Neurostimulation: ECT Flashcards
what is the response rate to ECT for mood disorders
75-85% for mood disorders
what is the response rate to ECT for those with mood disorders who have been medication resistant
60-70%
what population has an even higher response rate to ECT
the elderly over age 65
does efficacy of ECT drop off early or late in lifespan?
no
is ECT as good as, worse, or better than sham or standard AD?
PROVEN SUPERIORITY
superior to sham and superior to standard AD therapy (in medication RESISTANT patients)
what are some of the benefits to ECT treatment for patients and hospital systems
ECT can reduce length of stay + hospitalization cost
is both effective and rapid
does the benefit of ECT last after treatment stopped?
may have HIGH RELAPSE rates without maintenance ECT or antidepressant therapy
what 3 disorders have primary indications for ECT
MDD
Mania
Schizophrenia
list primary indications for ECT in someone presenting with MDD
ACUTE SUICIDALITY, high risk
PSYCHOTIC features
CATATONIA
rapidly deteriorating PHYSICAL STATUS due to the depression
history of poor response to meds
history of good response to ECT
if the risk of standard AD treatment is higher than ECT in this patient
patient PREFERENCE
list primary indications for ECT in those presenting with Mania
ACUTE SUICIDALITY, high risk
PSYCHOTIC features
CATATONIA
rapidly deteriorating PHYSICAL STATUS due to the depression
history of poor response to meds
history of good response to ECT
if the risk of standard AD treatment is higher than ECT in this patient
patient PREFERENCE
specific to mania:
–> extreme and sustained AGITATION
–> manic DELIRIUM
list primary indications for ECT in those presenting with schizophrenia
positive symptoms with ABRUPT or RECENT onset
CATATONIA
history of good response to ECT
do those with schizophreniform disorder respond to ECT
yes
in patients presenting with psychosis, which patients are likely to have significant benefit from ECT
is psychosis + significant affective sx
what should the approach to treatment be for someone presenting with psychotic symptoms who is felt to be a good candidate for ECT
ECT + antipsychotics
list disorders for which there is a secondary indication for ECT
catatonia (not due to MDE, mania, schizophrenia)
Parkinsons disease
NMS
delirium
intractable seizure disorder
mood disorder due to another medical condition
what benefit might someone with parkinsons disease see from ECT
may improve MOTOR symptoms (esp. “on/off”)
may need maintenance ECT to sustain remission
what should you do with someones medications if they have parksinsons disease and are receiving ECT
consider adjusting meds during ECT course due to risk of tx emergent dyskinesia or psychosis
how should you approach someone with NMS if you are considering ECT for this patient
DISCONTINUE ANTIPSYCHOTICS first
achieve autonomic stability first
should you do ECT for delirium
it is a secondary indication but should only be RARELY considered
correct reversible physical factors first
can you use ECT in patients with mood sx + dementia
YES
ECT is beneficial for mood symptoms in ALL STAGES of dementia
what benefits might there be from ECT in dementia
may be helpful for AGITATION/SCREAMING even without depression in patients with dementia
–> but NOT RECOMMENDED–> consider nonpharm/pharm approaches first
what are the risks of ECT in patients who are elderly with dementia
increased risk of POST ECT DELIRIUM and COGNITIVE side effects
–> consider changing frequency or technique, and tracking cognitive status
is older age a specific risk for ECT
no–> may actually predict a favorable response
however, dementia and physical illness DO increase the risk of ECT adverse events
–> consider physiological factors during an after anesthesia
**do a preop/anesthesia consult
can you do ECT in adolescents
yes–> can be effective for PRIMARY INDICATIONS and CATATONIA