ECT Flashcards
Indications for ECT
ECT is a highly effective treatment with a strong evidence base, particularly for the treatment of severe depressive disorders, especially when one or more of the following features are present:
- melancholic, catatonic or psychotic features
- suicide risk
- failure to eat or drink adequately
- inadequate response to antidepressant medication
- prior response to ECT.
Other indications may include:
- catatonia
- mania
- schizo-affective disorder
- neuroleptic malignant syndrome
- pregnancy-related disorders
- Parkinson’s Disease.
ECT was first used as a treatment for schizophrenia before neuroleptic medications existed. While no longer a primary indication in the treatment of patients diagnosed with schizophrenia, in particular subsets of patients (catatonia, drug resistance, prominent affective symptoms and signs), ECT still has a role in treatment including in conjunction with medication treatments.
Can you do ECT for a pregnant woman?
YES
- it can be used safely during the second and third trimesters
- Little evidence exists on its use in the first trimester, particularly relating to the potential teratogenic effects of the medications used during ECT
- close consultation with obstetrician and anaesthetist is necessary
Contraindications to ECT
- no absolute contraindications
“more risky” situations - consult with anaesthetist and get second psychiatric opinion / relevant medical/surgical specialist to evaluate risk
- raised ICP
- HTN
- MI within the last 10 days
- intracranial lesions including infarction, haemorrhage, aneurysms, trauma, tumours and dementia
- cochlear implant in situ
- history of post ECT delirium
- recent brain injury, infection, stroke or haemorrhage
- organic brain lesions, cerebral space occupying lesions but without raised intracranial pressure
- unstable angina
- poorly compensated heart failure
- valvular disease
optimising the person’s medical condition and making modifications to the treatment to reduce the risks
What are the risks of ECT?
Adverse effects:
- Mortality: 0.01%
- Sore muscles
- Headache
- Short-term confusion/delirium
- Memory loss
CV risks are the most serious
- sinus arrest, sinus bradycardia, hypotension/hypertension
Workup for ECT
- History
- HTN
- recent MI, any heart problems
- headaches - raised ICP
- intracranial pathology - tumours/bleeds
- previous ECT experience
- medications
- Physical exam
- Baseline cognitive assessment: Adenbrook’s or MMSE
- Investigations: FBC, U&E, ECG, CXR, consider CT
- Avoid medications that will increase risks of ECT or make it less therapeutic: theophylline, diuretics, hypoglycaemics, benzos, lithium, anticonvulsants
Explain the procedure of ECT
- Anaesthetise with low dose propofol (as it is an
- anticonvulsant), not intubated
- Apply electrodes to head (unilateral or bilateral)
- Shock, followed by 10-20 second seizure
Regime:
- 2-3/week
- 6-12 sessions (usually 8 required)
- Point of maximum improvement: when no more improvement is made after 2 further treatments
