Electroconvulsive Treatment (ECT)

• What are the contraindications of ECT?

  Raised ICP

  Under 11
• When is ECT recommended?

  Potentially life-threatening circumstances (pt not eating/drinking due to severe depression)

  Or to achieve rapid & short-term improvement of severe symptoms after adequate trial of other treatment options have been ineffective
• Are pts intubated for ECT?

  No

  Brain is pre-oxygenated, but intubation is not required due to short length of procedure
• What conditions is ECT indicated for?

  Severe depression (psychomotor retardation)

  Mania

  Mixed episode of bipolar disorder

  Catatonia

  Schizophrenia/schizoaffective disorder (not routine, but can be used in treatment-resistant states)

  Severe mental illness in pregnancy & postpartum
• What medical conditions increase the risk in ECT?

  Space-occupying intracerebral lesion (tumour, haematoma etc.)

  Other condition causing raised ICP

  Recent MI

  Recent intracerebral haemorrhage

  Unstable vascular aneurysm or malformation

  Pheochromocytoma

  High anaesthesia risk
• How long is an average course of ECT?

  4-12 treatments

  Usually given 1-2 times a week
• Why might unilateral ECT be done over bilateral ECT?

  Reduce cognitive side effects

  BUT thought to have lower antidepressant effects
• How long does the ECT process take?

  Less than an hour
• What is the process of ECT?

  Anaesthetic given -> given muscle relaxant & mouth guard -> given O2 -> two metal discs placed on head -> ECT machine will deliver series of brief electrical pulses (3-8 secs) -> body will stiffen and begin twitching -> then muscle relaxant begins to wear off & pt is 'recovered'
• Who are the members of the core team in ECT treatment?

  ECT Team Manager

  ECT Coordinators

  ECT Nursing Team – Specialist Training

  Lead Consultant Psychiatrist

  Lead Consultant Anaesthetist

  Operating  Department Practitioners / Anaesthetic Nurses x 2 per session  (1 works specifically with the Anaesthetist, 1 recovers the patents)

  SLA with the local acute trust

  ECTAS – Accredited with commendations by the RCP
• How does ECT work?

  We don't exactly know

  Thought to cause significant increase in serotonin, dopamine & noradrenaline
• What is catatonia?

  Awake/conscious but unable to respond to others/environment

  Affects movement, speech & behaviour
• What are the possible causes of catatonia?

  Psychiatric causes

  • psychosis
  • bipolar disorder
  • depression
  • PTSD
  • dissociation

  Physical causes

  • infections
  • brain injury
  • drugs
  • alcohol
  • metabolic disorders (diabetes mellitus)
  • autoimmune disorders

  Autism spectrum disorder/neurodiversity
• What are symptoms of catatonia?

  Sudden or gradual onset

  Sit in unusual positions for hours/ days

  Staring into space & non responsive

  Unusual postures for lengthy time period

  Waxy Flexibility

  Repeating same movement or copying others (echopraxia)

  Repeating same word or phrase as others (echolalia)

  Holding strange faces

  Not speaking, eating or drinking for long periods

  Not doing something or resisting (negativism)

  Extreme agitation or restlessness (Excited Catatonia)
• What are the immediate side effects of ECT?

  Disorientation (usually lasts around 60 mins)

  Impaired attention

  Amnesia

  Headaches

  Muscle aches (esp in jaw)

  Nausea

  Tiredness

  Confusion
• What are the cognitive side effects of ECT?

  Anterograde amnesia (impaired ability to learn new information from time of commencing ECT onwards)

  Retrograde amnesia (impaired ability to remember info learned before ECT life event memory)

  Autobiographical memory can be impaired (less common & reversible)
• What are the non-cognitive side effects of ECT?

  Cardio-pulmonary complications

  Prolonged seizures (> 120 secs)

  Mania

  Suicide
• What are the short term side effects of ECT?


  Headache

  Nausea

  Short term memory impairment

  Memory loss of events prior to ECT

  Cardiac arrhythmia