ECT

Question 1

What is ECT?

Answer 1

The passage of a small electrical current through the brain, sufficient to induce a seizure, that is considered to be therapeutic

Question 2

What is ECT used for?

Answer 2

Severe depressive illness
Uncontrolled mania
Catatonia

Question 3

What is catatonia?

Answer 3

State of immobility and behavioural abnormalities manifested by stupor

Question 4

What are the main groups of side effects which arise from ECT?

Answer 4

Memory issues
Risks of anaesthesia
Risks of ECT itself

Question 5

What side effects can arise as a result of the anaesthesia?

Answer 5

MI
Arrythmias
Aspiration pneumonia
Prolonged apnoea
Malignant hyperthermia
Muscle aches (due to suxamethonium)
Death (1 in 100,000)

Question 6

What side effects can arise from the ECT itself?

Answer 6

Confusion
Headache
Status epilepticus
Stroke
Arrythmias
Bleeding from ulcers
PE
Subconjunctival haemmorhage
Raised intraocular pressure
Broken teeth due to muscle clenching of masseter muscle

Question 7

What types of memory changes can arise from ECT?

Answer 7

Retrograde amnesia
Aterograde
Episodic (remembering specific events)
Somantic (meaning of words)
Procedural memory 
Geographical orientation

Question 8

What are some contraindications to ECT?

Answer 8

Raised intracranial pressure
Cerebran aneurysm 
Recent cerebrovascular event
MI within 3 months
DVT
K+ imbalance 
Uncontrolled HR or BP
Acute respiratory infection 
Recent food, fluids, chewing gum, cigarettes, sweets
Cochlear implants
Phaeochromocytoma
Unstable fractures 
Bariatric patients

Question 9

What are some conditions in which you must take caution when giving ECT?

Answer 9

Pregnancy - teratogenic effects in the first trimester
Controlled epilepsy
Pacemakers - can turn it off for the procedure

Question 10

What is the difference between bilateral and unilateral ECT?

Answer 10

Bilateral = 1 electrode over each hemisphere
Unilateral = 2 electrodes over the non-dominant hemisphere

Question 11

What are the differences between using bilateral and unilateral ECT?

Answer 11

Bilateral is effective, has a quicker action, is effective at threshold. Can give cognitive side effects and can be effective when unilateral ECT has failed

Unilateral - not effective at threshold, slower action, less cognitive side effects and is technically more difficult