ELECTROCONVULSIVE THERAPY

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Presentation transcript:

ELECTROCONVULSIVE THERAPY

ECT mechanism of action Decrease of cerebral metabolism markedly in the frontal lobe Changes in NT receptors - Down regulation of postsynaptic beta adrenergic receptors Changes in second messenger systems - G-proteins - Adenylyl cyclase - Phospholipase c - calcium

ECT Indications MDD Severe with melancholic feature With psychotic symptoms With suicidal thoughts and plan Refusion of eating Manic episodes Dangerous level of exhaustion severe Schizophrenia With marked positive symptoms Catatonia Pregnancy No tolerance to drugs Drug contraindications Geriatric and medically ill patients delirium

ECT Pretreatment Evaluations Blood and urine chemistries CXR ECG Dental examination Brain imaging if indicated

ECT Premedications Muscarinic anticholinergic drugs Anesthetics Muscle relaxants

ECT Bilateral or unilateral electrode placement Inducing seizures at least 25 sec. Number of ECT treatments Maintenance treatment Contraindications Mortality

ECT Adverse Effects Headache Delirium Memory impairment Break teeth Back pain Nausea, vomiting Muscle soreness

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