Mental Health Book

Depression

  • Electroconvulsive Therapy

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Electroconvulsive Therapy

Aka: Electroconvulsive Therapy
  1. History
    1. First ECT performed in 1938 by Cerletti and Bini
  2. Indications
    1. Medication resistant Major Depression
    2. Severe Major Depression with Suicidal Ideation
    3. Delusional Depression
    4. Acute Mania
    5. Severe psychiatric illness with food and fluid refusal
    6. Severe adverse medication affects
      1. Neuroleptic Malignant Syndrome
    7. Comorbid Condition
      1. Parkinson's Disease
    8. Pregnancy
      1. See Psychiatric Medications in Pregnancy
  3. Contraindications
    1. Brain Tumor or other space occupying lesion
    2. Cerebrovascular Accident within the last month
  4. Symptoms most responsive to ECT
    1. Guilt
    2. Loss of interest
    3. Agitation
    4. Anxiety
    5. Dysphoria
    6. Helplessness
    7. Worthlessness
    8. Delusions
      1. Nihilism
      2. Impoverishment
      3. Sin or guilt
  5. Examination: Pre-procedure evaluation
    1. Complete History and Physical Examination
    2. Focused areas of attention
      1. Cardiopulmonary examination
      2. Neurologic Examination
      3. Musculoskeletal Examination
  6. Labs: Pre-procedure evaluation
    1. Hemoglobin
    2. Hematocrit
    3. Serum electrolytes
  7. Diagnostics: Pre-procedure evaluation
    1. Electrocardiogram
  8. Technique
    1. Monitoring
      1. Blood Pressure
      2. Oxygen Saturation
      3. Telemetry monitoring of Heart Rate and rhythm
      4. Electroencephalogram
    2. Respiratory support
      1. Airway management
      2. Bag Valve Mask ventilation
    3. Anesthesia
      1. Sedative-Hypnotic agent: Methohexital (Brevital)
      2. Paralytic Agent: Succinylcholine
    4. Electrical Stimulus
      1. Brief unilateral or bilateral stimulus
      2. Results in 50 second generalized Seizure
    5. Course
      1. ECT administered 3 times per week
      2. Total course may last 6-12 treatments
  9. Cost
    1. Each treatment: $1500
    2. Total Course (6-12 treatments): $9,000 to $18,000
  10. Adverse Effects
    1. Hypertension
    2. Cardiac arrhythmia
    3. Post-ECT Confusion
  11. Efficacy
    1. High response rate in refractory Major Depression
    2. Relapse rate after ECT: 50% within one year
  12. Management following ECT (relapse prevention)
    1. Example protocol: Nortriptyline and Lithium
  13. References
    1. Banazak (1996) Am Fam Physician 53(1):273-8
    2. Sackeim (2001) JAMA 285:1299-307

Electroconvulsive Therapy (C0013806)

Definition (NCI) A treatment for severe depression and certain mental disorders. A brief seizure is induced by giving electrical stimulation to the brain through electrodes placed on the scalp.
Definition (CSP) used for severe depression resistant to drug treatment; patients are anesthetized and given a muscle relaxant, and a brief pulse of current is passed through the brain, triggering a short seizure, 6-12 times over a 2-4 week period.
Definition (MSH) Electrically induced CONVULSIONS primarily used in the treatment of severe AFFECTIVE DISORDERS and SCHIZOPHRENIA.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D004565
ICD10 1907
SnomedCT 150913001, 171932003, 23835007, 150914007, 182674004
English Convulsive Therapies, Electric, Convulsive Therapy, Electric, ECT (Psychotherapy), Electric Convulsive Therapies, Electric Convulsive Therapy, Electric Shock Therapies, Electric shock therapy, Electroconvulsive Therapies, Electroconvulsive Therapy, Electroshock Therapies, Electroshock Therapy, Shock Therapies, Electric, Shock Therapy, Electric, Therapies, Electric Convulsive, Therapies, Electric Shock, Therapies, Electroconvulsive, Therapies, Electroshock, Therapy, Electric Convulsive, Therapy, Electric Shock, Electroconvulsive therapy, NOS, Electroshock therapy, NOS, ECT, ELECTROCONVULSIVE THERAPY, Electric Shock Therapy, Therapy, Electroconvulsive, Therapy, Electroshock, ECT - Electroconvulsve therapy, Electroconvulsive therapy (ECT), Electroconvulsive therapy NOS, Electroshock therapy (EST), ELECTROSHOCK THER, CONVULSIVE THER ELECTRIC, SHOCK THER ELECTRIC, ELECTROCONVULSIVE THER, ECT PSYCHOTHER, ECS, electric shock treatment, electroplexy shock therapy, shock treatment, Electroconvulsive therapy (regime/therapy), ECT (electro-convulsive therapy), electroconvulsive therapy (treatment), electroconvulsive therapy, Electroconvulsive therapy NOS (procedure), electroconvulsive shock therapy, ecs, ect, electric shock treatments, ect therapy, electroconvulsive therapy (ECT), est, shocking treatment, Therapy;electroconvulsive, electric shock therapy, electroconvulsive treatments, electroshock treatment, shock treatments, electric convulsive therapy, electroconvulsive treatment, electroshock therapy, ECT therapy, EST therapy, Electroconvulsive therapy, Electroshock therapy, ECT - Electroconvulsive therapy, EST - Electroshock treatment, Electroconvulsive treatment, Electroplexy, Electroshock treatment, Electroconvulsive therapy (procedure), Electroconvulsive ther., ECT (Therapy), Electroconvulsive Shock Therapy, ECS Therapy, EST
Dutch ECT, ECT (elektroconvulsieve therapie), elektroshocktherapie, Convulsieve therapie, elektro-, ECT (psychotherapie), Elektro-convulsieve therapie, Elektroshocktherapie, Shocktherapie, elektro-
French TE, ECT (traitement électro-convulsif), Sismothérapie, Sismothérapie électrique, Électrochocs, ECT (ÉlectroConvulsivoThérapie), Séismothérapie, Électro-convulsivothérapie, Électroconvulsivothérapie
German ECT, ECT (Elektrokonvulsionstherapie), ECT (Psychotherapie), Elektrokrampftherapie, Elektroschocktherapie, Krampftherapie, Elektro-, Schocktherapie, Elektro-
Portuguese TEC (terapia electroconvulsivante), Terapia Eletroconvulsiva, Terapia electroconvulsivante, ECT (Psicoterapia), Eletrochoqueterapia, Eletroconvulsoterapia, Terapia por Choque Elétrico, Terapia por Eletrochoque
Spanish TEC (tratamiento electroconvulsivo), ECT, Electroconvulsive ther., Electroconvulsive therapy, ECT therapy, Terapia de Choque Electrico, Terapia por Electrochoque, Terapia de Shock Eléctrico, Terapia de Shock Electrico, Terapia de Choque Eléctrico, TEC, electrochoque, terapia de choque eléctrico, terapia de electroshock, terapia electroconvulsiva (procedimiento), terapia electroconvulsiva, SAI (procedimiento), terapia electroconvulsiva, SAI, terapia electroconvulsiva, Terapia electroconvulsiva, ECT (Psicoterapia), TEC (Psicoterapia), Terapia Electroconvulsiva, Terapia por Electroshock
Japanese ＥＣＴ（電撃療法）, ﾃﾞﾝｹﾞｷﾘｮｳﾎｳ, ECTﾃﾞﾝｹﾞｷﾘｮｳﾎｳ, 電気けいれん療法, けいれん療法-電気, 電撃療法, 電気ショック療法, 電気痙攣療法, 電気衝撃療法, ショック療法-電気
Swedish Elbehandling
Czech elektrokonvulzívní terapie, Elektrokonvulzivní terapie, ECT (elektrokonvulzivní terapie), ECT
Finnish Sähkösokkihoito
Italian Elettroshock terapia, Terapia di shock elettrico, ECT (Psicoterapia), Terapia elettroconvulsivante
Russian ELEKTROSHOKOVAIA TERAPIIA, EKT (PSIKHOTERAPIIA), SHOKOVAIA TERAPIIA ELEKTRICHESKAIA, ELEKTROSUDOROZHNAIA TERAPIIA, SUDOROZHNAIA TERAPIIA ELEKTRICHESKAIA, ELEKTROKONVUL'SIVNAIA TERAPIIA, СУДОРОЖНАЯ ТЕРАПИЯ ЭЛЕКТРИЧЕСКАЯ, ШОКОВАЯ ТЕРАПИЯ ЭЛЕКТРИЧЕСКАЯ, ЭКТ (ПСИХОТЕРАПИЯ), ЭЛЕКТРОКОНВУЛЬСИВНАЯ ТЕРАПИЯ, ЭЛЕКТРОСУДОРОЖНАЯ ТЕРАПИЯ, ЭЛЕКТРОШОКОВАЯ ТЕРАПИЯ
Croatian ELEKTROKONVULZIVNA TERAPIJA, ELEKTROŠOK TERAPIJA
Polish Terapia elektrowstrząsowa, Elektroterapia drgawkowa, Leczenie elektrowstrząsami
Hungarian Elektrokonvulzív terápia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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