SUBJECT: MENTAL HEALTH

NURSING

SEMINAR
ON
ECT
(ELECTROCONVULSIVE THERAPY)

SUBMITTED TO, SUBMITTED BY,

MRS SHIBY JAMES ROSHITA G PILLAI

ASSISSTANT PROFESSOR M SC (N) 1ST YEAR

MENTAL HEALTH NURSING

INTRODUCTION:-
Electroconvulsive therapy (ECT), also known as electroshock, is a well-established, albeit
controversial psychiatric treatment in which seizures are electrically induced in anesthetized
patients for therapeutic effect.

DEFINITION:-
“Artificial induction of a grandmal seizure (tonic phase 10-15sec, clonic phase: 30-60
sec.)Through the application of electrical current to the brain, the stimulus is applied through
electrodes which are placed either bilaterally in the fronto-temporal region or unilaterally on
the non-dominant side.”

HISTORY:-
 ECT first appearance was by the scientist, Meduna in 1935 when he notice that most
of schizophrenic symptoms are temporary disappear after a normal convulsion.
 He induced a seizure with an injection of camphor-in-oil in a patient with catatonic
schizophrenia,
 Cerletti and Bini introduced the use of "electric shock" to induce seizures in 1938,
and soon this method became the standard.

PARAMETERS:-
o VOLTAGE- 70-120 Volts
o Duration - .7-1 .5 sec

ECT TEAM:-
 Psychiatrist
 Anaesthetist
 Trained Nurses
 Nursing aids
 ECT assistant

INDICATIONS:-
1. Severe depression
Severe episodes.
Need for rapid antidepressant response (e.g. due to failure to eat or drink in depressive
stupor; high suicide risk).
Failure of drug treatments.
Patients who are unable to tolerate side- effects of drug treatment (e.g. puerperal
depressive disorder).
Previous history of good response to ECT.
Patient preference.
Suicidal ideas
2. Mania That hasn’t improved with medications
3. Severe Catatonia 
 4. Schizophrenia Psychosis
5. When medications are insufficient or symptoms are severe
6. All of the above disorders during pregnancy.

CONTRAINDICATIONS:-
1. Absolute
 Increased ICP
2. Relative
 Cardiovascular
(Coronary artery disease, HTN, aneurysms, arrhythmias)
 Cerebrovascular effects
(Recent strokes, space occupying lesions, aneurysms)
 Severe pulmonary diseases
(T.B, Pneumonia, Asthma)

TYPES OF ECT:-
1. Bilateral ECT
It involves placing the electrode of ECT machine simultaneously of each temple of
patients head. It means placing the electrodes on each side of head at the region
known as temporal fossa

DISADVANTAGE: - It has cognitive side effect such as memory loss and confusion
ADVANTAGE: - It has better therapeutic effect

2. Unilateral ECT
It involves placing both the electrode on same side of head. In this case, one electrode
is placed mid-line and the other over non-dominant hemisphere generally presumed to
be right

ADVANTAGE: - It reduces problems of memory

MODE OF APPLICATION:-
1. Direct ECT
In this ECT, no anaesthetic agent is given to client and electricity is applied through
the electrodes to the head to induce the grand mal seizures

2. Modified ECT
Client is given an anaesthetic agent before the application of electricity to induce the
seizure
Each electrode is placed 2.5-4cm on midpoint on a line joining the tragus of
ear and lateral canthus of eye

MECHANISM OF ACTION:-
 1. Neuro-transmitter theory
2. Neuro-endocrine theory
3. Anti-convulsant theory.
4. Brain damage theory.
5. Psychological theory.
 NEUROTRANSMITTER THEORY: - ECT works like anti-depressant
medication, changing the way brain receptors receive important mood-related
chemicals.
 ANTI-CONVULSANT THEORY:-ECT-induced seizures teach the brain to
resist seizures. This effort to inhibit seizures dampens abnormally active brain
circuits, establishing mood.
 NEUROENDOCRINE THEORY: - The seizure causes the hypothalamus to
release chemicals that cause changes throughout the body. The seizure may
release a neuropeptide that regulates mood.
 BRAIN DAMAGE THEORY: - Shock damages the brain, causing memory
loss and disorientation that creates an illusion that problems are gone, and
euphoria, which is a frequently observed result of brain injury.
 PSYCHOLOGICAL THEORY:-Depressed people often feel guilty, and ECT
satisfies their need for punishment. Alternatively, the dramatic nature of ECT
and the nursing care afterwards makes patients feel they are being taken
seriously – the placebo effect

MEDICATIONS USED IN ECT:-

o Inj Atropine (0.5 – 0.6 mg ) - given 30 min before procedure. It dry body secretions
and prevent aspiration
o IV Sodium pentathol (150-250 mg) and Inj Scoline (25-40 mg) – muscle relaxant ;
decreases the possibility of fracture or dislocated bone
o Pure oxygen (100%) inhalant

DRUGS TO BE DISCONTINUED BEFORE ECT TREATMENT :-

o Tricyclic antidepressant – They provide arrhythmias to patients
o Lithium – It enhance post ECT confusion
o Theophylline and Benzodiazepines – Lowers seizure threshold
o Anti convulsant – Lead to greater electrical stimulus to induce seizure

TREATMENT FACILITIES :-
3 ROOMS –
1) Waiting room
 2) ECT room
3) Recovery room

ARTICLES NEEDED FOR ECT:-

 Articles for anaesthesia
 Suction apparatus
 Face mask
 Oxygen cylinder
 Tongue depressor
 Mouth gag
 Resuscitation apparatus
 Full set of emergency drugs
 Defibrillator

PROCEDURE:-
1. Time – 10-15 sec for preparation and recovery
2. IV catheter is inserted on hand
3. Oxygen mask may be given
4. Electrodes are placed on position
5. Anaesthetic is injected into IV
6. Muscle relaxant is injected into IV
7. BP cuff placed around forearm or ankle
8. Seizure lasts for 30- 60 sec
9. Few minutes later, anaesthetic and muscle relaxant wear off

COMPLICATIONS:-
1) Medical complications
 Heart problems
 Small risk of death
 Laryngospasm
 Bradycardia
 Prolonged apnoea
 Fracture of vertebra and other bones of body
2) Other complications
 Memory loss
 Confusion
 Anoxia
 Nausea
 Headache
 Muscle ache
 Jaw pain
ROLE OF NURSE IN ECT:-
1) PRE ECT CARE
 Informed consent
 Fully explain the risks and benefits of procedure and answer questions
from patients or their relatives.
 Information sheets
 Reduce patient’s anxiety and help establish good patient-doctor
relationship
 Administration of drugs
 Check patient record
 Explain procedure
 Keep patient on NPO 6-8 hrs. before ECT
 Discourage smoking just before ECT
 Remove artificial dentures and articles
 Vital signs
 Ensure emergency articles are accessible
 Emotional support
 Transfer patient to ECT room with necessary records

2) CLIENT EDUCATION BEFORE ECT

 An instruction sheet describing the procedure is given to client & their
significant others.
 The nurse emphasizes that the client will be asleep during the
procedure.
 Although low voltage current is passed to the brain, the client will not
be harmed or feel any pain.

3) CLIENT EDUCATION BEFORE ECT

 Instruction for preparation: Nothing by mouth (NPO).
 Outline the need to void before the procedure.

4) ECT ROOM
 Check patient's identity.
 Check patient is fasted (for 8hrs) and has emptied their bowels and
bladder prior to coming to treatment room.
 Check patient is not wearing restrictive clothing and jewellery/
dentures have been removed.
 Consult ECT record of previous treatments (including anaesthetic
problems).
 Ensure consent form is signed appropriately.
 Check no medication that might increase or reduce seizure threshold
has been recently given.
  Check ECT machine is functioning correctly.
5) DURING ECT
 Reassurance & support
 Place patient in supine position
 Necessary Drug administration
 Mouth gag
 Apply upward pressure to mandible
 Oxygen administration
 Clean the Scalp with normal saline
 Prevent fall, fracture, dislocation
 Remove the mouth gag after seizure occurred
 Suck the oral secretion & apply o2 mask

6) POST ECT CARE

 Shift client to post-procedure room
 Check vital signs every 15 min
 Administer drugs if patient is aggressive/violated/ confused
 If respiratory difficulty continue oxygen
 Provide side rails
 Be with the client
 Documentation
 Reorient the client after recovery

SUMMARY:-
ECT is the induction of grandma seizure through application of electrical current to brain. It
is safe and effective treatment alternative to other forms of therapy. It is contradicted for
individuals with increased ICP. The nurse assists with ECT using the steps of nursing process
before, during, and after treatment
BIBLIOGRAPHY:-

1. Mary. c. townsmen; psychiatric mental health nursing ; concepts of care in

evidenced based practice; 6th edition; page no.-161 – 168
2. Ahuja niraj; textbook of postgraduate psychiatry; volume 2 ; 2nd edition; page no.-
833-840
3. Neeraja K.P; essentials of mental health and psychiatric nursing; volume 2; page no-
233-234
4. Sreevani R; essentials of mental health and psychiatric nursing; volume 2; page no-
433-437
5. Kaplan. H. I; synopsis of psychiatry – behavioural science or clinical psychiatry;9th
edition; page no- 121-125
6. Ahuja. N. A; short text book of psychiatry;5th edition ;page no. 167-169
7. Currentnursing,com/pn/grouptherapy.html