ECT Flashcards
indications principales pour ECT
- Mood Disorders
-MDD
-mania
-mixed
schizo
schizoaff
indications ECT pour MDD
pregnancy
elderly
psychotic D
severely suicidal
Tx resistant / refractory / intolerant
need rapid response
refuse food / fluids
D with motor sx: catatonic/retarded/agitated
indications ECT in mania
Manic Delirium
Acute mania with extreme agitation
indication ECT in schizo
catatonia
acute onset of positive Sx
refractory psychosis
previous response to ECT
secondary indications to ECT
NMS
parkinson
delirium
mood disorder 2ry to med condition
refractory status epilepticus
contraindications aux ECT
Aucune absolue
relatives:
intracranial bleeding / mass with increased ICP/ recent stroke
instable cardiac condition
instable / severe pulmonary condition
clinical effectiveness of ECT depends on…
quality of seizure
special precaution with anaestesia
myastenia gravis
pseudocholinesterase deficiency
NMS
dementia
pregnancy
special precautions to increased autonomic sensitivity
hyperT4
cardiac conditions
stroke
increased ICP
instable anevrism
glaucome
retinal detachment
pheochromocytoma
indications for maintenance ECT
3 R’
Reccurent
Relapse
Resistant
if good response to ECT - consider MECT
pharmaco Tx to prevent relapse
relapse rate is high even with pharmacoTx
are more efficient than M-ECT alone:
Nortriptyline + Li
Li + Effexor
PRIDE study
clear benefit of M-ECT
clear benefit of Li-Effexor-CECT for preventing relapse
Phase 1:
Effexor + unilateral high dose (x6) ECT - highly efficient (70% remission) in elderly
Phase 2:
Effexor + Li + M-ECT : more efficient than Rx alone and intent to treat ECT
cognitive risks of M-ECT
lower short term encoding
absence of cognitive impairment in pts with extensive ECT
no worsing of dementia
subjective memory deficit in some cases
many cognitive domains improve
