Download - Electroconvulsive Therapy
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Electroconvulsive Therapy
Psychiatric- SOMATIC Modality
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Copyright ©2008 Canadian Medical Association or its licensors
Hoag, H. CMAJ 2008;178:1264-1266
Electroconvulsive therapy is increasingly being delivered on an outpatient basis and being administered to seniors as treatment for depression
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ELECTROCONVULSIVE THERAPY
An effective treatment for depression that consists of inducing a grand mal (tonic-clonic) seizure by passing an electrical current through electrodes that are attached to the temples
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ELECTROCONVULSIVE THERAPY
The administration of a muscle relaxant minimizes seizure activity, preventing damage to long bones and cervical vertebrae
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ELECTROCONVULSIVE THERAPY
The usual course is 6 to 12 treatments given two to three times per week
Maintenance ECT once a month may help to decrease the relapse rate for the client with recurrent depression
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ELECTROCONVULSIVE THERAPY
ECT is not a permanent cure Not necessarily effective in clients
with personality disorders,
those with drug dependence, or those with depression secondary to situational or social difficulties
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ELECTROCONVULSIVE THERAPY
At-risk clients include:1. Those with recent myocardial
infarction2. cerebral vascular accident3. cerebral vascular
malformation4. clients with intracranial mass
lesions
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ELECTROCONVULSIVE THERAPY
Contraindications: 1. Angina pectoris2. Congestive heart failure3. Severe pulmonary disease4. Fractures
5. Glaucoma
PREGNANCY
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ECT
Uses Clients with major depressive
and bipolar depressive disorders, especially when psychotic symptoms are present such as delusions of guilt, somatic delusions, and delusions of infidelity
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ECT
Uses Manic clients whose conditions are
resistant to lithium and antipsychotic medications and clients who are rapid cyclers (a client with a bipolar disorder who has many episodes of mood swings close together)
Clients with schizophrenia (especially catatonia), those with schizoaffective syndromes, and psychotic clients.
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ECT
Indications for use When antidepressant medications
have no effect When there is a need for a rapid
definitive response, such as when a client is suicidal or homicidal
The client is in extreme agitation or stupor
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ECT
Indications for use The risks of other treatments
outweigh the risk of ECT The client has a history of
poor medication response, a history of good ECT response, or both
The client prefers it
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ECT
The usual course is 6-12 treatments in 2-3x per week
MAINTENANCE ECT once a month
Usual relief is seen after 2-3 ECTs
If after 12 treatments, no relief is seen, ECT in=s not anymore recommended
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ECT: Pre-procedure
Pre-procedure Explain the procedure
to the client Encourage the client to
discuss feelings, including myths regarding ECT
Teach the client and family what to expect
Informed consent must be obtained when voluntary clients are being treated
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ECT: Pre-procedure
Pre-procedure For involuntary clients, when
informed consent cannot be obtained, permission may be obtained from the next of kin, although in some states the permission for ECT must be obtained from the court
NPO after midnight or at least 4-8 hours prior to treatment
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ECT: Pre-procedurePre-procedure Baseline vital signs are taken The client is requested to void Hairpins, contact lenses, and
dentures are removed
Administer preoperative medication if prescribed; glycopyrrolate (Robinul) or atropine sulfate may be prescribed to prevent aspiration and brady-arrhythmias
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ECT: DURING procedure
Intra-procedure The nurse must obtain an IV line BP and Vitals taken ECG and EEG electrodes are
attached to the body SHORT acting anesthetics are
administered: Methohexital, Thiopental
Muscle relaxant is administered_ Succinylcholine
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ECT: DURING procedure
Intra-procedure Oxygen is given by mask Tongue guard may be
placed on the mouth 110-150 volts of electricity
is delivered for 0.5 to 2 seconds to initiate a tonic clonic seizure, usually lasting for 1-minute
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ECT: POST procedure
POST procedure Continue monitoring of vital signs Patient is usually brought to the
recovery room where emergency drugs and equipments are available
RE-ORIENT the client when he is awake
Provide reassurance that the amnesia is ONLY temporary
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ECT: POST procedure
POST procedure The patient is returned to the room
after all vitals are stable Mental status examination NPO temporarily and introduce foods
once GAG reflex will return
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Potential side-effects
Confusion Disorientation Short term memory loss- which may
last up to 6 months Fractures Arrhythmias