Pharmacological and ECT - ECT
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- - 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)
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
- - 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
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