ELECTROCONVULSIVETHERAPY(ECT)

Dr. Rabie A. Hawari

Consultant Psychiatrist

ECT

- May be safer than TCA for some Pt.- Reserved for Pts. Who have failed other

Rx.- For Pts. Who are so acutely dangerous or

suicidal & need fast Rx.- May be used prophylactically to prevent

recurrence.- Do not cure but induce remission.- Should be combined with other Rx.

Indications-:

- Major Depression,

- Bipolar Disorder II --- Depressed,

- Bipolar Disorder --- Manic,

- Schizophrenia --- acute, catatonic, paranoid, with

Affective s/s,

- High suicidelity,

- Pregnancy.

Procedure-:

- production of an epileptiform convulsion (35-80sec),

- modified by muscle relaxant (succinylcholine),

- under i.v. anesthesia (methohexitone),

- by the passage of v. small current of the order of

250-500 milliamps, for up to 1 second duration,

- at a voltage not exceeding 150 volts.

Pretreatment

Physical investigation,

Medical Hx.

Blood & urine chemistry,

Chest X-ray,

ECG,

NPO.

Types-:

Bilateral Uilateral

(nondominant(

- No. of Rx. Less more

- Amnesia greater less

- Cognitive

deficits more likely less

Course-:

- 3 times / wk,

- depressed Pts. need = 6 – 12 treatments,

- schizophrenic Pts. Need = 10 -20 treatments,

- reassess Pt. between treatments,

- stop when there is no evidence of improvement.

Side effects-:

- Ventricular Arrhythmias.

- Transient Memory Impairment 1-2 wks.

- Headaches.

- Prolonged Seizures.

- Prolonged Memory Impairment.

- Brain Herniation.

- side effects of Anesthesia.

Contraindication-:

• Relative:-

- fever, arrhythmia, extreme HTN, coronary ischemia

* Absolute:-

- recent myocardic infarction, increased Intracranial

pressure, brain ca., stroke.

( Mortality :- b/w 1-in- 1000 & 1-in- 10000).