Electroconvulsive therapy Flashcards
what dooes ECT do?
induces a generalised seizure by using an electric current
what is he pathophysiology behind it?
initially activates the vagus nerve causes bradycardia and hypotension, then sympathetic discharge occurs (increase in epinephrine and norepinephrine) which causs tachycardia and hypertension
what are the indications for ECT?
- severe depression (psychotic, melancholic, catatonic)
- depression, schizphrenia, manic disorder which is unresponsive to medication
- extreme suicidality with vegetative signs
- psychoses and depression during pregnancy (when medications are contraindicated)
- NMS
is ECT effective in chronic schizophrenia?
No
What are the side effects of ECT?
- memory loss
- headache
- delirium
- confusion
- osteoporosis/risk of fracture
- premature labour
- muscle pain
- aspiration of gastric onctents
- cardiovascular
who is more likely to suffer memory loss after ECT?
those who have had a lrge number of ECTs and at a high frequency
What are the ABSOLUTE contraindications for ECT?
only increased ICP and myocardial infarction
What are the RELATIVE contraindications for ECT?
- CVD
- aortic aneurysm
- bronchopulmonary disease
- venous thromboses
can i have ECT if i have a pace maker?
Yes, but must turn off during ECT or put magnet on it, depending on the manufacturer
what is the mortality rate of ECT?
1 in 10, 000
what is the normal procedure?
done twice a week and give 6 treatment (3 weeks)
fast from midnight and refrain from smoking 2 hours before
patient under a short-acting anaesthesia and muscle relaxing agent
a gel paste is used to create good conduction o te probes
is it better to use bilateral or unilateral?
depends on the preferenece of the treating psychiatrist
where are the EEG elctrodes to be palced during ECT?
2 electrode, 1 inch in above the middle of the eyebrows and on the mastoid processes
in bilateral ECT where are the electrodes placed?
placed bitemorally by measuring halfway between tragus and outer eye and 2cm above
where are the electrodes placed in unilateral ECT?
one is placed on the temple and the other is on the saggittal plane
how do you calculate bilateral ECT dose in an elderly patient?
use a fixed dose! calculate half age and round up to nearest energy level
iini an 84 year old patient what ECT dose would you give?
45%
how would you calculate the ECt dose inan adult patient?
use a titrated dose! use arbitrary levels based on dose start guidelines
how do you calculate does for unilateral ECT?
titrate to find dose necessary to cause a clinical seizure, then times by 6 to obtain dosse. give 100% energy if having diffuclty finding seizure threshold.
how do you define an effective seizure in bilateral ECT?
- clinical seizures lasts 20 seconds, EEg seizure lasts 25 seconds
- EEG seizure is of a high amplitude, is rapidly recruited, 3Hz waves and spike activity
- post-ictal suppression in >85%
What medications should be stopped prior to ECT?
anticholinergics
lithium
BZDs
atropine
if BZDs are contraindicated in ECT, what would you use to calm a patient?
olanzapinr
what is the average number of ECT treatments before improvement in symptoms?
9
How long does the EEG seizure fo for until you begin to worry?
45 seconds, 60 seconds MSUT STOP THE SEIZURE
how do you stop a seizure during ECT?
- propofol
- midazolam
What side do you place a unilateral ECT?
the non-dominant side, e.g. R side on R handed patient
