ECT Description ^ risk of complications involves unilateral (sometimes bilateral) electrode placement over the non-dominant hemisphere to induce tonic-clonic seizure under sedation due to unregulated electrical activity Violent m. contractions followed by rhythmic muscle jerks Indications Indicated in the following refractory cases in which Past antidepressant effect is needed, where there are life threatening symptoms e.g. severe suicidality, malnutrition due to food refusal & severe psychosis or if medications are contraindicated such as in pregnancy Most commonly = depression (most common) MOD with psychosis Schizoaffective disorder Schizophrenia with catatonia Bipolar mood disorders e.g. manic episodes High suicidality or pregnant depressed women (not usually 1st line) Neuroleptic Malignant Syndrome intolerable side effects from med Contraindications No absolute contraindications Relative Contraindications: ^ ICP & space occupying lesions in the brain Recent MI within last 3 months Severe arterial HTN Acute glaucoma Changes in cerbal arteries e.g. aneurysm, angioma strokes bleeding disease & vessel disease lung disease -> anaesthesia related risks ECT is the most effective Tx for severe MOD Techniques/Steps General prep & procedure electrode placement 4-6 sessions before starting to see improvement Max 3 hrs a week, Mon, Wed & Fri done on non-dominant hemisphere & temporal EEG as well as constriction of C/L arm & ankle via BP cuff for seizure monitoring Administration of O 2 via face mask & prep for emergency intubation if needed ECG & Pulse oximetry for vital monitoring Administration of pre-medications: Anti-cholinergics e.g. atropine to ↓ cardiac arrhythmias & oral/resp secretions Mild sedative & hypnotic e.g. methohexital to relieve anticipatory anxiety Short-term anaesthetic, inc. m. relaxants to avoid risk of fracture An electric current is passed from one side of cerebral cortex to the other 6-12 sessions in total, consisting of generalized tonic-clonic convulsion that last 25-30 secs usually 2-3 times per wk. number values according to illness severity if symptoms are esp. severe ECT may initially be administered 3x in 24 hrs in course of Tx the frequency usually ↓ to a monthly maintenance ECT may be considered Tx sessions can be discontinued once symptoms improve Maintenance may be implemented once every 1-8 wks Side Effects More Common Less Common * Reversible memory loss<br> rightarrow retrograde more common than anterograde<br> rightarrow usually resolves within 6 months * Skin burns * Tension type headache<br> rightarrow improves a few weeks after ECT * Temporary, short-term functional disorders<br> e.g. amnesic aphasia * Nausea * Prolonged seizures * Transient m. pain * Disorientation Prognosis safe in all pts including pregnant women & elderly risk of mortality due to cardiac or pul. compromise, is associated with anaesthesia if done properly, ECT is one of safest procedures involving sedation To date no brain damage has been reported with the current method