PRESENTED BY:

ELECTROCONVULSIVE SHWETA SURWASE

THERAPY F.Y. M.Sc. (Mental Health Nursing)

MIMH, Pune.
Electroconvulsive therapy “For extreme diseases,
extreme methods of cure…are most suitable.”
-- Hippocrates, ca. 400 B
 INTRODUCTION
Most of people ( educated and non educated ) think that life inside
mental illness hospitals is horror and scary.
 It is the effect of media that shows psychotic patients in
disgusting appearance and doing unbelievable acts
 INTRODUTION
It is also shows the role of electroconvulsive therapy in a
scary scenario , -when two or more huge male nurses pull
the patient - then connect him to an electrical device ,
while he is fully awake - –which make him scream with a
loud voice - - cry and then lose his consciousness because
of the severe pain he got.
 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.
 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 campor-in-oil
in a patient with catatonic schizophrenia.
 HISTORY
Cerletti and Bini
introduced the use of
"electric shock" to induce
seizures in 1938, and soon
this method became the
standard.
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.”
PARAMETERS
VOLTAGE: 70-120 Volts
DURATION: 0.7-1 .5 sec
 BENEFITS OF ECT
ECT relieve very severe depressive illnesses when other
treatments have failed.
ECT has saved patients' lives because 15% of people
with severe depression will kill themselves.
ECT works faster than all antidepressants drugs.
MECHANISM OF ACTION
Neuro-transmitter theory
Neuro-endocrine theory
Anti-convulsant theory.
Brain damage theory.
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,
estabilishing 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. Both are temporary.
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
 TYPES OF ECT
Direct ECT
Modified ECT
Unilateral ECT
Bilateral ECT
 ELECTRODE PLACEMENT
Bilateral (BL) - most common, most effective, most cognitive dysfunction

Right unilateral (RUL) - less cognitive effect, may be less clinically effective
 MODERN ECT
Electrode’s are placed on the side of a patient’s head just above the temples.
The patient is given anesthetic injections and a muscle relaxant to stop muscle
contractions that can lead to broken bones.
A small electric current is passed through the brain.
ELECTRODE PLACEMENT
Each electrode is placed 2.5 -4 cm(1- 1.5 inches) on the midpoint on a line joining the
tragus of the ear and the lateral canthus of the eye
 INDICATIONS
SEVERE DEPRESSION
i. Severe episodes.
ii. Need for rapid antidepressant response (e.g. due to failure to eat or drink in depressive
stupor; high suicide risk).
iii. Failure of drug treatments.
iv. Patients who are unable to tolerate side- effects of drug treatment (e.g. puerperal
depressive disorder).
v. Previous history of good response to ECT.
vi. Patient preference.
vii. Suicidal ideas
 INDICATIONS
 MANIA That hasn’t improved with medications
SEVERE CATATONIA
SCHIZOPHRENIA PSYCHOSIS When medications are
insufficient or symptoms are severe
All of the above disorders during pregnancy.
 CONTRAINDICATIONS
Absolute:
Increased ICP
Relative:
i. Cardiovascular (Coronary artery disease, HTN, aneurysms,
arrhythmias)
ii. Cerebrovascular effects (Recent strokes, space occupying
lesions, aneurysms)
iii. Severe pulmonary diseases (T.B, Pneumonia, Asthma)
 COURSE OF ECT
ECT is usually given 3 times a week, reduced to twice a week or
once a week once symptoms begin to respond. This limits
cognitive problems.
There is no evidence that a greater frequency enhance treatment
response.
 COURSE OF ECT
Treatment of depression usually consists of 6-12
treatments.
Treatment-resistant psychosis and mania up to (or
sometimes more than)20 treatments.
Catatonia usually resolves in 3-5 treatments.
 ECT TEAM
 Psychiatrist
 Anesthetist
Trained Nurses
 Nursing aids
 ECT assistant
MEDICATIONS USED IN ECT
Inj.Atropine 0.6mg
Inj.Scoline 25-40 mg
Sodium Pendothal 150-250 mg
MEDICATIONS USED IN ECT
A pretreatment medication such as Atropine sulfate , Glycopyrolate
is administered IM 30 minutes before treatment, to decrease
secretion and counteract the effect of vagal stimulation induced by
ECT.
 A short acting anesthesia ( the patient should be unconscious when
the ECT is given)
Muscle relaxant ( to prevent muscle contraction during the seizure
reduction of possibility of fracture or dislocated bone)
Pure oxygen before and after treatment .
TREATMENT FACILITIES
Waiting room
ECT room
Recovery room
ARTICLES NEEDED FOR ECT
 Articles for anesthesia
suction Apparatus
Face mask
O2 cylinder
Tongue depressor
 Mouth gag
 Resuscitation apparatus
 Full set of emergency drugs, ECT drugs
Defibrillator
 PROCEDURE
Time: 10-15 +time for prep & recovery
1. Intravenous (IV) catheter is inserted in the arm or hand
2. Oxygen mask may be given
3. Electrodes are placed on the head
Unilateral: one side receives electricity
Bilateral: both sides
4. Anesthetic drug is injected into IV.
PROCEDURE
1. Muscle relaxant is injected into IV.
Prevent violent convulsions
2. Blood pressure cuff placed around forearm or ankle
Prevents muscle relaxant from paralyzing, so doctor can confirm seizure with
movement of hand/foot
3. Electric current is sent through electrodes to brain.
4. Seizure lasts 30-60 sec.
5. Few minutes later, anesthetic and muscle relaxant wear off.
 RISKS & SIDE EFFECTS
Impairment of Cognition
 Period of confusion immediately after ECT
May not know where you are or why you are there
Generally lasts few min. to several hrs.
 Memory Loss
May forget weeks/months before treatment, during treatment, or after treatment has
stopped
Usually improves within couple of months
Permanent in relatively rare cases
MEDICAL COMPLICATIONS
 Heart problems
 Small risk of death same as other procedures using anesthesia
Physical Symptoms
 Nausea
 Vomiting
 Headache
Muscle ache
Jaw pain
 CONSENT
Description of the procedure
 Why recommended
Alternative treatment
 Benefits may be transient
 Behavioral restrictions
Voluntary treatment
 Available to answer questions
Implies consent for emergency treatment
 Risks major and minor
 ROLE OF NURSE IN ECT

 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
 PRE ECT CARE
 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
 PRE ECT CARE
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.
INSTRUCTION FOR PREPARATION:
Nothing by mouth (NPO).
Outline the need to void before the procedure.
 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.
 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
Suction the oral secretion & apply o2 mask  
 POST ECT CARE
Shift client to post-procedure room
Check vital signs every 15 mts
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
 ETHICS IN ECT
Ethics in ECT People with a serious mental illness who
are at risk of self harm or are thought to be a risk to other
people can be sectioned under the Mental Health Act.
RESEARCH
Electroconvulsive therapy services during COVID-19 pandemic
Rohini M. Surve,a Preeti Sinha,b,* Sachin P. Baliga,b,1 Radhakrishnan M,a Nupur Karan,a Anju JL,a 
Shyamsundar Arumugham,b and Jagadisha Thirthallib
Author information Article notes Copyright and License information Disclaimer
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Abstract
The COVID-19 pandemic has hit the electroconvulsive therapy (ECT) services hard worldwide as it is considered
an elective procedure and hence has been given less importance. Other reasons include the risk of transmission of
infections, lack of resources, and the scarcity of anesthesiologists due to their diversion to intensive care units to
manage COVID-19 patients. However, ECT is an urgent and life-saving measure for patients diagnosed with
depression and other severe mental illnesses who have suicidality, catatonia, or require a rapid therapeutic response.
COVID-19 pandemic is a significant source of stress for individuals due to its impact on health, employment, and
social support resulting in new-onset psychiatric illnesses and the worsening of a pre-existing disorder. Hence, a
continuation of the ECT services during the COVID-19 pandemic is of paramount importance. In this narrative
review, the authors from India have compiled the literature on the ECT practice during the COVID-19 pandemic
related to the screening and testing protocol, necessity of personal protective equipment, modification in ECT Suite,
electrical stmulus settings, and anesthesia technique modification. The authors have also shared their experiences
with the ECT services provided at their institute during this pandemic. This description will help other institutes to
manage the ECT services uninterruptedly and make ECT a safe procedure during the current pandemic.
Keywords: COVID-19, ECT practice, Anesthesia, Personal protective equipment
1.
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3.Kapoor B. Text book of psychiatric nursing, vol-II. 1st edn.Delhi.Kumar publishing

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5. Surve RM, Sinha P, Baliga SP, M R, Karan N, Jl A, Arumugham S, Thirthalli J.