1. Electroconvulsive Therapy (ECT) In Psychiatry today

2. Definition of ECT The use of electric current to induce seizures to treat patients that have had pharmacological treatment failures and/or comorbidities that make conventional treatment unfeasible.

3. History of ECT ECT Scalp Machine, c1958.

4. Medically-induced seizures Camphor used in the 18 th through the 20 th century – Injected to induce seizures to treat schizophrenia – Seizures were violent Broken bones Painful Considered barbaric, causing more harm than good

5. Camphor uses today – Topical antiseptic – Vicks Vapor Rub – Prevents oxidation of metals – Embalming fluid – Insect repellent

6. From Camphor to Electric Shock Ugo Carlotta 1877-1963 1938 first electric shock on a human patient Did hundreds of clinical trials on animals and humans Safer than Camphor injections

7. ECT today Procedure done under general anesthesia Used today to treat patients with severe depressive disorders that have drug resistance Patients that are suicidal Medical conditions where drug therapy would be contraindicated

8. EBP 1) Safe procedure with a low mortality rate (0.002% or 1-2 deaths/10,000) Most effective with acute psychotic episodes 2) Early studies of continuation/maintenance of ECT in 27 depressed patients showed a reduction in re- hospitalization from 47% among those who did not receive further treatments to 8% in those who did. 3) Mild side effects include HA, muscle soreness, nausea and temporary memory loss

9. Indications for ECT Sever Depressive disorders not responding to medication Psychosis Suicidal plans/attempts Schizophrenia Psychosis When medication are not tolerated Medical conditions that do not allow for conventional treatment

10. What to tell the Patient Education is essential for both the patient and the patients family What the procedure involves – General anesthesia – Electro current applied to brain To induce seizure – Post op confusion – Need for continued medications – Treatment regiment

11. The side effects/ Memory loss – Headache – Muscle soreness – Nausea – Memory loss that can be significant A few weeks Some never recover all memory Risk vs. benefit – Often a last resort option

12. Nursing Responsibilities INFORMED CONSENT IS A MUST Patents and families must receive written and verbal information before consent is signed.

13. Nursing continued 1) Pre-procedure preparation – Typical pre-op procedures 2) The Procedure – General anesthesia – Other medications used 3) Post Procedure – ABC’s – Reorienting / reassuring

14. After-care and follow-up May see improvement in just a few treatments 6 to 12 treatment are typically required over 2 to 3 months Maintenance therapy and drug therapy

15. Five “Must-Know” Facts about ECT: 1)Used to treat major depressive disorder, schizophrenia, and mood disorders conventional treatment has not been effective 2)Patient and family education is key 3)Decreases the number of re-hospitalizations in comparison to medications alone 4)Nursing responsibility for the patient post procedure include ABC’s of post-op and reorientation of the pt. 5)Typical treatment regimen is 6 – 12 treatments in the space of 1 to 2 months, in combination with meds.

16. References Anderson, J. (2009). Electroconvulsive Therapy (ECT). Retrieved from http://sciencemuseum.org.uk/broughttolife/techniques/ect.aspxhttp://sciencemuseum.org.uk/broughttolife/techniques/ect.aspx Hauser, J., M.D. (2012). An Overview of Electroconvulsive Therapy (ECT). Retrieved from http://psychcentral.com/lib/2006/an-overview-of- electroconvulsive-therapy-ect/http://psychcentral.com/lib/2006/an-overview-of- electroconvulsive-therapy-ect/ Hinds, M. M. PhD, RN, NCS, Hyland, J. R., MS, RN et al. (Eds.). (2011). HESI Comprehensive Review for the NCLEX-RN examination, edition 3. (pg. 325). St Louis: Elsevier. Mayo Clinic Staff. (2010). Electroconvulsive Therapy (ECT). Retrieved from http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129 Mental Health America Staff. (2012). Electroconvulsive Therapy (ECT). Retrieved from http://www.nmha.org/go/information/get- info/treatment/electroconvulsive-therapy-ecthttp://www.nmha.org/go/information/get- info/treatment/electroconvulsive-therapy-ect New York State Office of Mental Health. (2011). Electroconvulsive Therapy Review Guidelines. Retrieved from http://www.omh.ny.gov/omhweb/ect/guidelines.htm http://www.omh.ny.gov/omhweb/ect/guidelines.htm Rosedale, M. (2012). Mary Rosedale on ECT. Retrieved from http://psychcentral.com/lib/2011/mary-rosedale-on-ect/http://psychcentral.com/lib/2011/mary-rosedale-on-ect/ Sabbatini, R. M.E., PhD. (1997). Urgo Cerletti: A Brief Biography. Retrieved from http://www.cerebromente.org.br/n04/historia/cerletti_i.htmhttp://www.cerebromente.org.br/n04/historia/cerletti_i.htm St. James Hospital Staff. (2010). Electro Shock Therapy: Part 1. Retrieved from http://www.youtube.com/watch?v=jgWVyIzGyf0&feature=fvwrelhttp://www.youtube.com/watch?v=jgWVyIzGyf0&feature=fvwrel Unknown Author. (2008). Nutriology: Complete Nutrition to Maximize Your Health. Retrieved from http://www.nutriology.com/camphor.htmlhttp://www.nutriology.com/camphor.html Vines, D., MD., M.S.J. (2009). Taber’s Cyclopedic Medical Dictionary, edition 21. (pg. 735). Philadelphia: F.A. Davis Company