Transcript Mental Health Nursing

LECTURE NO. 11
Electroconvulsive
Therapy
Learning Objectives
Define ECT
Describe the possible mechanisms of
action of ECT
State the indications, contraindications
and adverse effects of ECT
Apply the steps of nursing care to clients
receiving ECT
Definition
Electroconvulsive therapy (ECT) is a
procedure in which generalized seizures
are induced by passing electrical current
through the brain with the help of
electrodes applied across the scalp.
Historical Background
Von Meduna (1934) observed that there
was relief in the symptoms of
schizophrenia after a client had
generalized seizure.
Ugo Cerletti and Lucio Bini introduced
ECT in 1938.
ECT was modified in 1951 with the advent
of succinylcholine, a muscle relaxant.
Historical Background (cont.)
There have been numerous
modifications in the electrical
waveforms and electrode placements,
making the procedure all the more
safe and comfortable for the client.
Mechanism of Action
The mechanism of action remains uncertain.
It is speculated that generalized seizure cause
biochemical changes in the areas that control
emotions, sleep and appetite.
 The neurotransmitter theory
ECT corrects the levels of various
neurotransmitters responsible for various
psychiatric symptoms.
Mechanism of Action (cont.)
 The neuroendocrine hypothesis
ECT stimulates the hypothalamus and
pituitary, causing release of various hormones
which in turn control mood, appetite and sleep.
 Another hypothesis
ECT alters the way chemical messages are
passed in the brain by modifying various
messenger systems involved in
neurotransmission.
Indications of ECT
Clinical Indications:
Life-threatening situations
Suicidal
Violence towards self or others
Catatonia—refusal of food/water
Poor response to drug treatment
Intolerance to drug treatment, e.g.
marked side effects
Indications of ECT (cont.)
Diagnostic Indications:
Major depressive disorder especially
with psychotic symptoms
Acute schizophrenia
Mania with over excitement
Catatonia
Others: NMS, Parkinson’s disease
Contraindications
There are no absolute contraindications to ECT
although any condition that causes increased
intracranial pressure calls for extra care and
caution.
Relative contraindications:
– Recent myocardial infarction
– Recent cerebrovascular accident
– Intracranial mass
– Retinal detachment
Contraindications (cont.)
–
–
–
–
Acute narrow angle glaucoma
Congestive heart failure
Uncontrolled hypertension
Conditions associated with increased
anaesthetic risk such as bronchial asthma
and severe chronic obstructive pulmonary
disease
Pregnancy is not a contraindication.
Pre-treatment Evaluation
Detailed general physical examination
Routine laboratory tests including complete
blood count, complete urine examination
and serum electrolytes
Fundus examination
Electrocardiogram
Pre-treatment Evaluation (cont.)
Assessment of dentition especially in
the elderly
Pre-anaesthetic consultation (PAC)
Informed consent for both the ECT and
the anaesthesia
Pre-treatment Nursing Care
Provide information and emotional support
to the client and the family
Complete pre-ECT protocols/documents
Ensure a process of ongoing assessment
of the efficacy of the ECT
Prepare the patient the night before and
on the morning of the ECT
Nursing Care during ECT
Escort the client to ECT room
Introduce the client to the staff in ECT
room
Secure various monitoring leads as well
as ECT electrodes in place
Explain the procedure to the client as it
takes place
Monitor the vitals
Post-treatment Nursing Care
Monitor the vital signs
Ensure the safety of the client
especially if he is confused
Give reorientation reminders to the
client
Frequently reassure the client to
lessen the anxiety
Post-treatment Nursing Care
(cont.)
Shift the client to the ward
Communicate with the other nurses
regarding the client’s condition,
medications given, recovery pattern
and any untoward incidence during
ECT
Assessment and Evaluation
Review the progress of ECT.
– improvement as well as side effects
Document any changes prescribed for
the next treatment.
Communicate these with the family
and the other members of the treating
team.
Adverse Effects of ECT
Prolonged apnoea
Cardiac arrhythmia
Headache
Confusion
Amnesia
Agitation
Fractures and vertebral compression—
rare