15 - Psychiatric Emergencies Flashcards
What is ECT?
The application of an electrical current through the brain to induce a seizure. This increases blood flow, dendrites and neurotransmitters
What are the indications for ECT?
- Severe life threatening depression
- Moderate depression that has failed to respond to treatment
- Catatonia
- Prolonged or severe mania
NOT schizophrenia
What are some contraindications to ECT?
- Raised ICP
- Cerebral aneurysm
- MI within 3 months
- Uncontrolled HR/BP
- Respiratory conditions
- Food/fluids in last 6 hours
- Phaeochromocytoma
- Pregnancy
- Epilepsy
What are the side effects of ECT?
1. Anaesthesia: Aspiration pneumonia, nausea, malignant hyperthermia, MI, arrhythmias
2. ECT: confusion, headache, status epilepticus, stroke, broken teeth, subconjunctival haemorrhages
3. Memory: Retrograde and Anterograde amnesia. May also have autobiographical loss
What are the physiological changes that occur during ECT?
CVS: Bradycardia followed by tachycardia
ICP: Increased
Hormone Changes: Increased TSH, ACTH, GH, PRL, Endorphins
How do you get consent for ECT?
- *Has Capacity**
- Informal: Obtain informed consent
- Formal: Obtain informed consent and complete T4
- *Does not have capacity**
- SOAD and complete T6
- If emergency compete C6 (section 62)
If somebody has capacity but does not consent to ECT, can you give it to them?
NO
What monitoring do you need to do for ECT?
- Monitor side effects
- Hamilton Depression Rating Scale (HDRS): baseline, after every treatment, one week and 1-2 months after
- MOCA for cognition: baseline, post 2 and 6, one week and 1-2 months after ECT
What are some alternatives to ECT?
- Vagal Nerve Stimulation
- Transcranial Magnetic Stimulation
What is the difference between unilateral and bilateral ECT?
Bilateral: More effective
Unilateral: Cognitive side effects less severe
What anaesthesia is used in ECT and why?
Propofol/Etomidate: For GA
Suxamethonium: For muscle relaxant for mild seizure
If a patient has severe depression with psychosis, how do you medically treat them?
- High dose Sertraline
- Low dose antipsychotic like Olanzapine
How long is the course of treatment for ECT?
12 sessions, 2 a week is maximum
Usually about 6-8 sessions
What does salicylate overdose do to the blood pH?
Mixed respiratory alkalosis and metabolic acidosis
Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis
In children metabolic acidosis tends to predominate.
What are some features of salicylate overdose?
Tinnitus is one of the earliest symptoms of aspirin OD
How is salicylate overdose treated?
- General (ABC, charcoal)
- IV sodium bicarbonate for urinary alkalisation
- Haemodialysis
