Start electroconvulsive therapy if it is determined you are a candidate for electroconvulsive therapy, the psychiatrist will tailor a treatment plan based on your needs and prescreening evaluation. Apr 04, 2020 electroconvulsive therapy ect is an effective treatment for clinical depression or major depression, as well as in some forms of recurrent or chronic clinical depression with one big caveat. Electroconvulsive therapy is not a required subject in us medical schools and not a required skill in psychiatric residency training. Recovery after electroconvulsive therapy british journal of. Electroconvulsive therapy ect is available for people suffering from particular behavioral and emotional disturbances, including some forms of depression, bipolar disorder, and schizophrenia. Anaesthesia for electroconvulsive therapy sage journals. Electroconvulsive therapy treatment in patients with somatic symptom and related disorders kawai leong,1 joseph cw tham,2 anton scamvougeras,2 fidel vilarodriguez3 1department of psychiatry, 2bc neuropsychiatry program, department of psychiatry, 3noninvasive neurostimulation therapies laboratory at ubc, department of psychiatry, university of british columbia, vancouver, bc, canada. Ect is a treatment that uses a small electrical current to stimulate the brain and cause a seizure. Previous position papers were published in 1980 1 and 1992. This article explains how and why ect is performed, and what nurses need to know to provide competent and compassionate patient care. Electroconvulsive therapy ect is now an accepted treatment for certain psychiatric disorders. Electroconvulsive therapy ect, even after all these decades of use, and in spite of the psychopharmacologic revolution, has remained the most effective treatment in psychiatry and is highly effective, safe, and even a lifesaving treatment for patients suffering from persistent and severe depression, bipolar disorder, and schizophrenia. Chapter 20 electroconvulsive therapy flashcards quizlet. Electroconvulsive therapy ect is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure.
Ect was introduced in 1938 and has since undergone dramatic changes so that modern ect no longer resembles the early treatment often portrayed in the media. Electroconvulsive therapy ect is one of the more controversial treatments offered by psychiatrists. Electroconvulsive therapy program ucsf department of psychiatry. In 146 out of the 147 treatments, the anaesthesia proceeded uneventfully.
Sep 24, 2019 electroconvulsive therapy ect is a safe and effective treatment for major depressive disorder, bipolar disorder, catatonia, schizophrenia, and several other conditions. Performance specifications electroconvulsive therapy. April 20 saw the 75th anniversary of the first use of electroconvulsive therapy ect, making it the oldest surviving physical treatment in. Shelley miller when jane finished her series of electroconvulsive therapy ect, her mother was furiousbut not for the reasons youd expect. Atotw 306 anaesthesia for electroconvulsive therapy 742014 page 4 of 7 should be used cautiously. Pdf despite advances in pharmacotherapy, electroconvulsive therapy ect remains a mainstay treatment option in psychiatry since its introduction in. Anaesthesia for electroconvulsive therapy bja education.
Electroconvulsive therapy as a treatment for mental. Electroconvulsive therapy ect, formerly known as electroshock therapy, is a psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders typically, 70 to 120 volts are applied externally to the patients head resulting in approximately 800 milliamperes of direct current passed through the brain, for 100 milliseconds to 6 seconds. Electroconvulsive therapy today indepth report people who have had ect before and responded well are good candidates for ect. Stimulus is applied through electrodes placed bilaterally in the frontotemporal region or. Treating mental illness with electroconvulsive therapy. Several modifications including general anaesthesia and muscle relaxation are used to increase the safety and patient acceptability of ect. Ect major depression severe with or without psychotic features. It is the largest professional membership organization committed to the specialty practice of psychiatricmental health nursing pmhn. Electroconvulsive therapy lifts depression, sustains remission in older adults july 18, 2016 science update an individualized program of followup treatment with electroconvulsive therapy ect combined with an antidepressant was effective in preventing relapse in patients 60 years and older who had had a successful initial course of. Anaesthesia for electroconvulsive therapy bja education oxford. Electro convulsive therapy ect is the electrical induction of a grandmal seizure. Several evidencebased documents on the use of electroconvulsive therapy ect indicate that it is a safe and effective treatment for a variety of psychiatric disorders. Electroconvulsive therapy ect procedures have risks, and these risks are associated with general anesthesia, tonicclonic seizure and convulsion, the interaction between concomitant medications and ect, and other procedural aspects of ect.
Ect for depression in the elderly national elf service. Pdf on dec 1, 2010, vishal uppal and others published anaesthesia for electroconvulsive therapy find, read and cite all the research you need on researchgate. Electroconvulsive therapy ect is a safe and effective evidencebased medical treatment. The use of electroconvulsive therapy ect to provoke a generalized epileptic seizure was first described in 1938 and was performed without anesthesia for almost 30 yr. The findings suggest that provision of anaesthesia and electroconvulsive therapy in patients with cardiac pacemakers, including rateresponsive pacemakers, is a safe undertaking, with no extra precautions.
Anesthesia for electroconvulsive therapy free download as powerpoint presentation. It is an effective therapy used as part of the treatment of several psychiatric conditions including depression, mania, catatonic schizophrenia and other psychosis. Electroconvulsive therapy ect is a nonmedication medical treatment that addresses severe psychiatric symptoms, after trials of medications and psychotherapy have been unsuccessful or a mental health disorder is determined to be severe and acute enough to warrant this intervention. Ect is the induction of a grand mal generalized seizure through the application of electrical current to the brain. Anesthesia for electroconvulsive therapy electroconvulsive. A variety of adverse physiological and physical effects occurcardiovascular and central nervous system responses are potentially most dangerous.
Electroconvulsive therapy treatment in patients with somatic symptom and related disorders kawai leong,1 joseph cw tham,2 anton scamvougeras,2 fidel vilarodriguez3 1department of psychiatry, 2bc neuropsychiatry program, department of psychiatry, 3noninvasive neurostimulation therapies laboratory at ubc, department of psychiatry, university of british columbia, vancouver, bc, canada objective. Outpatient services electroconvulsive therapy ect electroconvulsive therapy ect is a procedure during which an electric current is passed briefly through the brain via electrodes applied to the scalp to induce generalized seizure activity aimed at reducing refractory acute. Electroconvulsive therapy ect is a physical treatment used for a range of mental illnesses. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. Her daughter had undergone a series of procedures in which doctors at the university neuropsychiatric institute uni induced seizures by sending electric currents through janes brain. Ect is often undertaken on remote sites in elderly patients with significant comorbidity. Electroconvulsive therapy nursing care and interventions. An acute course of electroconvulsive therapy usually involves two to three treatments per week, for a total of six to 12 treatments. Electroconvulsive therapy ect is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. Studies have reported that obese patients have delayed gastric emptying and are therefore at increased risk for aspiration of gastric contents. Obese outpatients undergoing electroconvulsive therapy ect pose a special dilemma for many anesthesiologists.
Because electroconvulsive therapy can be used as a form of treatment for those with depression or bipolar disorder, and some types of schizophrenia, there is potential for social workers to provide education and support to clients from many different cultural, religious, or ethnic backgrounds about this form of treatment. Electroconvulsive therapy pdf pdf file the page you are accessing is a downloadable pdf file. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pdf anesthesia for electroconvulsive therapy enrique. Pdf anaesthesia for electroconvulsive therapy researchgate. It has proven superiority in prospective studies comparing ect with sham ect1,2, and with standard antidepressant treatment in medicationresistant patients. Originally known as electroshock therapy, ect was first introduced by a pair of italian psychiatrists in 1938. Now the number of ect procedures performed each year under general anesthesia in the united states exceeds the number of coronary revascularization, appendectomy, and herniorrhaphy procedures. The patient is put to sleep for approximately 5 to 10 minutes with a short acting anesthetic agent and given. Electroconvulsive therapy has been used in pregnancyinduced depression. It is also a valuable resource for medical students and psychiatric residents, as.
Ect uses an electric current to cause a seizure in the brain and is one of the fastest ways to treat severe symptoms of mental illness. On 18th april 1938, italian neuropsychiatrists, lucio bini and ugo cerletti were the first to use electricity to induce seizures as treatment for schizophrenia. It is also a valuable resource for medical students and psychiatric residents, as well as experienced clinicians and researchers. An overview with an update on its role in potentiating electroconvulsive therapy article pdf available in indian journal of anaesthesia 615. Electroconvulsive therapy ect is most commonly used to treat severe or medicationresistant depression, although it can also be beneficial in mania and catatonia. Electroconvulsive therapy ect is a safe and effective treatment for a variety of psychiatric and some medical conditions. Sometimes, it is helpful for mania, acute schizophrenia, parkinsons disease, and some other disorders. We compared sevoflurane, a shortacting halogenated anesthetic, to methohexital for induction in ect. It is typically administered by a team of trained medical professionals. The goal is to produce a therapeutic generalized seizure 3060 sec in duration. Monoamine oxidase inhibitors too show a profound pressor effect with both direct and indirectly acting sympathomimetic agents and have traditionally been stopped at least 2 weeks prior to ect. You may retrieve this document by clicking the following link. Ect is used most often to treat serious depression.
Apa official actions position statement on electroconvulsive. Electroconvulsive therapy as a treatment for mental illness. Medication management during electroconvulsant therapy. Effective for dates of service on or after january 1, 1994 if anesthesia is given by the same physician who is performing the therapy, the anesthesia would be included in the therapy service.
Electroconvulsive therapy ect is an effective treatment for clinical depression or major depression, as well as in some forms of recurrent or chronic clinical depression with one big caveat. Privileging for ect practice at institutions is a local option. Other firstline indications for the procedure include people who are catatonic or suffering from a form of depression known as psychotic depression depression associated with delusions and hallucinations. Isen is an international organization dedicated to promoting the safe, ethical and effective use of electroconvulsive therapy ect and other brain stimulation therapies for the treatment of neuropsychiatric illness through education and research. Several anaesthetic agents such as methohexital, etomidate, ketamine, enflurane, thiopental and propofol are used for this purpose, but the ideal anaesthetic. Not only does it work better than medications according to weeks, medications have a success rate of 5060% of patients getting better, while ect succeeds at a rate of 7090%, it. Based on the findings of a recent paper, ect may be safer than is widely reported. They underwent a total of 147 electroconvulsive therapy treatments. Previous position papers were published in 19801and 1992.
It is most often used in the treatment of severe depression that has not responded to medications and psychotherapy. Cognitive recovery after electroconvulsive therapy and. An international organization dedicated to promoting the safe, ethical and effective use of electroconvulsive therapy ect and other brain stimulation therapies for the treatment of neuropsychiatric illness through education and research. Feb, 2017 for patients with the crippling diagnosis of severe depression, bipolar disorder, or psychosis, electroconvulsive therapy ect can be a lifechanging procedure. Electroconvulsive therapy ect is a form of psychiatric treatment that involves inducing seizures with the use of electrical stimulation while a patient is under general anesthesia. Attacks on it have appeared in movies and television documentaries, as well. For almost 30 years it was performed without an anaesthetic. Caroff 8 hormonal effects of electroconvulsive therapy 149 conrad m. Electroconvulsive therapy canadian psychiatric association. Electroconvulsive therapy in patients with cardiac pacemakers. Nimh electroconvulsive therapy lifts depression, sustains. Performance specifications electroconvulsive therapy effective july 1, 2014 worsening of those present at preect, should be evaluated prior to the next treatment.
Electroconvulsive therapy has become a national issue. The standard anesthetic agent for electroconvulsive therapy ect has been methohexital. Electroconvulsive therapy ect is most commonly used to treat severe or medicationresistant. For most people, information about ect is primarily through media representations. The authors of clinical manual of electroconvulsive therapy offer this expansive yet readerfriendly volume to help psychiatrists successfully incorporate ect into their clinical practices. It is used mainly to treat severe depression, but is also indicated for patients with other conditions, including bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, and neuroleptic malignant syndrome. Electroconvulsive therapy introduction the american psychiatric nurses association apna was founded in 1986. Isen international society for ect and neurostimulation. Initiatives include wellness promotion, prevention of mental health. Treatment should be planned in consultation with the obstetrician, and the potential risks to both mother aspiration and premature labour and the foetus spontaneous abortion and death should be taken into consideration. Individuals at high risk with ect include those with myocardial infarction or cerebrovascular accident within the preceding 3 to 6 months, aortic or cerebral aneurysm, severe underlying hypertension, and congestive heart failure. Electroconvulsive therapy ect is a commonly used, effective treatment for major depressive dis orders 1, 2. Ect is endorsed by the apa when administered by properly qualified psychiatrists for.
Cognitive recovery after electroconvulsive therapy and general anesthesia rcc2 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Sudden death following psychiatric electroconvulsive therapy. The only absolute contraindication for ect is increased intracranial pressure from brain tumor, recent cva, or other cerebrovascular lesion. Anesthesia for electroconvulsive therapy in obese patients. Complication of electroconvulsive therapy springerlink. Start studying chapter 20 electroconvulsive therapy. Ect involves a brief electrical stimulation of the brain while the patient is under anesthesia. Electroconvulsive therapy ect is a safe and effective treatment for major depressive disorder, bipolar disorder, catatonia, schizophrenia, and several other conditions. Electroconvulsive therapy lifts depression, sustains. Electroconvulsive therapy a current perspective nejm. During this brain stimulation procedure, a health care professional passes an electric current through the. April 20 saw the 75th anniversary of the first use of electroconvulsive therapy ect, making it the oldest surviving physical treatment in psychiatry. Apr, 2016 electroconvulsive therapy ect procedures have risks, and these risks are associated with general anesthesia, tonicclonic seizure and convulsion, the interaction between concomitant medications and ect, and other procedural aspects of ect.
Electroconvulsive therapy ect is a procedure during which an electric current is passed briefly through the brain via electrodes applied to the scalp to induce generalized seizure activity aimed at reducing refractory acute behavioral health symptoms. A short general anaesthetic is usually given for the procedure. The position paper was developed by the cpas standing committee on professional standards and practice. It often works when other treatments are unsuccessful. Electroconvulsive therapy ect is a safe and effective treatment for severe medicationresistant depression. Anesthesia for electroconvulsive therapy in early pregnancy article in the journal of ect 274. Anesthesia management of special patient populations. Ect is endorsed by the apa when administered by properly qualified psychiatrists for appropriately selected patients. Electroconvulsive therapy ect is practiced widely in the united states and the rest of the world. N2 depression is diagnosed in 14 million americans every year, and. Listing a study does not mean it has been evaluated by the u. Update on anesthesia considerations for electroconvulsive.
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