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PD06 - Electroconvulsive Therapy (ECT) || Already Graded A+.

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PD06 - Electroconvulsive Therapy

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PD06 - Electroconvulsive Therapy

Friedberg 1976; Breggin 1991 correct answers barbarous psychiatric past, associated with the era of bleeding & purging than with penicillin and L-dopa APA 1990 correct answers ECT is a safe, very effective, and often life-saving treatment. It has a better side-effect profile than drugs and, for ...

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friedberg 1976 breggin 1991

Institution PD06 - Electroconvulsive Therapy
Course PD06 - Electroconvulsive Therapy

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PD06 - Electroconvulsive Therapy (ECT) || Already Graded
A+.
Friedberg 1976; Breggin 1991 correct answers barbarous psychiatric past, associated with the era
of bleeding & purging than with penicillin and L-dopa

APA 1990 correct answers ECT is a safe, very effective, and often life-saving treatment. It has a
better side-effect profile than drugs and, for some patients, is the only effective or medically-
tolerated treatment

Early history of convulsive therapy correct answers - Ancient Rome - Pliny applied electric fish
to head as cure for pain of childbirth

- Oliver (1785) - physician to HRH Prince of Wales - successfully used a chemical convulsant
(camphor) to treat melancholiavon Meduna (Hungary, early-mid 1930's)
camphor; metrazol

+ve results in schizophrenia

Cerletti & Bini (1938) - in Rome - first to use electrically-induced convulsions to treat severe
mental disorder: +ve results

Reputation across time correct answers - use of ECT peaked in 1940s/1950s, but declined in
1960s with the advent of antidepressant drugs

- no doubt that ECT used indiscriminately in past - legitmate basis for poor reputation

- still in use - but on a much smaller scale - with tighter regulation & a very specific target
population

- primary use of ECT is for severe depression - target of ECT

- used indiscriminately
- threat of torture
- not targetting disorder

ECT: current prevalence correct answers 0.5-1.0% psychiatric inpatients receive ECT
of these, the vast majority (>85%)

Patients receive ECT because correct answers - fail to respond to antidepressant drugs
- progress to ECT if fail to respond to antidepressant drugs
- cannot tolerate drug side-effects,

&/or

, - are so very ill that they cannot wait for drugs to take full effect [up to 3-4 weeks]
- Suicidal and require very rapid relief

Attacks on ECT correct answers [Breggin 1979, 1991]

critics claim that ECT is
ν brutal
ν damaging to the brain
ν ineffective

ECT banned in some US states

UK ECT Review Group (2003) correct answers good source of up to date information in this
area

- the ECT technique
- effect of the shock & patient experience
- side-effects of ECT - memory loss, brain damage, mortality
- efficacy of ECT
- mechanism of action - are convulsions necessary for therapeutic response?

ECT process correct answers ν ECT administered in morning to maximum of 3 per week (at least
24h intervals); total sessions 6-12

ν no food for 12h prior to ECT - overnight food deprivation

ν electrodes positioned bi-temporally, biteblock inserted, & patient ventilated

ν shock applied: 0.5-4.0 seconds / voltage 200-300V / current 600-900mA

premedication correct answers atropine, muscle relaxant & short-acting general anaesthetic

atropine correct answers dry's up mucus and saliva secretion to protect airways

Muscle relaxant correct answers To stop damage of muscles/tendons

General anaesthetic correct answers To promote anaesthetic state

Experience of ECT correct answers ν shock causes a tonic seizure (duration of shock) followed
by clonic movements (25-60 sec)

ν patient awakens within 5 mins, & may be disoriented for 30-60 min

patient self-reports correct answers ν no awareness of seizure, no pain - under general anesthesia

ν 80% report ECT no worse than visit to dentist, & 50% claim to prefer ECT

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