1. ELECTROCONVULSIVE THERAPY (ECT) Dr. Rabie A. Hawari Consultant Psychiatrist

2. ECT -May be safer than TCA for some Pt. -Reserved for Pts. Who have failed other Rx. -For Pts. Who are so acutely dangerous or suicidal & need fast Rx. -May be used prophylactically to prevent recurrence. -Do not cure but induce remission. -Should be combined with other Rx.

3. Indications:- - Major Depression, - Bipolar Disorder II --- Depressed, - Bipolar Disorder --- Manic, - Schizophrenia --- acute, catatonic, paranoid, with Affective s/s, - High suicidelity, - Pregnancy.

4. Procedure:- - production of an epileptiform convulsion (35-80sec), - modified by muscle relaxant (succinylcholine), - under i.v. anesthesia (methohexitone), - by the passage of v. small current of the order of 250-500 milliamps, for up to 1 second duration, - at a voltage not exceeding 150 volts.

5. Pretreatment Physical investigation, Medical Hx. Blood & urine chemistry, Chest X-ray, ECG, NPO.

6. Types:- Bilateral Uilateral (nondominant( - No. of Rx. Less more - Amnesia greater less - Cognitive deficits more likely less

7. Course:- - 3 times / wk, - depressed Pts. need = 6 – 12 treatments, - schizophrenic Pts. Need = 10 -20 treatments, - reassess Pt. between treatments, - stop when there is no evidence of improvement.

8. Side effects:- - Ventricular Arrhythmias. - Transient Memory Impairment 1-2 wks. - Headaches. - Prolonged Seizures. - Prolonged Memory Impairment. - Brain Herniation. - side effects of Anesthesia.

9. Contraindication:- Relative:- - fever, arrhythmia, extreme HTN, coronary ischemia * Absolute:- - recent myocardic infarction, increased Intracranial pressure, brain ca., stroke. ( Mortality :- b/w 1-in- 1000 & 1-in- 10000).