateral ECTs
• Confusion may occur in the postictal perial
• Vomiting due to increased ICP
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10. Side effects
• Memory lost from a day or a month due to hypoxia of the brain
• Thoracic spine or long bones fracture
• Dislocation of shoulder joint and wrist
• Arrhythmia, aspiration, pneumonia, status epilepticus
• Muscle pain, nausea
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11. Method/Technique
• ECT can be given by a direct and indirect method
• The patient is administered atropine sulphate subcutaneously 0.6 mg to 1.0
mg, half an hour before the treatment or IV immediately before the
treatment.
• Minor Tranquillizer like Calmpose is also used
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12. Method/Technique
• A grand mal seizure is induced in the patient by passing an electric current
through the temporal lobe.
• Atropine prolongs the period of disorientation after the seizures
• It also reduces vomiting.
• Immediately after the ECT treatment appropriate resuscitative and other
emergency management equipment and supplies are kept ready.
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13. Modified ECT
• Electroconvulsive therapy is modified with the use
of Anesthesia, muscle relaxation and
oxygenation.
• The use of anesthesia is necessary to allay
anxiety and achieve the maximum effect.
• It is used to modify the force of convulsion and to
avoid complications like bone fractures.
• Modified ECT is also used for the patients who
are recovering from heart conditions.
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14. Modified ECT-
Drugs used
• A short acting Barbiturate, methohexial sodium
(Brevital sodium) or Theopental (pentothal) 5 ml to
10 ml (1 ml = 10 mg) and ultra short acting
depolarizing agent succinylcholine 0.3 ml to 0.5 ml
(1 ml = 20 mg) are given intravenously.
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15. Observation of
production of
seizure
• The production of grand mal seizure is necessary
for direct and modified ECT.
• In direct ECT, the Tonic phase that is muscle
contractions last for 10 seconds
• The clonic phase that is movement or convulsion
lasts for 25 to 30 seconds
• Then the patient goes into the relaxation phase
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16. Observation of
production of
seizure
• With the use of anaesthesia in modified ECT, mild
grimace or blepharo-spasm, (a tonic spasm of the
eyelid muscles) is observed when the current is
applied.
• There is a slow planter flexion (reverse Babinski)
during the tonic phase and there are fine
movements of the toes during the clonic phase.
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17. Number and
frequency of ECT
treatment
• There is no clinical justification for a fixed number
of treatments.
• Peak response is attained between five and ten
treatments for patients with bipolar disorders,
manic type, schizoaffective disorders, or catatonic
schizophrenia.
• Twenty to 25 treatments may be required for
chronically ill schizophrenic patients.
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18. Number and
frequency of ECT
treatment
• ECT treatment is most often given three times a
week.
• The frequency of treatment can be reduced if the
patient shows a severe confusional state.
• With an extremely agitated, psychotic or suicidal
patient it may be useful to give the first few
treatments on a daily basis.
• ECT does not prevent relapse. So maintenance
treatment should be with drug and psychotherapy.
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19. Mode of action
• Changes in behaviour due to ECT are attributed to an acute amnesic
change in the patient.
• Many patients who are getting ECT, seem to forget what had been bothering
them during the depressive episode.
• Biological mechanism by which a therapeutic effect has been brought about
by ECT includes
• Neuro-chemical, Neuro-endocrine and Neuro- physiological.
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20. Mode of action
• Neuro-chemical investigations have shown that the role of
catecholaminergic effect is due to pre- synaptic and postsynaptic receptor
effect and may not be due to neurotransmission.
• This effect is also achieved due to seizures caused by ECT treatment.
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21. Mode of action
• Neuro-physiological effect due to ECT is achieved probably due to cerebral
hypometabolic state.
• Neuro-endocrine changes have effects on depressive illnesses.
Polypeptides from the hypothalamus change the neuro-endocrine activity
which affects thalamocortical pathways.
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22. Role of the nurse
• Emotional and Educational Support to the Client & Family
• Encourage the client to discuss feelings, including myths regarding ECT.
• Teach the client and the family what to expect with ECT.
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23. Pre-treatment Protocol for ECT
• Ascertain if the client and the family have received a full explanation, including the
option to withdraw the consent at any time.
• Withhold food and fluids for 6 to 8 hours before treatment.
• Remove dentures, glasses, contact lenses, hearing aids, hair pins and etc.
• Have client void before the treatment.
• Give preoperative medications as ordered:
• Give either glycopyrrolate (Robinul) or atropine to prevent potential for aspiration and to
help minimize brady-arrhythmias in response to electrical stimulants.
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24. Nursing Care During the Procedure
• Place a blood pressure cuff on one of the client’s arms.
• As the intravenous line is inserted and EEC and ECG electrodes are attached, give a brief
explanation to the client.
• Put on the pulse oximeter to the client’s finger.
• Monitor blood pressure throughout the threatement.
• Medications to be given:
• Short-acting anesthethic (Brevital)
• Muscle relaxant (Succinylcholine)
• 100% oxygen by mask via positive pressure
• Check if the bite block is placed in prevent biting of the tongue
• Electrical stimulus given (seizure should last 30 to 60 seconds).
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25. Post treatment nursing care
• Have the client go to a properly staffed recovery room.
• Once the client is awake, talk to the client and check the vital signs.
• Give frequent orientation and reassurance to allay confusion.
• Check the gag reflex before giving client fluids, medications or breakfast.
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26. References
• Matt Vera, BSN, R.N. Electrocunvulsive therapy. Nurseslabs.Online resource from
https://nurseslabs.com/electroconvulsive-therapy-nursing-care/
• Mayoclinic. Electrocunvulsive therapy online sourse:-
https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-
20393894
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