ECT

Question 1

What happens during ECT?

Answer 1

Small electric current passed through brain to induce a tonic-clonic seizure which is therapeutic in some way

Question 2

What are the indications for ECT?

Answer 2

• Prolonged/severe mania
• Catatonia
• Severe depression - treatment-resistant, suicide risk, or not eating/drinking

Question 3

What are the contraindications to ECT?

Which are relative and which is absolute?

Answer 3

“MARS”:

• MI within 3 months
• Aneurysm - cerebral
• Raised intracranial pressure
• Stroke within 1 month

Only absolute contraindication is raised ICP

Question 4

Give some side effects of ECT

Answer 4

• Headaches
• Muscle aches
• Status epilepticus
• Short-term memory impairment
• Confusion
• Arrhythmias
• Stroke
  Plus side effects of GA

Question 5

What are the long-term side effects of ECT?

Answer 5

Anteretrograde and retrograde amnesia

Question 6

Outline the ECT procedure

Answer 6

• Short-acting GA inc muscle relaxant

- Electrical current via 2 electrodes - unilateral (right) or bilateral, for at least 30 seconds

Question 7

How many treatments are usually needed and how often?

Answer 7

6 - 12, twice a week +/- further weekly maintenance

Question 8

What is the “seizure threshold”

Which drugs decrease it?

Answer 8

Minimum electrical stimulus required to induce a seizure

Antipsychotics, TCAs, SSRIs, lithium

Question 9

If a patient has capacity but is refusing to consent to ECT, can it be imposed? If so, how?

Answer 9

Yes, if condition is life-threatening

Can use section 3 with section 62 to give 2 treatments, but need a SOAD to authorise more

Question 10

If a patient is under the MHA and lacks capacity, can ECT be given?

Answer 10

Yes, with SOAD approval, but LPA/AD always trumps that.