Electroconvulsive Therapy (ECT) In Psychiatry today

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.

History of ECT ECT Scalp Machine, c1958.

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

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

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

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

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

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

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

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

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

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

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

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.

References Anderson, J. (2009). Electroconvulsive Therapy (ECT). Retrieved from Hauser, J., M.D. (2012). An Overview of Electroconvulsive Therapy (ECT). Retrieved from electroconvulsive-therapy-ect/ 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 Mental Health America Staff. (2012). Electroconvulsive Therapy (ECT). Retrieved from info/treatment/electroconvulsive-therapy-ecthttp:// info/treatment/electroconvulsive-therapy-ect New York State Office of Mental Health. (2011). Electroconvulsive Therapy Review Guidelines. Retrieved from Rosedale, M. (2012). Mary Rosedale on ECT. Retrieved from Sabbatini, R. M.E., PhD. (1997). Urgo Cerletti: A Brief Biography. Retrieved from St. James Hospital Staff. (2010). Electro Shock Therapy: Part 1. Retrieved from Unknown Author. (2008). Nutriology: Complete Nutrition to Maximize Your Health. Retrieved from Vines, D., MD., M.S.J. (2009). Taber’s Cyclopedic Medical Dictionary, edition 21. (pg. 735). Philadelphia: F.A. Davis Company