ELECTROCONVULSIVE THERAPY (ECT)

 ELECTROCONVULSIVE THERAPY (ECT)

Mr. Mumba, a 36 year old man is due to undergo Electro-convulsive therapy (ECT) following a major depressive episode.

A.    Define ECT   (5%)

B.    State two types of ECT   (6%)

C.    List four indications for ECT    (4%)

D.    Explain the contraindications for ECT    (10%)  

E.    State five (5) side effects of ECT   (15%)

F.    Explain the role of the nurse during ECT under the following headings:   (60%)

I.                 Pre-treatment evaluation (before ECT)  20%

II.               Intra-procedure care (during ECT)  20%

III.             Post-procedure care  20%

Mrs Charity Chela, a 25 year old secretary and mother of two is admitted to your psychiatric ward with history of attempted suicide. She is tearful, withdrawn, unkempt and has insomia

Electro convulsive therapy is prescribed.

1. Discuss the management of Mrs Chela(30)
2. Discuss how you will prepare for Electro convulsive therapy :

                                               i.          Before (25 marks)

                                              ii.          During (10 marks)

                                            iii.          After    (15 marks)

State 5 Differences between major and minor depression (15 marks)

 

ELECTROCONVULSIVE THERAPY (ECT)

 Electroconvulsive therapy is the artificial induction of a grandma seizure through the application of electrical current to the brain. The stimulus is applied through electrodes that are placed either bilaterally in the front-temporal region, or unilaterally on the non-dominant side

Parameters of electrical current applied

Standard dose according to American psychiatric Association, 1978

• Voltage- 70-120 volts
• Duration- 0.7-1.5seconds

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.

Indications

A)    Major depression, especially with suicidal risk

B)    Severe catatonia

C)   Severe psychosis ( mania)

D)   Organic mental disorders

Contraindications

(A) absolute:

Raised ICP (intracranial pressure)

(B) Relative

-cerebral aneurysm

-cerebral hemorrhage

-brain tumor

-acute myocardial infarction

-retinal detachment

SIDE EFFECTS OF ECT

-Memory impairment

-Drowsiness, confusion and restlessness-

-Poor concentration, anxiety

-Headache, weakness/fatigue, backache, muscle aches

-Dryness of the mouth, palpitations, nausea, vomiting

-Unsteady gait

-Tongue bite and incontinence

ROLE OF THE NURSE

Pre-treatment evaluation

- detailed medical and psychiatric history, including history of allergies

- An informed consent should be taken. Allay any unfounded fears and anxieties regarding the procedure.

- Patient should be on empty stomach for 4-6hrs prior to ECT.

- Withhold night doses of drugs, which increase seizure threshold like diazepam, barbiturates and anticonvulsants.

-Withhold oral medications in the morning

- Head shampooing in the morning since oil cause impedance of passage of electricity to brain.

- Any jewellery, prosthesis, dentures, contact lens, metallic objects and tight clothing should be removed from the patients body.

- Empty bladder and bowel just before ECT

- Administer of 0.6mg atropine IM 30minutes before ECT or IV just before ECT

 

Intra-procedure care

-Place the patient comfortably on the ECT table in supine position

-Assist in administering the anesthetic agent (thiopental sodium) and muscle relaxant –succinylcholine

-Since the muscle relaxant paralyzes all muscles including respiratory muscles, patient airway should be ensured and ventilator support should be started.

-Mouth gag should be inserted to prevent possible tongue bite.

-The place (s) of electrode placement should be cleaned with normal saline or 25% bicarbonate solution, or a conducting gel applied

-Monitor voltage, intensity and duration of electrical stimulus given

-100% oxygen should be administered

-Monitor vital signs during seizure , ECG, oxygen saturation EEG etc

-Record the findings and medicines given in the patient chart.

Post-procedure care

-Monitor vital signs

-Continue oxygenation till spontaneous respiration starts

-Assess for post-ictal confussion and restlessness

-Take safety precautions to prevent injury (side-lying position and suctioning to prevent aspiration of secretions, use of side rails to prevent falls)

-If there is severe post-ictal confussion and restlessness, IV diazepam may be administered

-Reorient the patient after recovery and stay with the patient until fully oriented.

-Document any findings as relevant in the patients record