Transcript ELECTROCONVULSIVE THERAPY By:

ELECTROCONVULSIVE
THERAPY
By:-Dr.Santosh Mishra
HISTORY
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Von Mesuna in 1934,used 25% camphor in oil
intramuscularly to produce convulsion for the
first time for therapeutic purposes.
Later he used metrazol for the same
purposes.
A much safer form of convulsive therapy was
used by Cerletti and Bini in 1938 called it EST
or electroshock therapy.
Later this method of treatment came
to be known as ECT or electroconvulsive
therapy.
INDICATION
1.Major severe depression
a.With suicidal risk(this is the first and most
important indication for ECT)
b.With stupor
c.With poor intake of food and fluids.
d.With melancholia
e.With psychotic features.
f.With unsatisfactory response to drug
therapy.
g.Where drugs are contraindicated or have
serious side effects.
h.Where speedier recovery is needed.
2.Severe catatonia
a.With stupor
b.With poor intake of foods and fluids
c.With unsatisfactory response to drug
therapy.
d.Where drugs are contraindicated or have
serious side effects.
e.Where speedier recovery is needed.
3.Severe psycoses(schizophrenia or
mania)
a.With risk of suicide,homicide or danger of
physical assault.
b.With unsatisfactory response to drug
therapy.
c.Where drugs are contraindicated or have
serious side effects.
d.With very prominent depressive
features(eg;schizo-affective disorder)
CONTRAINDICATIONS
A.Absolute
The only absolute contraindication is the
presence of raised intracranial tension.
B.Relative
1.Recent myocardial infarction
2.Severe hypertension
3.Cerebrovascular accident
4.Severe pulmonary disease
5.Retinal detachment
6.Pheochromocytoma
TECHNIQUES
The techniques used for ECT administration
are of two types:a.Direct ECT:Here ECT is given in the
absence of muscular relaxation and
general ansesthesia.
All other step are same as modified
ECT.This method of treatment is now very
infrequently used.
b.Modified ECT:Here ECT is modified by drug-induced
muscular relaxation and general
anaesthesia given by anesthetist.
Pre-Treatment Evaluation
The pre-treatment evaluation consists of
the following steps:1.An informed consent.
2.Detailed medical and psychiatry history
taking,which includes the current and past
treatment history.
3.General and systemic physical
examination.
4.Routine laboatory investigation like
Hb,TC,DC,ESR,urine-RME,ECG,chest X-ray,
and other needful investigation.
5.Examination of fundus to rule out
papilledema.
PROCEDURE
-ECT is usually administered in the morning
after an overnight fast.
-If given at any other time during the
day,the patient should be empty stomach
for at least 4hrs.
-No oral medication should be given in the
morning.
-The bladder and bowel should be emptied
just before the treatment,as incontinence
can occur during the induced seizure.
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The usual anaesthetic precautions are taken.
The patient is placed on a hard bed which is
well insulated.
A slow intravenous drip started.
Atropine(0.6mg)is given i.v. just before the
treatment (given to decrease oral secretions
and to prevent vagal stimulation which can
cause cardiac arrest).
This is followed by administration of an
anaesthetic agent like propofol or
thiopentene and a muscle relaxant
succinylcholine.
An oxygen mask is placed on the face and
ventilation with 100% oxygen is given.
Then a mouth gag is inserted between the
teeth,to prevent tongue bite during the
convulsion.
 Then the electrodes(u-shaped in most
equipments)are moistened with saline or
25%bicarbonate solution and are applied on
the head.
 According to position of application of
electrodes,ECT is of two types:i.Bilateral ECT:This is the standard form of ECT
used most commonly.Each electrode is placed
2.5-4.0cm(1-1half inch)above the midpoint
on a line joining the tragus of the ear and the
lateral canthus of the eye.
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ii.Unilateral ECT:-
Here,the electrodes are
placed only on one side of head.
The therapeutic adequacy of the treatment is
gauzed by the occurrence of a generalized
tonic-clonic seizure lasting for not less than
25-30 secs.
This is made sure by:a.Observing the seizure(in direct ECT)
b.EEG recording during ECT(in modified ECT).
c.Occluding the circulation of one extremity
with a BP apparatus cuff,before giving
succinylcholine.Thus the whole body is
paralyzed but one extremity convulses and
can be directly observed.
d.Observing plantar extension and eyelid
contractions,which may be seen even
despite the muscular relaxation.
The usual dose for
obtaining
an adequate seizure response is90-150volts
(average 110volts)for 0.1-1.0seconds
(average0.6seconds).
The usual amount of current passed in an
ECT session is 200-1600mA.
Duration of therapy
The total duration and number of
treatments given depends on the
diagnosis,presence of side-effects and the
response of treatment.
Usually 6-10 treatments
are sufficient,although up to 15 tretments
can be given if needed.
The treatment should be spaced,so that no
more than 3ECTs are given per week.
Side-Effects
1.Side effect associated with general
anesthesia:
Death during ECT are due to general
anesthesia,
Succinylcholine and drug reactions(1:1000).
2.Memory disturbances(both anterograde
and retrograde)are very common.
These are mild and recovery
occurs within 1-6 months after treatment.
3.Confusion may occur.
4.Other side-effects include
headache,prolonged apnea,prolonged
seizure,cardiovascular
dysfunction,emergent mania, muscle
aches.