Pharmacological and ECT - ECT

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Pharmacological and ECT - ECT
2014-05-28 11:42:49
psy ect
ECT indications, admin, MoA, SE
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  1. Indications
    • - predominantly used for depression, and can be particularly effective in older adults.
    • - Although antidepressants are usually tried first
    • + Life-threatening poor fluid intake
    • + Strong suicidal intent
    • + Psychotic features or stupor
    • + Antidepressants are ineffective or not tolerated.

    - Effective for established mania (though may precipitate a manic episode in bipolar)

    - Effective for certain types of schiz, esp. catatonic states, positive psychotic symptoms, and schizoaffective disorder.

    • - Also used for puerperal psychosis
    • (with prominent mood symptoms or severe postnatal depression where a rapid improvement is nec. to reunite mother with her baby)
  2. Admin and MoA
    • - administered 2-3 times/ week. most need 4-12 treatments
    • + general anaesthetics (short-acting induction agent) and muscle relaxant
    • + 2 electrodes to scalps, bilateral or unilateral
    • + deliver sufficient electric current to have a generalized seizure of at least 15 secs

    • - MoA: not clear.
    • causes a release of neurotransmitters as well as hypothalamic and pituitary hormones; it also affects neurotransmitter receptors and second messenger systems, and results in a transient increase in blood–brain barrier permeability
  3. SE
    • - mortality is same as minor surgical procedure under GA (1 in 100 000)
    • - common: loss of memory, part events surrounding ECT (can be reduced by unilateral electrode placement)
    • - Minor complaints: confusion, headache, nausea, muscle pains reported in 80% of pt
    • - Anaes complications e.g. arrhythmias, aspiration can be reduced by goof preop assessment.
    • - Prolonged seizure (in pt on drugs that lower seizure threshold e.g. antidepressant and antipsychotics)
    • - More difficult to induce seizure - benzodiazepines