Electroconvulsive Therapy: Aban, Katherine Maebelle G. Esguerra, Dianne Carmela R

Electroconvulsive
Therapy
Aban, Katherine Maebelle G.
Esguerra, Dianne Carmela R.
SOMATOTHERAPY
Somatotherapy
→ is the treatment of mental illness by physical

means (such as medication, electroconvulsive
therapy, or psychosurgery) rather than
psychotherapy.
Two main methods of treatments
1. Chemotherapy
• uses drugs to alter the functions

of the body
• usually combined with psychotherapy

Drugs use on chemotherapy
• Anti-anxiety drugs or minor tranquilizers
- to relieve worries and tension.

• Antipsychotic drugs or major tranquilizers
- to relieve delusions and hallucinations.
• Antidepressant drugs
- to counteract depression.
2. Physical Therapy
• uses physical techniques

Physical therapy used in
psychiatric treatment includes:
1. Electroshock therapy
• an electric current is passed through the

brain producing a convulsive seizure.
• to treat severe depression.

2. Psychosurgery
• a type of brain surgery
• to relieve extreme forms of mental illness

that do not show improvement under other
kinds of treatment.
• rarely used
ELECTRO CONVULSIVE
THERAPY
Electroconvulsive Therapy
 Also known as electroshock
 the introduction of a controlled grand mal
seizure by passing an electrical current
through the brain.
 It raises the level of norepinephrine which is
low in patients with depression
 Most often used as a treatment for
depression that has not been responsive to
other forms of treatment
 Mania (bipolar disorder), catatonia,
schizophrenia
 Procedure requires 15 minutes but the shock
lasts only a few seconds
 Usually given 3 times a week; a patient may
require 3-4 times a week, or as many as 12
to 15 times a week
 Certain types of ECT have been shown to
cause persistent memory loss, whereas
confusion usually clears within hours of
treatment
 Informed consent is a standard
Indication
(according to the APA 2001 guidelines)
Primary indications for ECT:
 patients with depression as a lack of a
response to, or intolerance of, antidepressant
medications;
 a good response to previous ECT; and
 the need for a rapid and definitive response
(e.g. because of psychosis or a risk of
suicide)
 Severity and chronicity of the depression
 The likelihood that alternative treatments
would be effective
 The patient's preference
 Weighing of the risks and benefits
 Cognitive behavioral therapy or other
psychotherapy should generally be tried
before ECT is used.
Conditional Contraindication of ECT:
 History of trauma
 Tumor of the brain
 CHF
 Hypertension
 Any cardiac condition
 Respiratory failure
 Active PTB
 Fracture
 Any febrile condition
 Pregnancy (applied to ANA and NICE)
Equipment needed in ECT:
 ECT machine with electrodes and perforated
rubber band
 Wooden bed with mattress
 Mouth protector or gag
 Small pillow
 Electrodes jelly
 Towel
 Restraints
 Hypo tray with emergency stimulants
 Inhalator
 3-4 assistants
Effectiveness
 20-50% relapse after 6 months;
antidepressants, lithium, or ECT are given
monthly or 6-week intervals
 Dysrythmia, substance abuse, anxiety, or
personality disorder
Administration
 Application may differ in the ff ways:
 Electrode placement
 Length of time stimulus is given
 Property of stimulus
 Electrode placement
 Bilateral
 Unilateral
 Bifrontal
 Unilateral is thought to cause fewer

cognitive effects than bilateral, but is
also less effective
 Stimulus levels
 Levels below threshold may not be effective for
treatment, while levels excessively above may
expose patients to the risk of more severe
cognitive impairment
 Seizure threshold is determined by trial and
error (dose titration) or “fixed” dose
 Others may estimate dose based on patient’s
age and gender
 Patient is put to sleep with a very short-
acting barbiturate
 Succinylcholine is given to temporarily
paralyze the muscles
 Occasionally, Atropine is given to inhibit
salivation
 An electrode is placed  Or one electrode may
above the temple of the be placed above the
nondominant side of temple on each side of
the brain and another in the brain (Bilateral
the middle of the ECT)
forehead (Unilateral
ECT)
 Patient breathes through an oxygen mask
 A small current is passed through the brain,
producing a seizure
 Patient sleeps peacefully while an EEG
monitors seizure activity and an ECG
monitors the heart rhythm
 A clinically effective seizure ranges from 30
seconds to sometimes more than a minute
 Patient wakes up 15 minutes later
 Patient may experience a brief period of
confusion, headache, or muscle stiffness;
symptoms typically ease in 20 or 60 minutes
 In the few seconds after introduction of
stimulus, there may be a temporary drop in
blood pressure
 May be followed by a marked increase in
heart rate, which may lead to a rise in blood
pressure
 Heart rhythm disturbances generally subside
without complications
Effects on Cognition
and Memory
 Short-term memory loss and changes in
memory function may persist a few days
following treatment, but may return to normal
in a month
Acute effects of ECT:
 Retrograde and anterograde amnesia
 Retrograde amnesia is more pronounced
when it comes to events weeks or months
prior to therapy
 Anterograde amnesia is usually limited to the
time of treatment or shortly afterwards
Nursing
Responsibilities
 initiating IV therapy
 administration of ordered medications
 monitor client's responses before, during
and after treatment
Preparation of the patient:
Before
 Complete thorough physical, neurological and
laboratory exam.
 Consent for therapy to be signed by a
responsible relative
 Explain to the px what is to be done.
After
 NPO 2-3 hours before the scheduled hour
 Omit AM dose of medication if any.
 Empty the bladder
 Check TPR nad BP.
Care after shock:
 Put the px to bed and make him feel
comfortable.
 Inspect any bleeding of the gums, or bitten
lips.
 Avoid draft and exposure.
 After recovery and rest, he may
shower,dress and start his usual activities.
Points to be recorded after ECT:
 Type of seizure
 Time of occurrence
 Duration and description of reaction
 Behavior, general reactions, attitude and
remark before and after therapy or
treatment.
Effects of ECT:
 Sedative effect for the manic

 Stimulating effect for the depressed
Complication of ECT:
 Apnea
 Fracture
 Temporary amnesia
Thank You!
BSN IV Group 23

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Electroconvulsive

→ is the treatment of mental illness by physical

• uses drugs to alter the functions

• usually combined with psychotherapy

• Anti-anxiety drugs or minor tranquilizers

- to relieve worries and tension.

- to relieve delusions and hallucinations.

• uses physical techniques

• an electric current is passed through the

• to treat severe depression.

• a type of brain surgery

• to relieve extreme forms of mental illness

 Length of time stimulus is given

 Unilateral is thought to cause fewer

 Sedative effect for the manic

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