ECT

Question 1

What is ECT?

Answer 1

Electroconvulsive therapy is the passage of a small electrical current through the brain with the intention of inducing a modified epileptic seizure which is therapeutic.

Question 2

What is the difference between uni- and bi-lateral ECT?

Discuss which is better

Answer 2

• Unilateral: both electrodes on non-dominant cerebral hemisphere
• Bilateral: one electrode on either side of head

Bilateral proven to be more effective but has more cognitive effects hence may consider unilateral if pt suffered from cognitive side effects previously or pt is elderly.

Question 3

ECT occurs under general anaesthetic; what else is given to limit motor effects of seizure?

Answer 3

Muscle relaxant e.g. suxamethonium

Question 4

How many sessions, approximately, does a course of ECT involve?

Answer 4

6-12 sessions

2 sessions per week

Question 5

What monitoring is done when pt’s have ECT?

Answer 5

• EEG throughout (before, during & after- continuous monitoring)
• Saturations & pulse throughout (under anaesthetic)
• BP (before & after)

Question 6

What is the seizure threshold?

Answer 6

Minimum electrical stimulus required to induce a seizure and it used to calculate therapeutic dose (which is 1.5x threshold)

Question 7

How long do you want the seizure to last?

Answer 7

25-30secs

Question 8

State main indications for ECT- highlighting which is most common

*HINT: think ECT “Euphoric Catatonic Tearful”

Answer 8

• Prolonged or severe mania
• Catatonia
• Severe depression
  
  • Treatment resistant
  • Suicideal ideation or serious risk to others
  • Life-threatening depression e.g. refuses to drink

Question 9

State some short term side effects of ECT

Answer 9

• Drowsiness
• Headaches
• Muscle aches
• Nausea
• Confusion
• Short term memory impairment
• Dental or oral trauma

Question 10

State a long term side effect of ECT

Answer 10

Retrograde and anterograde amnesia

Question 11

State some contraindications to ECT

*HINT: think MARS

Answer 11

• MI (<3 months ago), major unstable fracture
• Aneurysm (cerebral)
• Raised ICP
• Stroke (<1 month ago), status epilepticus, severe anaesthetic risk

Question 12

What questionnaires did LPT give pts to allow them to monitor improvements throughout course of ECT?

Answer 12

• MOCA (baseline, post 2w, post 6w. Then 1 week and 1-2 months after ECT)
• Hamilton depression score (baeline then every other treatment. Then 1 week and 1-2 months after ECT)

Question 13

What section may be used to allow you to give ECT to pts who don’t have capacity?

Answer 13

Section 62

Question 14

Discuss consent for ECT, include:

• What happens if pt has capacity and is consenting
• What happens if pt has capacity and is not consenting
• Does not have capacity

Answer 14

• Capacity and consenting= have ECT
• Capacity and NOT consenting= cannot give ECT
• Does not have capacity:
  
  • If treatment is immediately necessary must complete a C6 form to get section 62. Then should requrest an an assessment from SOAD (second opinion approved doctor) independent of trust is required ASAP
  • Continue to assess capacity to see if can consent
  • If not immediately necessary wait for SOAD before start course

Question 15

Does a pt need to fast prior to ECT?

Answer 15

Yes, fast for 6hrs

Drink clear fluids up to 2hrs before procedure

Question 16

What is placed in the mouth during ECT?

Answer 16

Mouthguard to protect teeth & tongue