Brain Stimulation Therapies Flashcards
ECT indications:
- Major Depressive Disorder (MDD)
- Clients whose manifestations are not responsive to pharmacologic treatment
- Clients for who the risks of other treatments outweight the risks for ECT
- Clients who are actively homicidal or suicidal and have a rapid need
- Clients who are experiencing psychotic manifestations
- Schizophrenia spectrum disorders
- Acute Manic Episodes (bipolar w/rapid cycling)
Electroconvulsive Therapy:
- uses electrical current to induce brief seizure activity while the client is anesthetized.
- may enhance the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain.
Medical conditions at risk for ECT:
- Recent MI
- History of CVA
- Cerebrovascular malformation
- Intracranial mass lesion
- Increased intracranial pressure
ECT is not useful for:
- Substance abuse disorders
- Personality disorders
- Dysthymic disorder
Preparation for ECT
Preformed 3x a week for 6-12 treatments
- Any meds. that affect seizure threshold must be discontinued
- MAOIs & lithium should be discontinued 2 weeks prior
- Sever HTN should be controlled, short HTN occurs after ECT
- monitor & treat cardiac conditions- dysrhythmias
- 30 min prior- IM injection of atropin sulfate or Robinul to decrease secretions & counteract vagal stimulation.
Electrical stimulus is applied for:
0.2-0.8 seconds, Seizure lasts from 25-60 seconds.
Complications of ECT:
- Memory Loss and Confusion (typically short term)
- Reactions to Anesthesia
- ECG changes (baseline HR my increase by 25%
- Headache, muscle soreness, and nausea
- Relapse of depression- not a permanent cure
Transcranial Magnetic Stimulation (TMS)
TMS is a noninvasive therapy that uses magnetic pulsations to stimulate specific areas of the brain.
A noninvasive electromagnet is placed on the client’s scalp, allowing the magnetic pulsations to pass through, client is alert during the procedure
Indications of TMS
- Major Depressive Disorder, Clients not responsive to pharmacologic treatment.
TMS Treatment:
- Commonly perscribed daily for 4-6 weeks
- can be performed on outpatient basis
- lasts 30-40 min.
Complications of TMS
- mild discomfort or a tingling sensations at site of the magnet
- lightheadedness
- Seizures are rare but potential complication
Vagus Nerve Stimulation (VNS)
VNS provides stimulation through the vagus never to the brain through a device that is surgically implanted under the skin on the client’s chest.
VNS is believed to result in an increased amount of neurotransmitters.
Indication for VNS
- Depression
2. Possibly for anxiety disorders
VNS treatment:
- Outpatient surgical procedure
- VNS device delivers around-the-clock programmed pulsations
- The client can turn off the device at any time by placing a special magnet over the site of the implant.
VNS complications
- Voice changes- due to proximity of the implanted lead on the vagus nerve to the larynx and pharynx.
- hoarseness, throat or neck pain, dysphagia
- Dyspnea, especially with physical exertion.
