Electroconvulsive Therapy

Question 1

What are the indications for ECT?

Answer 1

Severe depression

High suicidal risk

Refractory or medically unmanageable depression

Acute refractory mania

Refractory schizophrenia and catatonia

Safe in pregnancy puerperal psychosis

Neuroleptic malignant syndrome

Parkinson’s

Intractable seizures

Question 2

What to check for in pre ECT evaluation?

Answer 2

ASA III or less

Fit for anesthesia

Baseline mental state examination

CONTRAINDICATIONS 
MI in past 6 months
Raised ICP
Recent stroke
Aneurysm 

CAUTIONS
unstable angina
Heart failure 
COPD and asthma
Diabetes

Question 3

How do you prepare the patient for ECT?

Answer 3

Previous day bath

Clean hair

Remove all metal objects, sensory aids, etc.

Keep NBM

Stop benzodiazepines previous day

Continue medical drugs

Empty bowel and bladder

Question 4

How do you administer ECT?

Answer 4

General anesthesia with muscle block

Stimulus is 2 times the seizure threshold

Monitor seizure duration by EEG

Seizure should last 20 seconds

If not re administer after 20 seconds after re oxygenating

Full recovery in 45 mins

Mostly needs 6-8 cycles at 2-3 times a week