ECT Flashcards
What is ECT?
electroconvulsive therapy is the passage of a small electrical current through the brain to induce a modified epileptic seizure which is seen to be therapeutic
Given 6-12 rounds, twice a week
What does the pre ECT process entail?
performed by psychiatrists, with thorough pre-anaesthetic assessment (physical exam, blood tests, ECG, CXR)
What happens during ECT?
electric current applied to pt skull, via electrodes (unilateral or bilateral) to induce a 30 sec seizure
under GA, with muscle relaxant Suxamethonium to reduce motor SE
EEG carried out to distinguish end of seizure
Compare BL and UL ECT.
UL - both electrodes into non-dominant R hemisphere, elderly if high cognitive side effects
BL - electrode on each side of head, more SE, more effective, for elderly
What is a seizure threshold and what affects it?
*minimum stimulus required to induce seizure
increase - anaesthetic, anticonvulsants, benzo, barbiturates
decrease - antipsychotics, antidepressants, lithium
What are the indications for ECT?
severe depression: treatment resistant, suicidal, refusing to eat
catatonia
prolonged or severe mania
What are the legalities within ECT?
written and informed consent!
pt under MHA, independent second opinion needed
if capacity there, even under MHA can refuse!!
*may override if benefit outweighs risk and if life saving under T6 form?
What are some short term side effects of ECT?
peripheral nerve palsies
cardiac arrhythmias
confusion
dental trauma
anaesthetic risk
muscle pain
short term memory impaired
What are some long term side effects of ECT?
anterograde and retrograde amnesia
*BL worse than UL
What are some contraindications for ECT?
MI 3m ago
major unstable fracture
aneurysm
raised ICP, bleed or space occupying lesion ABSOLUTE
stroke 1m ago
status epilepticus hx, anaesthetic risk
3rd trimester pregnancy
