Electroconvulsive Therapy

Question 1

What are contraindications to ECT?

Answer 1

No absolute

> cardiac abormalities (AS, recent MI in last 4 weeks, hypertension, pacemakers)
brain tumor (increase ICP = herniation)
skull bony abnormalities - could have less resistant pathway causing easier access of impulse to CNS

Question 2

Indications for ECT

Answer 2

Major depressive episode
Bipolar
Mania
Schizophrenia (especially treatment resistant)
Epilepsy
OCD
Neuroleptic malignant syndrome
Severe delirium
Severe side effects of antidepressants

Question 3

What is an adequate seizure in ECT?

Answer 3

A generalized seizure of adequate quality and duration

1) generalized
2) tonic clonic (spike waves in tonic, spike and slow waves in clonic)
3) duration (20-25sec peripherally, 30sec EEG recorded)
4) seizure termination followed by postictal suppression

Question 4

Adverse effects of ECT

Answer 4

Epilepsy
Cardiac (MI, hypertension, arrhythmias)
Memory impairment (self limiting, depends on amount of stimulus)
Death
Pregnancy related (premature labour, foetal bradycardia, death)
Anaesthetic related (confused and disorientated on awakening which disappears,
Headaches, body aches)