ECT Flashcards
What is ECT?
Electroconvulsive therapy is the passage of a small electrical current through the brain with the intention of inducing a modified epileptic seizure which is therapeutic.
What is the difference between uni- and bi-lateral ECT?
Discuss which is better
- Unilateral: both electrodes on non-dominant cerebral hemisphere
- Bilateral: one electrode on either side of head
Bilateral proven to be more effective but has more cognitive effects hence may consider unilateral if pt suffered from cognitive side effects previously or pt is elderly.
ECT occurs under general anaesthetic; what else is given to limit motor effects of seizure?
Muscle relaxant e.g. suxamethonium
How many sessions, approximately, does a course of ECT involve?
6-12 sessions
2 sessions per week
What monitoring is done when pt’s have ECT?
- EEG throughout (before, during & after- continuous monitoring)
- Saturations & pulse throughout (under anaesthetic)
- BP (before & after)
What is the seizure threshold?
Minimum electrical stimulus required to induce a seizure and it used to calculate therapeutic dose (which is 1.5x threshold)
How long do you want the seizure to last?
25-30secs
State main indications for ECT- highlighting which is most common
*HINT: think ECT “Euphoric Catatonic Tearful”
- Prolonged or severe mania
- Catatonia
-
Severe depression
- Treatment resistant
- Suicideal ideation or serious risk to others
- Life-threatening depression e.g. refuses to drink
State some short term side effects of ECT
- Drowsiness
- Headaches
- Muscle aches
- Nausea
- Confusion
- Short term memory impairment
- Dental or oral trauma
State a long term side effect of ECT
Retrograde and anterograde amnesia
State some contraindications to ECT
*HINT: think MARS
- MI (<3 months ago), major unstable fracture
- Aneurysm (cerebral)
- Raised ICP
- Stroke (<1 month ago), status epilepticus, severe anaesthetic risk
What questionnaires did LPT give pts to allow them to monitor improvements throughout course of ECT?
- MOCA (baseline, post 2w, post 6w. Then 1 week and 1-2 months after ECT)
- Hamilton depression score (baeline then every other treatment. Then 1 week and 1-2 months after ECT)
What section may be used to allow you to give ECT to pts who don’t have capacity?
Section 62
Discuss consent for ECT, include:
- What happens if pt has capacity and is consenting
- What happens if pt has capacity and is not consenting
- Does not have capacity
- Capacity and consenting= have ECT
- Capacity and NOT consenting= cannot give ECT
- Does not have capacity:
- If treatment is immediately necessary must complete a C6 form to get section 62. Then should requrest an an assessment from SOAD (second opinion approved doctor) independent of trust is required ASAP
- Continue to assess capacity to see if can consent
- If not immediately necessary wait for SOAD before start course
Does a pt need to fast prior to ECT?
Yes, fast for 6hrs
Drink clear fluids up to 2hrs before procedure
