Electroconvulsive therapy

Question 1

what dooes ECT do?

Answer 1

induces a generalised seizure by using an electric current

Question 2

what is he pathophysiology behind it?

Answer 2

initially activates the vagus nerve causes bradycardia and hypotension, then sympathetic discharge occurs (increase in epinephrine and norepinephrine) which causs tachycardia and hypertension

Question 3

what are the indications for ECT?

Answer 3

• 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

Question 4

is ECT effective in chronic schizophrenia?

Answer 4

No

Question 5

What are the side effects of ECT?

Answer 5

• memory loss
• headache
• delirium
• confusion
• osteoporosis/risk of fracture
• premature labour
• muscle pain
• aspiration of gastric onctents
• cardiovascular

Question 6

who is more likely to suffer memory loss after ECT?

Answer 6

those who have had a lrge number of ECTs and at a high frequency

Question 7

What are the ABSOLUTE contraindications for ECT?

Answer 7

only increased ICP and myocardial infarction

Question 8

What are the RELATIVE contraindications for ECT?

Answer 8

• CVD
• aortic aneurysm
• bronchopulmonary disease
• venous thromboses

Question 9

can i have ECT if i have a pace maker?

Answer 9

Yes, but must turn off during ECT or put magnet on it, depending on the manufacturer

Question 10

what is the mortality rate of ECT?

Answer 10

1 in 10, 000

Question 11

what is the normal procedure?

Answer 11

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

Question 12

is it better to use bilateral or unilateral?

Answer 12

depends on the preferenece of the treating psychiatrist

Question 13

where are the EEG elctrodes to be palced during ECT?

Answer 13

2 electrode, 1 inch in above the middle of the eyebrows and on the mastoid processes

Question 14

in bilateral ECT where are the electrodes placed?

Answer 14

placed bitemorally by measuring halfway between tragus and outer eye and 2cm above

Question 15

where are the electrodes placed in unilateral ECT?

Answer 15

one is placed on the temple and the other is on the saggittal plane

Question 16

how do you calculate bilateral ECT dose in an elderly patient?

Answer 16

use a fixed dose! calculate half age and round up to nearest energy level

Question 17

iini an 84 year old patient what ECT dose would you give?

Answer 17

45%

Question 18

how would you calculate the ECt dose inan adult patient?

Answer 18

use a titrated dose! use arbitrary levels based on dose start guidelines

Question 19

how do you calculate does for unilateral ECT?

Answer 19

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.

Question 20

how do you define an effective seizure in bilateral ECT?

Answer 20

• 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%

Question 21

What medications should be stopped prior to ECT?

Answer 21

anticholinergics

lithium

BZDs

atropine

Question 22

if BZDs are contraindicated in ECT, what would you use to calm a patient?

Answer 22

olanzapinr

Question 23

what is the average number of ECT treatments before improvement in symptoms?

Answer 23

9

Question 24

How long does the EEG seizure fo for until you begin to worry?

Answer 24

45 seconds, 60 seconds MSUT STOP THE SEIZURE

Question 25

how do you stop a seizure during ECT?

Answer 25

1. propofol
2. midazolam

Question 26

What side do you place a unilateral ECT?

Answer 26

the non-dominant side, e.g. R side on R handed patient