10 Brain stimulation therapy Flashcards
brain stimulation therapy
offers non-pharmacological treatment for clients w certain mental health disorders
types of brain stim therapy
ECT electroconvulsive therapy
TMS transcranial magnetic stimulation
VNS vagus nerve stimulation
Electroconvulsive therapy
uses electrical current to induce brief seizure activity while pt is anesthetized
-exact mechanism is unknown
ECT is thought to enhance…
the effects of neurotransmitters (serotonin, dopamine, norepinephrine, etc)
ECT is indicated for..
- major depressive disorder
- schizo spectrum disorder
- acute manic episodes
ECT indicated for major depressive disorder
- unresponsive to meds
- risk of other tx outweigh risk of ECT
- rapid tx needed bc suicidal/homicidal
- current psychotic manifestations
ECT indicated for schizo
- schizo w catatonic manifestations
- schizoaffective disorder
ECT indicated for acute mania
- bipolar disorder w rapid cycling
- —4+ eps of acute mania in 1 yr
- unresponsive to tx w lithium + antipsychotic meds
CI for ECT
no absolute CI
but careful w cardiovasc disorders + cerebrovasc disorders
ECT + cardiovascular disorders
ECT can incr stress on heart due to seizure activity
ECT + cerebrovascular disorders
ECT can incr intracranial pressure + blood flow thru brain
typical course of ECT is __ times per week for a total of ____ for depression
- 2-3x/week
- total 6-12x
if ECT is involuntary, consent may be obtained fr..
nect of kin or court order
Pre-ECT work ups
- chest x ray
- blood work
- ECG
___ should be discontinued as they will interfere w seizure process
benzodiazepines
30 mins before ECT, an IM injection of ____ is administered to ______
- atropine sulfate or glycopyrrolate
- decr secretion that could cause aspiration + counteract any vagal stim effects like bradycardia
at time fo ECT procedure, short acting anesthetic __ is given via IV bolus
etomidate or propofol
during ECT, muscle relaxant ___ is admin to paralyze
succinylcholine
short period of ___ may occur immediately after ECT procedure
HTN
during ECT, electrodes are applied to scalp to monitor __
EEG electroencephalogram
clients are expected to be alert __ after ECT
15 min
ECT complications
- memory loss/confusion
- rxn to anesthesia
- cardiovasc changes
- relapse of depressn
memory loss/confusion fr ECT
- short term mem loss/confusion occurs immediately after ECT + can persist for several wks
- can have retrogade amnesia
- most recover fr deficits
is ECT permanent?
NO, weekly/monthly maintenance is needed
-ECT on decr incidence of relapse
Transcranial Magnetic Stim
- uses magnetic pulsation (MRI strength) to stim CEREBRAL CORTEX
- noninvasive
TMS indications
-major depressive (when unresponsv to meds)
TMS is similar to ECT but it does not induce…
seizure activity
TMS is usually prescribed for a period of ____ + each procedure last ____
:4-6 wks
: 30-40min
is the client sedated during TMS?
client is alert during procedure
-might feel tapping/knocking sensation in head, scalp contractions, + tightening of jaw muscles
TMS complications
- mild discomfort/tingling at site of electromagnetics
- headache
- lightheaded
- seizure is RARE
TMS is CI for…
- cochlear implants
- brain stimulators
- medical pumps
- any other metal in devices bc it can interfere w Tx
Vagus Nerve Stim
provides electrical stim thru vagus nerve by a device that is surgically implanted under the skin on chest
VNS is believed to ___ + ___
- incr level of neurotransmitters
- enhance actions of antidepressants
VNS is indicated for..
-depression that is resistant to med or ECT
VNS device delivers around the clock programmed pulsations. Usually ever __ for a duration of ___
5 min, 30 sec
T/F VNS stays on all of the time
FALSE. pt can turn off anytime by playing special magnet over site of device
VNS complications
- voice changes bc device is close to larynx/pharynx
- hoarseness, throat/neck pain, cough [improve over time]
- dyspnea esp w exertion
VNS + dyspnea
-may turn off device during exercise or prolonged speaking
