Electroconvulsive therapy (ECT) counselling Flashcards
How should you open the consultation when explaining ECT?
Wash hands, introduction etc
Reason for the consultation:
- I understand that you have a diagnosis of depression and haven’t noticed any benefit from several different types of antidepressant medications
- I am here today to discuss an alternative treatment, called electroconvulsive therapy, that we feel may be beneficial
How would you explain ECT to a patient?
Electroconvulsive therapy, also known as ECT, is a psychiatric treatment in which a patient is put to sleep and a small amount of electrical energy is directed toward the brain which induces a controlled mini seizure
This is thought to alter chemical imbalances in the brain, therefore reducing the severity of psychological illness
What are the potential benefits of ECT?
- One of the most effective treatments for severe depression (70-80% response rate)
- Most patients will experience improvements within 2 weeks
- ECT can have a synergistic effect when used in conjunction with antidepressants to help stabilise mood
How many sessions does a course of ECT involve?
- Course of ECT usually comprises of 6-12 treatments given twice weekly and the patient is reassessed after every treatment
- If improvements are not noticed after 6 sessions of ECT, the course may be stopped
Describe what happens before an ECT session.
- Pre-procedure assessment is carried out by an anaesthetist
- The patient is required to be nil by mouth for 6h before the procedure
- ECT is carried out in an ECT suite - can be in a general or psychiatric hospital
- Short-acting anaesthetic is administered by an anaesthetist
- A muscle relaxant (suxamethonium) is administered in order to minimise the risk of harm to the patient during convulsions
- Patient is attach to an EEG machine for continuous monitoring for brain activity
Describe what happens during an ECT session.
- Carried out by a psychiatrist and can be delivered unilaterally or bilaterally
- Unilateral ECT electrode is placed on the non-dominant hemisphere of the brain
- Unilateral is generally associated with fewer side effects but is less effective than bilateral ECT, so more treatments are required at an increased frequency
- Bilateral ECT is more commonly used due to increased frequency; 2 electrodes are placed on either side of the temples
- A small amount of electrical energy is directed through the electrodes towards the brain; electrical charge lasts ~5 seconds
- The electrical energy to the brain induces a controlled seizure which lasts ~20 seconds; may only be identifiable on EEG
Describe what happens following an ECT session.
- When ECT is complete, the patient will wake up in the recovery room having no memory of the procedure
What are the side effects of ECT?
- Not everyone will experience side effects, but it is important that the patient is aware of them
- Short-term memory loss
- Retrograde amnesia
- Post-ECT headache
- Brief confusion/drowsiness following administration of anaesthetic
Main risks of the procedure are related to the anaesthetic; small risk that the patient will not respond to the treatment
How would you close a consultation involving discussing ECT?
“Today we have discussed ECT, an alternative treatment for your depression. I think this treatment option is something you should consider, given that the antidepressant medications you have tried have not resulted in any improvement in your mood. We know that ECT can help approximately 70-80% of people with the type of depression that you have.”
“You will probably require multiple treatments in order to help stabilise your mood.”
“You would be put to sleep for each procedure, which would involve placing electrodes on either side of your head and passing electrical energy to your brain. The aim is to alter the chemical imbalance in your brain, which is a factor underlying your depression.”
“You may have a mild headache or notice some short-term memory loss following the treatments, but this should not persist or affect you in the long term.”
