ELECTRO

CONVULSIVE THERAPY
(ECT)

BY
MR. KALYAN KUMAR MSC(N)
Introduction
 Electroconvulsive therapy is a type of somatic
treatment, first introduced by Bini and cerletti in
April 1938. From 1980 onwards ECT is being
considered as a unique psychiatric treatment. ECT
also known as electroshock therapy or Shock
Therapy.
 Electroconvulsive therapy is the artificial
induction of Grandmal seizure through the
application of electrical current to the brain. The
stimulus is applied through the electrodes that are
placed either bilaterally or unilaterally on the
non-dominant side.
Parameters of electrical current applied
 Voltage 70 - 120 volts
 Duration 0.7-1.5 seconds
 Frequency 3 times per week or as indicated
 Total number 6-10; upto 25 may be preferred as
indicated.
Mechanism of action
 The exact mechanism of action is not known. ECT
possibly effects the catecholamine Pathways
between diencephalon and limbic system also
involving the hypothalamus.
Types of ECT
 Direct ECT: It is given in the absence of
anaesthesia and muscular relaxation. This is not a
commonly used method now.
 Modified ECT: It is modified by drug induced
muscle relaxation and general anaesthesia.
Application of electrodes
 Bilateral ECT: Each electrode is placed 2.5- 4 cm
above the midpoint, on a line joining the tragus
of the ear and the lateral canthus of the eye.
 Unilateral ECT: Electrodes are placed only on
one side of the head, usually non dominant side
unilateral ECT is safer, with much fewer Side
Effects particularly those of memory
impairment.
Indications
 Major depression
 Severe catatonia
 Organic mental disorders
 Severe psychosis (Schizophrenia or
Mania)
Contraindications
 Raised ICP ( Intracranial pressure)
 Congestive heart failure
 Cerebral haemorrhage
 Retinal detachment
 Pneumonia
 Acute Myocardial Infarction
 Brain Tumor
 Cerebral aneurysm
Side effects
 Headache
 Short term memory loss
 Confusion, anxiety
 Dryness of mouth
 Palpitations
 Nausea, vomiting
 Drowsiness
 Tongue bite
 Muscle aches
 Restlessness
Drugs used
 Injection.Succinyl choline 0.5 mg/kg (Muscle
relaxant)
 Injection. Thiopentone sodium 3 mg/kg
(Anesthetic)
 Injection. Atropine 3 mg/kg (To reduce
Respiratory secretions)
Nursing responsibilities
PRE-TREATMENT EVALUATION
 Detailed Medical and psychiatric history including
history of allergies
 Assessment of patients and families knowledge of
indications, Side Effects, therapeutic effects and
risk associated with ECT.
 Assess vital sings
 Obtain informed consent.
 NBM for 4-6 hours prior to ECT.
 Withhold oral medication in the morning
 Any jewellery, prosthesis and contact lens,
metabolic objects and tight clothing should be
removed from the patient's body.
Intra procedure
care
 Place the patient comfortably on the ECT table
in supine position
 Stay with the patient to allay anxiety and fear.
 Mouth gag should be inserted to prevent
possible tongue bite
 The place of electrode placement should be
cleaned with normal saline
 Monitor voltage, intensity and duration of
electrical stimulus.
 100% oxygen should be provided
 Record the findings and medicines given in
the patient chart.
 Post procedure
Monitor vital signs
care
 Continue oxygenation till spontaneous
respiration starts
 Take safety precautions to prevent injury( use of
side rails to prevent Falls, side-lying position and
suctioning to prevent aspiration of secretions).
 If there is post-ictal confusion and
restlessness
severe IV Diazepam may be administered
 Document findings as relevant, in the
any patient's
record.
Summary
Conclusion