ECT

Question 1

What is ECT?

Answer 1

Electroconvulsive therapy

A psychiatric treatment in which electrodes are used to apply a small dose of electric current to the skull of an anaesthetised patient to produce seizure activity.

Question 2

What are the 2 different types of ECT?

Answer 2

Bilateral ECT - Electrodes placed on both sides of the head

Unilateral ECT - Electrodes placed on the same side of the head.

Question 3

Compare unilateral & bilateral ECT.

Answer 3

Unilateral ECT (on non-dominant side) results in less memory impairment but is less effective.

Therefore, bilateral preferred when rapid response needed or unilateral ECT not effective for patient.

Question 4

How is ECT carried out?

Answer 4

Anaesthetist, nurse & psychiatrist administer ECT. Anaesthetist gives pt general anaesthetic (Etomidate/Propofol) & muscle relaxant (Suxamethonium). ECG leads attached to chest & EEG pads attached to forehead. Mouth guard put in pt’s mouth. Psychiatrist applies electrical current via electrodes.

Question 5

What is the typical course of treatment?

Answer 5

Twice a week up to a maximum of 12 weeks.

Start to see a response after 2-3 weeks

Wtopped as aoon as pt has maximal benefit - typically seen at about 6-8 weeks.

Question 6

Are antidepressants taken alongside ECT?

Answer 6

Anti-depressant doses are reduced in the lead up to ECT & then are typically commenced again towards the end of the course.

Question 7

How does ECT compare to anti-depressants?

Answer 7

ECT is faster acting, although the outcomes are the same at about 3 months

Question 9

What are the indications for ECT?

Answer 9

• Severe / resistant / life-threatening depression
• Severe / resistant mania
• Catatonia
• Psychosis (rarely)
  
  • Severe depressive symptoms w/ SCZ
  • Postpartum psychosis

Question 10

What are the adverse effects of ECT?

Answer 10

• Risks of general anaesthesia
  
  • Nausea, drowsiness, prolonged apnoea,injury to teeth, tongue or lips
• Short term effects of ECT
  
  • Headaches, confusion, muscular aches, loss of appetite
• Memory impairment
  
  • Amnesia & persistent loss of autobiographical memories (poor evidence)

Question 11

What is the mortality for ECT?

Answer 11

4 in 100,000 - similar to that of general anaesthesia

Greater mortality in patients w CVD (VF or MI)

Question 12

What are the contra-indications?

Answer 12

Same asa those for anaesthetic procedure & any condition made worse by changes in BP & cardiac rhythm:

• Serious heart diseases
• Cerebral aneurysm
• Raised intracranial pressure

Question 13

What pts require extra care when recieving ECT?

Answer 13

• Pts w/ diabetes who take insulin
• Sickle cell pts

Question 14

What is done if the pt refuses or is unable to consent for essential ECT treatment?

Answer 14

Psychiatrist seeks second opinion & discusses situation w relatives

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