Treatment and Interventions

Question 1

Describe the process of Electroconvulsive Therapy.

Answer 1

• mechanism of action unknown
• effective treatment for severe depression
• reserved for patients whose d/o is refractory or intolerant to drug treatment OR who are so severely ill that rapid treatment is required

Contraindications:

• increased ICP
• recent MI
• recent CVA
• retinal detachment
• pheochromocytoma (tumor in adrenal cortex)

Role of Nurse:

• education
• emotional support
• assess baseline level of function
• prepare pt for treatment
• monitor and evaluate response to treatment

Process: brief electrical current passed through brain producing generalized seizures lasting 25 to 150 seconds, pt do not feel stimulus nor remember procedure, pt are given a short-acting anesthetic and a muscle relaxant

• can be unilateral or bilateral (former show less confusion after treatment, later is shown to resolve depression more readily); dominant or nondominant
• repeat 2 to 3 times per wk for total of 6 to 12 treatments
• twice weekly results in less memory loss
• antidepressants are use to prevent relapse of symptoms

Possible MOA:

• down regulation of beta-adrenergic receptors
• up regulation in serotonin
• increased calcium influx and effects on second messenger systems

Question 2

What are the possible adverse side effects of ECT?

Answer 2

Adverse Side Effects:

• hypotension or hypertension
• bradycardia or tachycardia
• minor arrhymias

Common Side Effects:

• headache
• nausea
• muscle pain
• memory loss or disturbance including
  a) transient postictal disorientation (clears in minutes to hours) and
  b) anterograde amnesia (gaps in memory during and soon after ECT)
  c) short-term retrograde amnesia (gaps in memory about things ocurring a few wks or mnths before ECT), usually clears within wks
  d) retrograde memory loss (persistent and severe memory deficits, occurs rarely)