Mental Health Book

Depressive Disorders

  • Electroconvulsive Therapy

http://www.fpnotebook.com/

Electroconvulsive Therapy

Advertisement

  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
    2. Sackeim (2001) JAMA 285:1299

Electroconvulsive Therapy (C0013806)

Definition (MSH)Electrically induced CONVULSIONS primarily used in the treatment of severe AFFECTIVE DISORDERS and SCHIZOPHRENIA.
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.
ConceptsTherapeutic or Preventive Procedure (T061)
ICD994.27
MSHD004565
EnglishCONVULSIVE THER ELECTRIC, ECS, ECT, ECT - Electroconvulsive therapy, ECT PSYCHOTHER, ECT therapy, Electric Convulsive Therapies, Electric Convulsive Therapy, Electric Shock Therapies, Electric Shock Therapy, electric shock treatment, ELECTROCONVULSIVE THER, Electroconvulsive ther., Electroconvulsive Therapies, Electroconvulsive Therapy, Electroconvulsive treatment, Electroplexy, electroplexy shock therapy, ELECTROSHOCK THER, Electroshock Therapies, Electroshock Therapy, Electroshock treatment, EST, EST - Electroshock treatment, EST therapy, SHOCK THER ELECTRIC, shock treatment
Spanishelectrochoque, TEC, terapia de choque electrico, terapia de electroshock, terapia electroconvulsiva
Parent ConceptsElectric Stimulation Therapy (C0013787), Psychological and psychiatric evaluation and therapy (C0810229), Therapeutic procedure (C0087111), Convulsive therapy (C0009953), Electroconvulsive Shock (C0013870), Electroconvulsive Therapy (C0013806), Psychiatric Somatic Therapies (C0037646), Duplicate concept (C1274013)
SourcesAOD, CCS, CSP, LCH, MSH, MTH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree