ECT Flashcards
What is ECT?
- Treatment for severe depression and a few other conditions
- In which a small dose of electric current is used to induce seizures
- Given under anaesthesia and with a muscle relaxant and a mouth guard to prevent injury
- EEG recorded throughout
- Can be bilateral or unilateral
What does a typical course of ECT look like?
- Twice weekly
- For up to 12 weeks
- But stopped as soon as patient has maximum benefit
- Can be inpatient or outpatient
What are the indications for ECT under NICE?
- Depression (5 cases where ECT is used in depression: severe depression, non-responding to medication, severe medication side effects, very suicidal, not eating or drinking)
- Catatonia
- Severe, intractable mania
Not NICE recommended, but can be effective in Sz patients not responding to any medications or very difficult to manage on the ward.
What are the contraindications for ECT?
Only absolute contraindications:
- Raised ICP
- Cerebral aneurysm
- Recent CVA
Relative CIs:
- MI within last 3 months, Unstable angina
- DVT
- K+ imbalance
- Acute resp infection
- Recently eaten
- Cochlear implants
- Unstable fractures
Not really CI but exercise caution:
- Pregnancy
- Controlled epilepsy
- Pacemakers
What are the main side effects from ECT?
Related to ECT:
- Confusion
- Headaches
- Status Epilepticus
- Stroke
- Arrhythmias
- Bleeding from ulcers
- PE
- Subconjunctival haemorrhage
- Raised intraocular pressure
- Broken teeth
Related to Anaesthesia:
- MI
- Aspiration pneumonia
- Prolonged apnoea
- Nausea
- Malignant hyperthermia
- Muscle aches
Memory issues: All forms of amnesia
What physiological changes can occur during ECT?
- Bradycardia followed by Tachycardia
- Low BP followed by High BP
- Cerebral blood flow and ICP increases
- Numerous hormonal changes (TSH, ACTH, GH, Prolactin, BNPs)
What are some theories behind how ECT works?
- Neurotransmitter hypothesis
- Neurophysiological changes
- Neuroanatomical changes
- Endocrine effects
- Neurogenesis and synaptic plasticity
How can ECT side effects be minimised?
- Thorough history and examination
- Educate patient and their family members about the transient nature of the side effects
- Let them know they have a choice, efficacy vs safety
- MONITOR for the severe side effects.
What forms relating to capacity may be necessary to fill out before undergoing ECT?
- If an informally admitted patient has capacity and consents, no need for forms just obtain consent.
- If patient has capacity and does not consent, cannot do ECT.
- If a detained (involuntary admission) patient has capacity and wants ECT you still need to fill out a form, a T4.
- If a patient lacks capacity and you feel they need ECT –> Second opinion from approved doctor SOAD) –> T6 form.
- If a patient lacks capacity and needs EMERGENCY ECT, need to fill out a C6 form (under section 62)
What monitoring is necessary around ECT?
- Pre-ECT physical health check
- Consent
- Medication given (anaesthetic and muscle relaxants)
- Side effect monitoring
Perform a number of assessments to check on functioning:
- Hamilton Depression Rating Scale @ Baseline + after every other treatment
- MOCA @ Baseline and every other treatment, + one week and one month after finishing course
What medications are used in Leicester for GA and MR?
- General Anaesthetics = Etomidate
- Muscle Relaxant = Suxamethonium
