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ECT

From ANCC Review

QuestionAnswer
ECT is electroconvulsive therapy
ECT does this elicits a grand mal seizure
usual course of ECT 6-12 treatments
ECT is considered as a late option for resistant illness - per Dr. Nickell, good option none the less. Many insurances will not pay until failure of a medication from each class occurs.
3 theories on the mechanism of action of ECT NT Theory Neuroendocrine Theory Anticonvulsant Theory
NT Theory states ECT acts like TCA, increasing DA, 5HT and adrenergic NT
Neuroendorcrine Theory states ECT releases hypothalamic and pituitary hormones, prolactin, TSH, ACTH and endorphins
ACTH is adrenocorticotropic hormone
Anticonvulsant Theory states ECT exerts anticonvulsant effect on brain leading to an antidepressant effect
situations where ECT may be used need for rapid response due to severe psychiatric or medical conditions risks of other tx outweigh risks of ECT hx of poor med response hx of good ECT response pt preference
Insurance wants this ECT as last resort
Contraindications to ECT pre-existing cardiac illness - must be assessed compromised pulmonary status - must be assessed hx of CNS problems medical complications after anesthesia
Adverse effects of ECT CV effects Systemic Effects Cognitive Effects
Systemic Effects include HA, anorexia, muscle aches, drowsiness, nausea
Cognitive Effects include memory disturbance, confusion
Placement of ECT electrodes (3 areas) Right Unilateral Bifrontal Bitemporal
When not to use Right Unilateral Initially When patient is Left Handed (85% of people are right brain dominant). Treatment over the dominant side can make pts delirius.
Right unilateral and bifrontal provide patients with: Good Response and Low Side Effects
Created by: jonquil
 

 



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