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kat'zC.Bengan,RN

OUTLINE

History and use The mechanism of ECT Side effects and risks Pro's and Cons

Nursing Care (Pre-, Intra-, Post-ECT)

kat'zC.Bengan,RN

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DEFINITION

Administration of electric current to the brain through electrodes placed on the head in order to induce seizure activity in the brain, used in the treatment of certain mental disorders, especially severe depression. Also called electroshock, electroshock therapy.
kat'zC.Bengan,RN American Heritage Dictionary (online)

OVERVIEW

Extremely safe and effective medical treatment (6-12)

a small amount of electricity (70-120 volts) is applied to the scalp (bitemporal), producing a seizure in the brain.
The procedure is painless Has an extremely high success rate for the treatment of major depressive disorder, catatonia, mania and various psychotic symptoms. kat'zC.Bengan,RN

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HISTORY
HIPPOCRATES - saw that insane patients showed reduced symptoms after suffering from convulsions brought on by malaria. There is an account in AD 47, of a physician using an electric eel to cure headaches of the Roman Emperor Claudius.
kat'zC.Bengan,RN

In the 1500s A Jesuit missionary wrote of Ethiopians using electricity to expel devils. Paracelsus, a Swiss physician, used camphor to produce seizures to cure insanity.

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In the 1700s Individuals treated with hellebore went into convulsions and coma and were cured of mania and raving madness. In 1792 John Birch used electric shocks to the head to cure patients. In the 1800s there were reports of insanity being cured with electric shock. Hellebore kat'zC.Bengan,RN flower

In 1927 insulin coma therapy was invented by Manfred Sakel. It involved giving insulin in order to lower levels of glucose, producing coma and convulsions.
Mathematician John Nash (A Beautiful Mind) was given this treatment in the 1960s.
Manfred Sakel

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In 1932 Ladislaus Von Meduna used camphor to treat schizophrenia. He later used metrazol since it was faster.

kat'zC.Bengan,RN

In 1937 two neurologists studying epilepsy, Ugo Cerletti and Lucio Bini, decided to use electric shock to induce seizure without the side effects of metrazol. The idea to apply shock therapy to humans came to Cerletti when he saw pigs being shocked into a coma before being slaughtered.

kat'zC.Bengan,RN

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In 1938 the first Electroconvulsive Therapy treatment was tested on a schizophrenic in rome. He had a full recovery.
In 1940 the first Electroconvulsive Therapy treatment was given in the United States.

First ECT device was developed by Italian medical scientists in 1938, four years after chemically based

kat'zC.Bengan,RN

Modern ECT methods monitor various physiological measuresheart rate (ECG), neural activity (EEG), muscular activity (EMG), blood pressure and blood-oxygen tensionto assess the patients status during treatment. In conjunction with other therapeutic advances anesthesia, muscle relaxants, physiologically efficient electrical currents and continuous oxygenationthe negative effects of ECT have been kat'zC.Bengan,RN markedly reduced.

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Neurotransmitter Theory
Neuroendocrine Theory Brain damage Theory

kat'zC.Bengan,RN

Neurotransmitter Theory
This explanation is based on evidence that the electricity sensitizes serotonin receptors Supporters also state that ECT desensitizes receptors that help reabsorb dopamine and norepinephrine, causing them to stay in the synapse kat'zC.Bengan,RN

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the induced seizure causes the hypothalamus

Hypothetical mechanism to explain the effectiveness of ECT

peptides

hormonereleasing factors blood portal system to the anterior pituitary

cerebrospinal fluid (CSF) of the ventricles

diffuse to many other parts of the the brain (and so alter brain function)

release hormones

readjust a patients hormonal balance ==> NORMAL kat'zC.Bengan,RN EMOTION

Brain Damage Theory

Memory loss and disorientation lead to the illusion of problems being gone

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The bioethics of ECT - is this a safe, effective procedure or should it be banned?

kat'zC.Bengan,RN

What is the sense of ruining my head and erasing my memory...and putting me out of business? It was a brilliant cure...but we lost the patient.

kat'zC.Bengan,RN

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"ECT has a higher success rate for severe depression than any other form of treatment. -Dr. Dimitris Popolos
Since the 1960s, the methods of ECT have changed somewhat and it seems to be safer. It is known to produce some memory loss, but seems to be the most effective treatment for people with severe depression. It is estimated that in the united states, 100,000 people per year undergo ECT treatments and that there are about 1,300 treatments per week.

kat'zC.Bengan,RN

NURSING MANAGEMENT

PRE-PROCEDURE

Consent NPO Void first

Oxygen

Mouth guard
Proper positioning of patient

Vital signs
Pre-Meds

succinylcholine (Anectine) methohexital Na (Brevital) atrophine sulfate

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NURSING MANAGEMENT

kat'zC.Bengan,RN

NURSING MANAGEMENT

POST-PROCEDURE
Reorient the client to TIME, PLACE, and PERSON Vital signs Stay with the client during period of confusion

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Tapos na po! Oye! Oye!

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