Electroconvulsive therapy is an important therapy which is used for psychotic patient

2. Introduction:
 Electroconvulsive therapy is a type of
somatic treatment, friend introduced by BINI
AND CERLETTI IN APRIL 1938.from 1980
onwards ECT is being considered as a unique
psychiatric treatment.

3.  Electroconvulsive therapy (ECT) is defined as
a physical /somatic therapy in which with
the help of two electrodes, current is passed
through the temporal region in between the
two hemisphere of the brain, to produce a
grand mal- type of seizures, which safe,
effective and life is saving.

4.  Neurotransmitter levels all increased in CSF
after seizure. Results in down regulation of
Beta adrenergic receptors.
 During seizure- PET studies show an increase
in BBB permeability and in cerebral blood
flow and metabolism.
 After seizure, blood flow and metabolism is
decreased especially in the frontal lobes.
Research shows this correlated w/ response.

5.  ECT machine
 Jelly and electrodes
 Sphygmomanometer to monitor seizures
duration
 Stethoscope
 Intubation set
 Availability of EEG and ECG monitoring
desirable
 anaesthetic trolley containing anaesthetic
appliances

6.  suction apparatus
 face masks
 tongue depressors
 resuscitation apparatus complete set of
emergency drugs
 Oxygen delivery system
 Oxygen cylinder
 Ambu bag, defibrillator
 Stretchers
 Case file

7. There are two types of E.C.T.
 1. Direct ECT: Direct ECT is given without
any muscle relaxant and anaesthesia.
 2. Modified ECT

8.  Unilateral electrode position: The electrode
is placed only on one side of head usually
non dominant side. (Right side of the head in
a right handed individual).
 Bilateral ECT:
 Each electrode is placed 2.5-4 cm (1-11/2
inch)

9.  Major Depressive Disorder
 Mania
 Schizophrenia
 Postpartum Psychosis
 Schizoaffective Disorders
 Psychosis in first trimester of pregnancy
 Others-OCD, epilepsy, organic mental
disorder, hypochondriac neurosis with
depression

10.  Absolute:
 Raised ICP (intra cranial pressure)
 Relative :
 Cerebral aneurysm
 Cerebral haemorrhage
 Brain tumour
 Acute myocardial infarction
 Congestive heart failure
 Pneumonia or aortic aneurysm
 Retinal detachment

11.  Amnesia, confusion memory loss.
 Palpitation, nausea, anxiety, restlessness,
sweating, respiratory distress, tongue bite and
incontinence.
 Fracture and dislocation are caused by muscular
contraction.
 Fracture of vertebrae, femur and humorous can
occur.
 Dislocation of jaw, Muscle soreness
 CVS adverse effect- Bradycardia, tachycardia,
hypertension.
 Death-Very rare due to anaesthetic
complication.

12. Pre ECT care:
 Check for written consent
 Detailed physical examination is done
 Fill ECT chart
 Keep the patient nil orally.
 Withhold the night dose of drug, which increase seizure
threshold.
 Ask the patient to take bath. Not to put oil hair and face.
 Remove jewellery, artificial denture, contact lens, metallic
object tight cloths.
 Empty bladder and bowel just before ECT.
 Administer inj. Atropine IM 0.6mg in 30 mins before ECT.


13. Intra ECT care:
 Keep the patient comfort in supine position on a
well padded bed.
 Well padded mouth pad is placed in between the
teeth.
 Support the arm and shoulders lightly.
 Hyper extension of the head with support the
chin by the nurse.
 Give few breath of oxygen to the patient.
 Clean the area with normal saline where
electrode to be placed.
 Observation of convulsion by use of cuff method.

14.  Post ECT care:
 Record vital sign.
 Do suction.
 Put side railing and keep the patient in side
position.
 Record the level of consciousness.
 Reassure the patient.