ECT and Rapid Tranquilisation

Question 1

ECT acronym

Answer 1

Electroconvulsive therapy

Question 2

ECT

Answer 2

Electrical current passed through brain to induce a seizure

Not always a last resort

Question 3

Uses of ECT

Answer 3

Sever depression
Prolonged or severe mania
Catatonia

Question 4

Risks of ECT

Answer 4

Memory loss
Short term anterograde amnesia
Long term retrograde amnesia

Question 5

Course of ECT

Answer 5

6-12 sessions twice weekly usually

2-5 treatments needed before any noticeable change

Question 6

ECT procedure

Answer 6

Given in hospital ECT suite
Electrodes on skull
General anaesthetic and muscle relaxant
Electrical current for 20-50 seconds

Question 7

Types of ECT

Answer 7

Unilateral

Bilateral - most common in UK

Question 8

Unilateral ECT

Answer 8

Thought to cause less memory loss

Higher current required

Question 9

Bilateral ECT

Answer 9

Thought to cause more memory loss
Quicker to work and recover
Lower current required

Question 10

Side effects of ECT

Answer 10

Memory loss
Headache
Nausea
Confusion
Risks of GA
Arrhythmias / Hypotension

Question 11

Rapid tranquilisation

Answer 11

Use of medication to calm / lightly sedate a pt to reduce risk or allow psychiatric evaluation

Question 12

Section 2 of Mental Health Act

Answer 12

Detained up to 28 days for mental health assessment

Question 13

Section 3 of Mental Health Act

Answer 13

Detained up to 6 months for treatment

Question 14

Section 5 (2) of Mental Health Act

Answer 14

Doctor’s holding power

Detained up to 72 hours for assessment

Question 15

Rapid tranquilisation process

Answer 15

Non pharmacological measures
Rapid tranq
Monitoring

Question 16

Non pharmacological measures for rapid tranquilisation

Answer 16

Why are they distressed and fix it
Distraction and calming
Provide privacy and time out

Question 17

Pharmacological measures for rapid tranquilisation

Answer 17

Oral medication preferred to IM

Lorazepam
Olanzapine
Haloperidol

Question 18

CIs to haloperidol

Answer 18

Prolonged QT

Question 19

Lorazepam

Answer 19

Short acting benzodiazepine

1-2 mg (max 4 mg per day) PO or IM

Question 20

Promethazine

Answer 20

Antihistamine
Licenced for sedation and insomnia Rx
25-50 mg (max 100 mg per day)

Question 21

SE of Lorazepam

Answer 21

Drowsiness

Don’t use with Promethazine as too drowsy

Question 22

SE of Promethazine

Answer 22

Drowsiness

Don’t use with Lorazepam as too drowsy

Question 23

Section 135

Answer 23

police need warrant to remove patient from private property

Question 24

Section 136

Answer 24

police removing patient from public property/community