Biological Therapies; ECT

Question 1

URAP for ETC

Answer 1

U- Originally developed to treat schizophrenia, now used to treat severe depression and suicidal patients; still used for catatonic schizophrenia
R/A- There is abnormality of neurotransmitters and hormones; the shock disrupts/corrects this abnormality
P- Small electric current (70-130 mv) for 0.5 to 5 secs, induces a mini seizure by producing electrical convulsions in the brain, continued for several weeks. Anaesthetic and muscle relaxants are administered to stop them hurting themselves. Electrical current is usually passed unilaterally.

Question 2

ETC

Answer 2

• Usually given 3 times a week over a few weeks
• It is usual for patients to have 1 or 2 additional treatments to prevent relapse
• Patient is put to sleep and then a drug is administered to temporarily paralyze muscles
• The patient is also breathing pure oxygen through a mask
• Seizures can last 30sec -1 min
• They wake up and stiffness may last for 20-60 mins

Question 3

Dangers with ETC

Answer 3

• There may be a temporary drop in blood pressure, this then may increase blood rate and may lead to a rise in blood pressure.
• A patient with a history of high blood pressure or cardiovascular problems should have a cardiology consultation.

Question 4

Tharyan & Adams Cochrane review

Answer 4

Method:
-Meta-analysis 26 studies (798 pps)
-Inclusion of all randomised controlled clinical trials comparing ETC with a sham ETC
Results:
-More patients improved with real ETC
-ETC resulted in less relapses in the short term
Conclusions:
-Suggests ETC works in the short term in an increase in global improvement
-Drug + ETC may be considered for rapid global treatment

Question 5

Effectiveness of ECT

Answer 5

• Should be used in serious cases or suicidal cases as they need rapid global treatment
• Still unclear on long term effects of ECT, also lack of evidence for drug resistant patients
• Evidence suggest ETC is more effective in combination with drugs
• It should not be used with patients who have high blood pressure
• ETC does not produce a cure to sz.
• Recommended for depressive and catatonic patients
• Lacks randomised evidence for specific subgroups