S.no Duration 1.

2 mins

Specific objectives Define electroconvulsive therapy

Content Electro Convulsive Therapy DEFINITION Electro convulsive therapy is a type of somatic treatment in which the electric current is applied to the brain through electrodes placed on the temples of the patient. The passage of an electrical stimulus of 70 to 150 volts to the brain for 0.1 to 0.5 second to produce a grandmal seizure INDICATIONS Major Severe Depression Severe depression with suicidal risk With stupor With melancholia Psychotic feature With unsatisfactory response to drug therapy Where drugs are contraindicated, or have serious side-effects Severe Catatonia With stupor With poor intake of food and fluids With unsatisfactory response to drug therapy Where drugs are contraindicated, or have serious side-effects Where speedier recovery is needed Severe psychosis Schizophrenia or mania With risk of suicide, homicide or danger

Teachers activity Explaining with roller board

Learners activity Listening

Evaluation What is ECT?

2.

3 mins

Mention the indications for electro convulsive therapy

Explaining with chart

Listening

List down the indications for ECT?

3.

3 mins

4.

3 mins

of physical assault With unsatisfactory response to drug therapy Where drugs are contraindicated, or have serious side effects With very prominent depressive features (e.g. schizo - affective disorder List the CONTRAINDICATIONS contraindications Absolute of electro Presence of raise intracranial tension convulsive therapy Relative Recent myocardial infarction Severe hypertension Cerebrovascular accident (CVA) Severe pulmonary diseases Retinal detachment Pheochromocytoma Congestive heart failure Discuss the MECHANISM OF ACTION mechanism of One hypothesis states that ECT possibly affects action the catecholamine pathways between diencephalon (from where seizure generalizations occurs) and limbic system (which may be responsible for mood disorders) also involving the hypothalamus As ECT increases the threshold for further seizures, it may paradoxically act as an anticonvulsant. ECT also causes down- regulation of B1 receptors in cortex and hippocampus

Explaining with OHP

Listening

Can you tell the contraindications for ECT?

Explaining with OHP

Listening

What is the mechanism of action for ECT?

S.no Duration 5. 5 mins

Specific objectives Explain the technique and administration of ECT

Content TECHNIQUE Direct ECT Modified ECT Direct ECT It is administered in the absence of muscular relaxation and general anaesthesia. All other steps are the same as in modified ECT. Modified ECT It is modified by drug-induced muscular relaxation and general anaesthesia administered by an anaesthetist. It is usually administered in the morning after overnight fast for 4 hours before ECT According to the position of application of electrodes, it os of two types Bilateral ECT Unilateral ECT Bilateral ECT This is the standard form of ECT used most commonly. Each electrode is placed 2.5 4.0 cm (1 11/2 inch) above the midpoint, on a line joining the tragus of the ear and the lateral canthus of the eye. Unilateral ECT In this type, electrodes are placed only on one side of head, usually the non-dominant side (right side of head in right handed individual)

Teachers activity Lecturing

Learners activity Listening

Evaluation What are the techniques in ECT?

Parameters of electric current applied Standard dose according to American psychiatric association, 1978 Voltage 70 to 120 volts Duration 0.7 to 1.5 seconds Type of seizure produced Grandmal seizure tonic phase lasting for 10 15 seconds Clonic phase lasting for 30 60 seconds Application of electrodes Special care must be taken to apply the electrodes properly. They should be suitably moistened with electrolyte solution, electrode gel or paste and so also areas of scalp where they are to be applied. The interelectrode should be dry. The electrodes should be applied firmly and rotated slightly. The firm pressure should be continued throughout the passage of current. The person who administers the stimulus should have dry hands and all personnel should avoid direct, contact with metallic parts of the electrodes. Frequency and total number of ECT Frequency: three times per week or as indicated Total number: 6 to 10; up to 25 may be preferred Administration ECT can be administered in a hospital, clinic or in nursing homes. Usually administered in morning hours 6. 5 mins Explain the role of Nurse in administration of ECT NURSES ROLE ECT Team This team consists of psychiatrist, anaesthesiologist, trained nurses and attender Preparation Pre ECT Psychiatric history and mental status examination to determine the indication for ECT Lecturing Observing with demonstration How will you prepare the patient for ECT?

Check for signed consent form Involve the family as much as possible to inform them Discourage cigarette smoking before the procedure Ensure that liquids and solids are not taken six hours before treatment Remove dentures, glasses, pins from the patients and dress them in loose clothing Have the client evacuate bladder and bowels Monitor vital signs before, during and after treatment Give atropine as ordered before treatment Display a warm, supportive attitude to reduce apprehension Withhold night doses of drugs, which increase seizure threshold like diazepam, barbiturates and anticonvulsants carbamazepine Withhold oral medications in the morning Head shampooing in the morning since oil cause impedance of passage of electricity to brain Medicine Tray Sodium pentothal 5 mg kg body weight (150 200 mg) Succinylcholine 0.75 mg/kg body weight (30 -50 mg) Injection atropine sulphate 0.6 mg IM All emergency drugs like diazepam, nitro-glycerine tablets Anticholinergic agents Sufficient autoclaved syringes and needles Spirit swabs

 IV glucose in water, glucose in saline Tourniquet Pre ECT room A room which is pleasant and calm with dim lights Sitting arrangements Attached bathroom and toilet Stretchers ECT room ECT machine Jelly and electrodes Sphygmomanometer to monitor seizures duration Stethoscope Intubation set Availability of EEG and ECG monitoring devices Anaesthetic trolley containing anaesthetic appliance, suction apparatus, facemasks. Tongue depressors, resuscitation apparatus and complete set of emergency drugs Mouth guards (or bite block) made of soft rubber autoclavable and gauze pads Oxygen delivery system Oxygen cylinder with adjustable flow Stretchers Case file cabinet Intra ECT procedure Place the patient comfortably on the ECT table in supine position Stay with the patient to allay anxiety and fear Assist in administering the anaesthetic agent (thiopental sodium 3-5 mg/kg body weight) and muscle relaxant (succinylcholine 1 mg/kg body weight)

Since the muscle relaxant paralyzes all muscles including respiratory muscles, patent airway should be ensured and ventilator support should be started Mouth gag should be inserted to prevent possible tongue bite The place of electrode placement should be cleaned with normal saline or 25% bicarbonate solution, or a conducting gel applied Monitor voltage, intensity and duration of electrical stimulus given Monitor seizure activity using cuff method (in direct method) Monitor EEG during ECT ( in modified ECT) 100% oxygen should be provided Monitor vital signs, oxygen saturation, ECG etc. Record the findings and medicines given in the patients chart Post ECT room Once the patient response to a painful stimulus, he is transferred to post ECT room Spontaneous respirations have resumed with adequate tidal volume and return of pharyngeal reflexes Vital signs are sufficiently stable to permit transfer to a lower level of observation No adverse effect requiring immediate medical evaluation or intervention is present Place the patient on lateral position on a railing cot Orient the patient to time, place and events as he awakens Give medications for minor discomforts such as headaches or nausea

 Document patients responses during and after treatment Check his vital signs and record every 15 mins for the first hours. Allow him to ambulate only when he is awake, alert and able to ambulate Side effect of ECT Amnesia, confusion and EEG slowing. The post ECT confusional state follows tonicclonic seizures Memory impairment, which is reversible consequence of ECT Palpitation, nausea, vomiting, dizziness, dryness of mouth, headache, weakness/fatigue, muscle pain Poor concentration, anxiety, restlessness, sweating, respiratory distress, tongue bite and incontinence Complication Respiratory arrest result of the anaesthesia or muscle relaxant Memory loss Role of Nurse Nurses play an integral role by providing: Accurate education to client and family She must fully understand the indications, contraindications, procedures and side effects of ECT Support the client recommended for ECT and his or her family Nursing diagnosis Anxiety related to impending therapy Deficient knowledge related to necessity for side effects or risks of ECT Risk for injury related to risks associated with ECT

SUMMARY So far I have discussed about the electroconvulsive therapy, its definition, indications, contraindications, mechanism of action, techniques and nurses role while administration of ECT. CONCLUSION Electroconvulsive therapy (ECT) formerly known as electroshock. Electro convulsive therapy is a type of somatic treatment in which electric current is applied to the brain through electrodes placed on the temples of the patient. The passage of an electrical stimulus of 70 to 150 volts to the brain for 0.1 to 0.5 second to produce a grandma seizure.

INTRODUCTION

Electroconvulsive therapy was first described by Cerletti and Bini in 1938 as a treatment for schizophrenia. It is a treatment in which a grandma seizure is artificially induced in an anesthetized patient by passing an electrical current through electrodes applied to the pa tients head. Traditionally the electrodes have been applied bilateral electrodes. It is a safe and effective treatment alternative for individuals with depression, mania, or schizoaffective disorder who do not respond to other forms of therapy. ECT has been used continuously for more than 50 years longer than other physical treatment available for mental illness.

CENTRAL OBJECTIVES The student teacher helps the student to gain adequate knowledge about ECT and develop a desirable attitudes toward the procedure and develop skills in caring of patient pre, during and post ECT procedure CONTRIBUTORY OBJECTIVES At the end of the class, the student will be able to define electro convulsive therapy mention the indications for electro convulsive therapy list the contraindications for ECT Discuss the mechanism of action of ECT Explain the technique and administration of ECT Explain the technique and administration of ECT