ECT tutorial Flashcards
(15 cards)
What is ECT
-electroconvusive therapy
- often used for people with severe depression that haven’t responded to treatment
- when fast response is needed due to severe symptoms
- Anaesthetic given
- small, carefully controlled electric current passed through brain for a few seconds
- Triggers brief seizure
- 3-4 weeks 2,-3 times a week -> cumulative efficacy
-rapidly improves symptoms
when is it used
-Talk drug therapies are first-line treatment for mild /mod
- ECT preferred for severe
- NIC E - ECT considered if other treatment hasn’t helped
- If ECT works other therapy May resume
Timeline of ECT
-1st century- treats physical illness
-1700 - treat hysterical illness
-1938- used for SZ
-1980 - modernised
History of ECT - before 1960s
-Largus -> headache taken away by live fish placed on head till pain stops
- Kellaway -> first recorded use, functionally effective
-Le Roy- hysterical blindness cured with ECT
- cerletti + Bini - produced apparatus to deliver shocks to head - loose consciousness , tremor
History of ECT - After 1960s
- Public backlash –> widesprread use, involuntary, lack consent
- Ethical concerns –> Used as quick fix, force treatment
- Psychological effects –> memory loss, cog impairement, brain damage
- Rise of anti-psychiatry movement –> ECT tool to control
History of ECT - 1980s to today
- Safer procedure –> anaesthesia + muscle relaxant
- Technology improved - precise dosing, unilateral
- Stricter regulation –> legal protection, guideliness
Risks of ECT
- Short term memory loss
- Headaches
- Muscle ache
- Invasive
- Varying success rates
- Short lasting (6 months)
- Might not work –> disappointment
- Stigma
Benefits of ECT
- Some sucessful cases
- Good if treatment not working - hope
- Sig improvement (efficacy)
- Quicker than drugs
- Short procedure
Evidence of ECT to treat depression
- Pagnin et al (2004) - meta-analysis of efficacy of ECT in depression
- Many studies show ECT work more than simulated ECT (control)
- ECT more effective than antidepressants for severe cases
Evidence for treatment of depression resistant to other treatment
- Sackeim et al (2000) - fouble blind study
- ECT could be effective even in med-resistent cases
- Effectiveness was dose-dependent
- Not resistant also showed very sig responses
- Half of people not responding to anything else responded to high dose
Side effects
- Cerletti + Bini nominated as safer alternative but
- Cog: Memory loss (41% - Sackeim et al, Squire + Slater 1978 - minimised with unilateral application), attention deficits, executive function
- Physical: headaches (48%), muslce pain (15%), tiredness (73%), nausea, joint dislocation + bone fraction (alleviated with muscle relaxant)
ECT: Mode of action
- Exact neurological mechanisms not fully understood
1) Changes in functioning + levels of NT
2) Increased neuroplasticity - new connections in areas assoc with mood + memory
3) reduces neuroinflammation which causes psychiatric conditions
Mode of action - Serotonin
- Nowak + Dulinski (1991) - gave repeated ECT
- Greately increased sensitivity + number of serotonin receptors
Mode of action - Dopamine
- Strome et al (2007)
- Increased binging to a variety of dompamine receptor subtypes in striatum following ECT
- Increased receptor density
Mode of action: Brain reorganisation
- Perrin et al (2012)
- Hyperconnectivity hypothesis –> suggests ecess connections in PFC
- Has lasting effects on functional architecture
- Excess connections in PFC reduced by ECT
- Accompanied by reduced symptoms
