CH 10: Brain Stimulation Therapies Flashcards
Electroconvulsive therapy (ECT)
electrical current that induces brief sezure activity while client is anesthisized
- thought to enhance neurotransmitters (serotonin, dopamine, norepinepherine
Indications of ECT
- major depressive disorder
- schizophrenia spectrum disorder (catatonic manifestations; schizoaffective)
- acute manic episodes with rapid cyclining (4 or more epidosed of acute mania within 1 year)
Contraindications of ECT
- CV disorders (recent MI, HTN, heart failure, cardiac arhythmias) which increases stress on the heart
- cerebrovascular disorders (hx of stroke, brain tumor, subdural hematoma) which increases ICP and blood flow
ECT is not used for?
substance use disorder, personality disorder, dysphoric disorder
Procedure of ECT
- 2-3 times a week for a total of 6-12 treatments
- informed consent
- pre-ect work up: chest x-ray, blood work, and ECG
- benzos should be D/C
- short period of severe HTN immediately after
- monitor vitals and mental status before and after
- IV inserted and maintained until full recovery
- electrode on scalp for electroencephelogram
- ongoing BP, ECG, and O2 sat monitoring
- usually alert withing 15 mins
Medication management of ECT
- 30 mins prior: atropine sulfate or glycopyrrolate IM to decrease secretions
- at time: short-acting anesthesia (propofol) via IV bolus
- muscle relaxant (succinylcholine) to paralyze muscles to decrease injury (also decrease respiratory muscles=requires assistance in breathing and oxygenation)
Transcranial magnetic stimulation (TMS)
noninvasive, magnetic to stimulate cerebral cortex
- daily for 4-6 weeks
- lasts 30-40 mins
- tapping or knocking, scalp skin contraction, tightening of jaw
Vagus nerve stimulation (VNS)
electrical stim through vagus nerve through surgically implanted device under skin of chest
- programmed pulsations, usually every 5 min lasting 30 secs
- obtain informed consent
- comps: voice change, hoarseness, throat/neck pain, coughing
