Antonio,Aileen BeatriceJunior InternElectroconvulsive
TherapyHistorical BackgroundHippocrates 400 B.C. Melancholic black
bileParacelsus 1520 Psychiatric illness not demonic but natural
diseasesKraeplin Illnesses divided into two major groups
Etiologies of DepressionBioamine Hypothesis
NeurotransmittersFreud Loss of the love objectGenetic FactorsLifes
StressorsLearned HelplessnessCognitive TheoriesOrganic Cause drugs,
medications, illnesses, sleep abnormalities
Epidemiology20% lifetime expectancy2:1 female to male ratio50%
have onset by age 30More common in single/divorcedNo correlation
between social classes or race10% complete suicide 66%
contemplateTreatment OptionsMedicationsECTTranscranial Magnetic
TherapyVagal Nerve StimulatorVarious
PsychotherapiesPsychoanalysisECT HistoryCan a seizure be
protective?Meduva 1930s camphorCerletti and Bini electrical
charge75,000 treatments per yearTwice as effective as
medicationMortality .01% per course same as any anesthesia
inductionECT INDICATIONSMajor Depression 90% effectiveMania 80%
effectiveAcute Schizophrenic Psychosis 50% effectiveNeuroleptic
Malignant SyndromeAdvanced ParkinsonsIntractable
EpilepsyCatatoniaContraindicationsNo absolute contraindicationsHigh
risk with:Space occupying lesionRecent myocardial infarctionBrain
aneurysmECT ProcedureConfirm DiagnosisMedical and Psychiatric
ExamEKGLab testsHead CT/Spine films if indicatedConsent
formsAnesthesia evaluationRisks, benefits, alternativesPrimary
ChoiceUrgent need for rapid responsePatient historyPatient
preferenceElderly Psychotic DepressionsCatatonic StatesAdverse
EffectsGeneral AnesthesiaComplicated seizureMedication
InteractionsCognitive ChangesCardiovascular ProblemsRisk
ReductionOxygenationReduce medicationsPre treatment with RobinulUse
of Beta BlockersCheck electrolytesBP and EEG monitoringNPO after
midnight, clean scalp, usual BP meds with sip of waterAtropine if
necessary
Anesthetic Agents
Diprovan Non barbituate short actingBrevital barbituate yet less
effect on seizureSuccinylcholineBeta BlockersVersed
AmnesiaRetrograde and AnterogradeFew weeks to month in
durationLess with non dominant unilateral treatmentDiscontinue
LithiumOccurs in patients with severe Depression who do not have
ECTBDNF theoryECT does not injure the brain ComplicationsHeadache,
muscle sorenessJaw pain, oral injurySpinal
problemsNauseaConfusionCardiovascular ProblemsDeath 1:10,000
