1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 17Somatic Therapies

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Despite studies proving efficacy, it (ECT) remains the most controversial treatment in psychiatry. Hall & Bensing, 2005

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Compare and contrast the rationale for the use of electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), transcranial magnetic therapy (TMS) and magnetic seizure therapy (MST), and deep brain stimulation (DBS) Explain the ECT procedure Identify the indications for using ECT Discuss the conditions associated with increased risk during ECT Recognize the presence of ECT side effects Describe advances in ECT Formulate nursing interventions to prepare a client for ECT

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Therapy Present-day somatic therapies include the following: Psychopharmacology Electroconvulsive therapy (ECT) Vagus nerve stimulation (VNS) Transcranial magnetic stimulation (TMS) Magnetic seizure therapy (MST) Deep brain stimulations (DBS)

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Electroconvulsive Therapy Indications for Use Depression Schizophrenia Depressive phase of bipolar disorder Clients at risk for suicide Therapy-resistant depression Delusional depression Obsessive–compulsive disorder (OCD) Acute schizophrenia Schizoaffective disorder Intractable mania Catatonia Pseudodementia Neuroleptic malignant syndrome Individuals who cannot take antidepressants

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Conditions Associated with Increased Risk During ECT Special considerations Conditions associated with increased risk

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Side Effects of ECT Headache Nausea Disorientation Memory disturbance Postictal (seizure) agitation

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Advances in ECT Seizure duration, characteristics, and end point Augmentation strategies when treatments are ineffective – Changing the placement of electrodes – Selecting an alternate anesthesia – Using intravenous caffeine – Reducing the impact of benzodiazepines by administering the antagonist flumazenil (Anexate) – Blocking serotonin uptake by administering pindolol (Visken)

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Electrode Placement (A) Bitemporal electrode placement (B) Unilateral electrode placement

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Guidelines for ECT ECT is a major treatment with well-defined indications, and it should not be reserved as a last resort. The most common use of ECT is with clients who have not responded to alternative treatments such as pharmacotherapy, exhibit a deterioration in clinical symptoms, or exhibit suicidal ideations. There are no absolute contraindications to ECT; however, consideration is given to the degree of risk to potential benefits of ECT.

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for the Client Receiving ECT Client education prior to ECT Informed consent Client preparation for treatment Care during ECT and the recovery period Resources for client education

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Alternative Somatic Therapies Vagus nerve stimulation (VNS) – Epileptic seizures – Refractory depression Transcranial magnetic stimulation (TMS) – Major depression – Auditory hallucinations – Other psychiatric and neurological disorders Magnetic seizure therapy (MST) – Depression

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Clitoridectomy Deep brain stimulation (DBS) Electroconvulsive therapy (ECT) Electronarcosis Insulin shock therapy Lobotomy Magnetic seizure therapy (MST) Physiotherapy Postictal agitation Psychosurgery Somatic therapy Sterilization Transcranial magnetic stimulation (TMS) Vagus nerve stimulation (VNS)

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection The chapter-opening quotes present “pro” and “con” views of ECT for debate. Which view would you defend? If your answer is “con,” what additional information would you offer to defend your choice? If your answer is “pro,” explain the rationale for your choice. ?