ECT

Question 1

When in ECT indicated?

Answer 1

For the following forms of depression.

• With life threatening poor fluid intake
• With strong suicidal intent
• With psychotic features or stupor
• When antidepressants are ineffective or not treated
• It can precipitate a manic episode for bipolar pts but is also an effective treatment in established mania
• Certain types of schizophrenia, specifically catatonic states, positive psychotic symptoms and schizoaffective disorder
• Puerperal psychosis (new mothers) to rapidly reunite her with her baby.

Question 2

MOA
-How many treatments are given and how often?
What is the pts given before treatment?
-What type of seizure does the electric current cause and how long does this last for?
-How is it thought to work?

Answer 2

• Pts need 4-12 treatments which they receive 2-3x per week
• An anaesthetist gives a short acting inducing agent and muscle relaxant that ensures 5 minutes of general anaesthesia
• A generalised seizure for 15 seconds or more

-Its not clear how ECT works; it causes a release of neurotransmitters in the brain as well as hypothalmic and pituitary hormones and whilst also affective neurotransmitter receptors and 2nd messenger systems thereby resulting in a transient increase in BBB permeability

Question 3

What are the S.Es of ECT?

Answer 3

• Mortality is the same as any surgery under GA. Loss of memory particularly of events surrounding the ECT process. Some pts have an impairment of autobiographical memory. Memory impairment can be reduced by unilateral electrode placement
• 80% of pts experience minor problems such as nausea, confusion, headache and muscle pains
• Pts on antipsychotics and antidepressants may experience a prolonged seizure as these lower seizure threshold

Question 4

What are the CIs of ECT

Answer 4

-No absolute CIs some relative ones; Heart disease, raised intracranial pressure, risk of cerebral bleeding and poor anaesthetic risk