ECT

Question 1

What are the indication of ECT?

Answer 1

• Severe depression if there is a life threatening situation (e.g. poor oral intake, acutely suicidal (no consent needed if under MHA only in emergency situation) or the depressive illness is treatment resistant
• Uncontrolled mania
• Catatonia
• (also schitzophrenia but not NICE approved)

Question 2

What are contraindications of ECT?

Answer 2

No absolute contraindications as is a life-saving treatment

Caution in higher risk patients
◆ Heart disease/stroke
◆ Raised ICP
◆ Risk of cerebral bleeding (hypertension, stroke etc)
◆ Pacemaker, Pregnant women, Epilepsy

Question 3

How is a procedure of ECT done?

Answer 3

1. Patient under general anaesthesia (+ routine physical investigations for GA + NBM 8h prior to ECT)
2. Administration of muscle relaxant (to avoid dislocations)
3. Administration of ECT
4. Monitoring EEG
5. Repeat rating scale before and after

Question 4

What is catatnoia?

Answer 4

Increased resting muscle tone which is not present on active or passive movement

Question 5

What are the legal restrictions

Question 6

What are the effects of bilateral

Answer 6

Advantage
* effective at threshold, more eficacious, quicker

Disadvantage
cognitive side effects; language problems or visiospatial
orientation problems

Question 7

What are the side effects of ECT?

Answer 7

1. Anterograde Memory loss (a few hours after) (retrograde can occur, but less)
2. Risk of Anaesthetic
3. Risk of ECt
   * confusion, muscle pain, headache nasuea
   * Effect on cognition, most people will recover by 6 months

Question 8

Unilateral

Answer 8

Advantage
* fewer cognitive side effects

Disadvantage

Question 9

What is the prognosis of ECT?

Answer 9

• 80% respond well to ECT treatment

Often fewer side effect than antidepressants and quicker acting
* robust evidence, optimal time of convulsion 15-25s

Question 10

How does ECT work?

Answer 10

Unsure
* potentially neurotransmitter release and changes
* Restructuring of brain
* more theories

Question 11

What is the treatment regime of ECT?

Answer 11

Usually
* 2 sessions / week
* 6-12 sessions
* can be both inpatient and outpatient
* prescribed and reviewed after each session

Question 12

What is TMS?

Answer 12

Transcranial Magnetic Stimmulation
* Magnetic curren
* Evidence: might work short-term, but not amazing evidence that it is very effective longer term
* But included in NICE now, as no major safety concern