electroconvulsive therapy (redirected from Electroconvulsive shock)

Electroconvulsive Therapy 

Definition

Electroconvulsive therapy (ECT) is a medical treatment for severe mental illness in which a small, carefully controlled amount of electricity is introduced into the brain. This electrical stimulation, used in conjunction with anesthesia and muscle relaxant medications, produces a mild generalized seizure or convulsion. While used to treat a variety of psychiatric disorders, it is most effective in the treatment of severe depression, and provides the most rapid relief currently available for this illness.

Purpose

The purpose of electroconvulsive therapy is to provide relief from the signs and symptoms of mental illnesses such as severe depression, mania, and schizophrenia. ECT is indicated when patients need rapid improvement because they are suicidal, self-injurious, refuse to eat or drink, cannot or will not take medication as prescribed, or present some other danger to themselves. Antidepressant medications, while effective in many cases, may take two-six weeks to produce a therapeutic effect. Antipsychotic medications used to treat mania and schizophrenia have many uncomfortable and sometimes dangerous side effects, limiting their use. In addition, some patients develop allergies and therefore are unable to take their medicine.

Precautions

The most common risks associated with ECT are disturbances in heart rhythm. Broken or dislocated bones occur very rarely.

Description

The treatment of severe mental illness, such as schizophrenia, using electroconvulsive therapy was introduced in 1938 by two Italian doctors named Cerletti and Bini. In those days many doctors believed that convulsions were incompatible with schizophrenia since, according to their obervations, this disease rarely occurred in individuals suffering from epilepsy. They concluded, therefore, that if convulsions could be artifically produced in patients with schizophrenia, the illness could be cured. Some doctors were already using a variety of chemicals to produce seizures, but many of their patients died or suffered severe injuries because the strength of the convulsions could not be well controlled.

Electroconvulsive therapy is among the most controversial of all procedures used to treat mental illness. When it was first introduced, many people were frightened simply because it was called "shock treatment." Many assumed the procedure would be painful, others thought it was a form of electrocution, and still others believed it would cause brain damage. Unfortunately, unfavorable publicity in newspapers, magazines, and movies added to these fears.

Indeed, in those early years, patients and families were rarely educated by doctors and nurses regarding this or other forms of psychiatric treatment. In addition, no anesthesia or muscle relaxants were used. As a result, patients had violent seizures, and even though they did not remember them, the procedure itself was frightening.

The way these treatments are given today is very different from the procedures used in the past. Currently, ECT is offered on both an inpatient and outpatient basis. Hospitals have specially equipped rooms with oxygen, suction, and cardiopulmonary resuscitation (CPR) in order to deal with the rare emergency.

The treatment is carried out as follows: approximately 30 minutes before the scheduled treatment time, the patient may receive an injection of a medication (such as atropine) that keeps the pulse rate from decreasing too much during the convulsion. Next, the patient is placed on a cot and hooked up to a machine that automatically takes and displays vital signs (temperature, pulse, respiration, and blood pressure) on a television-like monitor. A mild anesthetic is then injected into a vein, followed by a medication (such a Anectine) that relaxes all of the muscles in the body so that the seizure is mild, and the risk of broken bones is virtually eliminated.

When the patient is both relaxed and asleep, an airway is placed in the mouth to aid with breathing. Electrodes are placed on the sides of the head in the temple areas. An electric current is passed through the brain by means of a machine specifically designed for this purpose. The usual dose of electricity is 70-150 volts for 0.1-0.5 seconds. In the first stage of the seizure (tonic phase), the muscles in the body that have not been paralyzed by medication contract for a period of five to 15 seconds. This is followed by the second stage (clonic phase) that is characterized by twitching movements, usually visible only in the toes or in a non-paralyzed arm or leg. These are caused by alternating contraction and relaxation of these same muscles. This stage lasts approximately 10-60 seconds. The entire procedure, from beginning to end, lasts about 30 minutes.

The total number of treatments a patient will receive depends upon many factors such as age, diagnosis, the history of illness, family support, and response to therapy. Patients with depression, for example, usually require six to 12 treatments. Treatments are usually administered every other day, three times a week.

The electrodes may be placed on both sides of the head (bilateral) or one side (unilateral). While bilateral ECT appears to be somewhat more effective, unilateral ECT is preferred for individuals who experience prolonged confusion or forgetfulness following treatment. Many doctors begin treatment with unilateral ECT, then change to bilateral if the patient is not improving.

Post-treatment confusion and forgetfulness are common, though disturbing symptoms associated with ECT. Doctors and nurses must be patient and supportive by providing patients with factual information about recovery. Elderly patients, for example, may become increasingly confused and forgetful as the treatments continue. These symptoms usually subside with time, but a small minority of patients state that they have never fully recovered from these effects.

With the introduction of antipsychotics in the 1950s, the use of ECT became less frequent. These new medications provided relief for untold thousands of patients who suffered greatly from their illness. However, there are a number of side effects associated with these drugs, some of which are irreversible. Another drawback is that some medications do not produce a therapeutic effect for two—six weeks. During this time the patient may present a danger to himself or others. In addition, there are patients who do not respond to medicine or who have severe allergic reactions. For these individuals, ECT may be the only treatment that will help.

Preparation

Patients and relatives are prepared for ECT by being shown video tapes that explain both the procedure and the risks involved. The physician then answers any questions these individuals may have, and the patient is asked to sign an "Informed Consent Form." This gives the doctor and the hospital permission to administer the treatment.

Once the form is signed, the doctor performs a complete physical examination, and orders a number of tests that can help identify any potential problem. These tests may include a chest x ray, an electrocardiogram (ECG), urinalysis, spinal x ray, brain wave (EEG), and complete blood count (CBC).

Some medications, such as lithium and a type of antidepressant known as monoamine oxidase inhibitors, should be discontinued for some time before treatment. Patients are instructed not to eat or drink for at least eight hours prior to the procedure in order to reduce the possibility of vomiting and choking.

Aftercare

After the treatment, patients are moved to a recovery area. Vital signs are recorded every five minutes until the patient is fully awake, which may take 15-30 minutes. Some initial confusion may be present but usually disappears in a matter of minutes. There may be complaints of headache, muscle pain, or back pain. Such discomfort is quickly relieved by mild medications such as aspirin.

Risks

Advanced medical technology has substantially reduced the complications associated with ECT. These include slow heart beat (bradycardia), rapid heart beat (tachycardia), memory loss, and confusion. Persons at high risk for ECT include those with recent heart attack, uncontrolled blood pressure, brain tumors, and previous spinal injuries.

Normal results

ECT often produces dramatic improvement in the signs and symptoms of major depression, especially in elderly individuals, sometimes during the first week of treatment. While it is estimated that 50% of these patients will experience a future return of symptoms, the prognosis for each episode of illness is good. Mania also often responds well to treatment. The picture is not as bright for schizophrenia, which is more difficult to treat and is characterized by frequent relapses.

A few patients are placed on maintenance ECT. This means they return to the hospital every one-two months, as needed, for an additional treatment. These individuals are thus able to keep their illness under control and lead a normal and productive life.

Resources

Books

Stuart, Gail W., and Michele T. Laraia. Principles and Practice of Psychiatric Nursing. St. Louis: Mosby-Year Book, Inc., 1998.

Organizations

National Institutes of Health. 5600 Fishers Lane. Room 7CO2, Rockville, MD 20857. (301) 496-4000. http://www.nih.gov.

Key terms

Mania — A mood disorder in which a person experiences prolonged elation or irritability characterized by overactivity that can lead to exhaustion and medical emergencies.

Relapse — A return of the signs and symptoms of an illness.

Schizophrenia — A severe mental illness in which a person has difficulty distinguishing what is real from what is not real. It is often characterized by hallucinations, delusions, and withdrawal from people and social activities.

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therapy /ther·a·py/ (-pe) the treatment of disease; see also treatment.

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ablation therapy  the destruction of small areas of myocardial tissue, usually by application of electrical or chemical energy, in the treatment of some tachyarrhythmias.

adjuvant therapy  the use of chemotherapy or radiotherapy in addition to surgical resection in the treatment of cancer.

antiplatelet therapy  the use of platelet-modifying agents to inhibit platelet adhesion or aggregation and so prevent thrombosis, alter the course of atherosclerosis, or prolong vascular graft patency.

art therapy  the use of art, the creative process, and patient response to the products created for the treatment of psychiatric and psychologic conditions and for rehabilitation.

aversion therapy , aversive therapy that using aversive conditioning to reduce or eliminate undesirable behavior or symptoms; sometimes used synonymously with aversive conditioning.

behavior therapy  a therapeutic approach that focuses on modifying the patient's observable behavior, rather than on the conflicts and unconscious processes presumed to underlie the behavior.

biological therapy  treatment of disease by injection of substances that produce a biological reaction in the organism.

chelation therapy  the use of a chelating agent to remove toxic metals from the body, used in the treatment of heavy metal poisoning. In complementary medicine, also used for the treatment of atherosclerosis and other disorders.

cognitive therapy , cognitive-behavioral therapy that based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected, the therapist guiding the patient to do so.

convulsive therapy  treatment of mental disorders, primarily depression, by induction of convulsions; now it is virtually always by electric shock (electroconvulsive t.) .

couples therapy  marital t.

dance therapy  the therapeutic use of movement to further the emotional, social, cognitive, and physical integration of the individual in the treatment of a variety of social, emotional, cognitive, and physical disorders.

electroconvulsive therapy  (ECT) a treatment for mental disorders, primarily depression, in which convulsions and loss of consciousness are induced by application of brief pulses of low-voltage alternating current to the brain via scalp electrodes.

electroshock therapy  (EST) electroconvulsive t.

endocrine therapy  treatment of disease by the use of hormones.

estrogen replacement therapy  administration of an estrogen to treat estrogen deficiency, as that following menopause; in women with a uterus, a progestational agent is usually included to prevent endometrial hyperplasia.

enzyme therapy  in complementary medicine, the oral administration of proteolytic enzymes to improve immune system function; used for a wide variety of disorders and as adjunctive therapy in cancer treatment.

family therapy  group therapy of the members of a family, exploring and improving family relationships and processes and thus the mental health of the collective unit and of individual members.

fibrinolytic therapy  the use of fibrinolytic agents (e.g., prourokinase) to lyse thrombi in patients with acute peripheral arterial occlusion, deep venous thrombosis, pulmonary embolism, or acute myocardial infarction.

gene therapy  manipulation of the genome of an individual to prevent, mask, or lessen the effects of a genetic disorder.

group therapy  psychotherapy carried out regularly with a group of patients under the guidance of a group leader, usually a therapist.

highly active antiretroviral therapy  (HAART) the aggressive use of extremely potent antiretroviral agents in the treatment of human immunodeficiency virus infection.

hormonal therapy , hormone therapy endocrine t.

hormone replacement therapy  the administration of hormones to correct a deficiency, such as postmenopausal estrogen replacement ttherapy.

immunosuppressive therapy  treatment with agents, such as x-rays, corticosteroids, or cytotoxic chemicals, that suppress the immune response to antigen(s); used in conditions such as organ transplantation, autoimmune disease, allergy, multiple myeloma, and chronic nephritis.

inhalation therapy  former name for respiratory care (2).

light therapy 

1. phototherapy (def. 1).

2. photodynamic t.

marital therapy  a type of family therapy aimed at understanding and treating one or both members of a couple in the context of a distressed relationship, but not necessarily addressing the discordant relationship itself; sometimes used more restrictively as a synonym of marriage therapy .

marriage therapy  a subset of marital therapy (q.v.) that focuses specifically on the bond of marriage between two people, enhancing and preserving it.

massage therapy  the manipulation of the soft tissues of the body for the purpose of normalizing them, thereby enhancing health and healing.

milieu therapy  treatment, usually in a psychiatric hospital, that emphasizes the provision of an environment and activities appropriate to the patient's emotional and interpersonal needs.

music therapy  the use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems.

occupational therapy  the therapeutic use of self-care, work, and play activities to increase function, enhance development, and prevent disabilities.

oral rehydration therapy  (ORT) oral administration of a solution of electrolytes and carbohydrates in the treatment of dehydration.

orthomolecular therapy  treatment of disease based on the theory that restoration of optimal concentrations of substances normally present in the body, such as vitamins, trace elements, and amino acids, will effect a cure.

photodynamic therapy  intravenous administration of hematoporphyrin derivative, which concentrates selectively in metabolically active tumor tissue, followed by exposure of the tumor tissue to red laser light to produce cytotoxic free radicals that destroy hematoporphyrin-containing tissue.

physical therapy 

1. treatment by physical means.

2. the health profession concerned with the promotion of health, the prevention of disability, and the evaluation and rehabilitation of patients disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical, surgical, or radiologic measures.

poetry therapy  a form of bibliotherapy in which a selected poem, which may be created by the patient, is used to evoke feelings and responses for discussion in a therapeutic setting.

PUVA therapy  a form of photochemotherapy for skin disorders such as psoriasis and vitiligo; oral psoralen administration is followed two hours later by exposure to ultraviolet light.

radiation therapy  radiotherapy.

relaxation therapy  any of a number of techniques for inducing the relaxation response, used for the reduction of stress; useful in the management of a wide variety of chronic illnesses caused or exacerbated by stress.

replacement therapy 

1. treatment to replace deficiencies in body products by administration of natural or synthetic substitutes.

2. treatment that replaces or compensates for a nonfunctioning organ, e.g., hemodialysis.

respiratory therapy  see under care.

substitution therapy  the administration of a hormone to compensate for glandular deficiency.

thrombolytic therapy  fibrinolytic t.

thyroid replacement therapy  treatment with a preparation of a thyroid hormone.

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electroconvulsive therapy

n. Abbr. ECT

Administration of electric current to the brain through electrodes placed on the head, usually near the temples, in order to induce unconsciousness and brief convulsions. Used in the treatment of certain mental disorders, especially acute depression. Also called electroshock, electroshock therapy.

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electroconvulsive therapy (ECT)

[-kənvul′siv]

the induction of a brief convulsion by passing an electric current through the brain for the treatment of affective disorders, especially in patients resistant to psychoactive-drug therapy. ECT is primarily used when rapid definitive response is required for either medical or psychiatric reasons, such as for a patient who is extremely suicidal and when the risks of other treatments outweigh the risk of ECT. A secondary use of ECT is treatment failure of other choices. Also called electric shock therapy, electroshock therapy, electrotherapy.

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electroconvulsive therapy,

n the induction of a brief convulsion by passing an electric current through the brain for the treatment of affective disorders, especially in patients resistant to psychoactive drug therapy.

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electroconvulsive therapy

Electroshock Psychiatry A therapy for mental disorders that consists in iatrogenic induction of generalized tonic-clonic seizures which, if of adequate duration, has an antidepressant effect Indications Refractory depression, need for rapid clinical response–inanition/starvation, psychosis, suicidality, Hx of previous response to ECT, non-affective psychotic disorders, manic episodes, bipolar disease–manic type, schizo-affective disorders, or catatonic schizophrenia; chronic disease requires longer therapy Complications 18%, usually minor; memory loss, ± permanent. See Major depressive episode, Vagus nerve stimulation. Cf Cranial electrotherapy stimulation, Lobotomy.

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Patient discussion about Electroconvulsive shock.

Q. What are the side effects of electroconvulsive therapy for depression? My sister is about to have electroconvulsive therapy for treating her severe depression. Is this method safe to use? What are the side effects?

A. I have been ob a cocktail of meds; I feel like a lab rat. Never to say any one helped;except zanax,however that's just covered up the feeling not to think about the depression when I awake. I had a phys...for over ten years. My phys...tried at least twelve diff...meds...:"I'm pisseed " I'm A GOOD LOOKING GUY,WOROuK OUT PEOPLE SAY WOW YOU LOOK GREAT" "I feel like a mess" compliments are nice,and believe me i'm not trying to build my outer aperance up. "Working out is a grat,but when that done,what else is there to do?

Q. What is the ECT method of treatment for depression? I have a friend who is suffering from major depression and is now about to start ECT treatment. What exactly is that?

A. ECT is the electroshock therapy for treating severe depression that does not heal with medication trials. In this treatment, an electric shock is induced, in levels that are not by any means risking the patient’s life. It has been proven to be of great effectiveness in people with refractory depression (meaning that drugs no longer have a therapeutic effect) and is saved as a “last resort”.

Q. HOW CAN ENERGIES AFFECT THE HEALING OF THE BODY?CHI, ELOPTIC, YOU'R SEVEN SHOCKERS ECT POSITIVE OR NEGITIVE? ENERGIES WE EXPRESS AND RECIEVE TO AND FROM OTHERS

A. Chinese medicine and alternatives should be approached with caution, but that said, a modality that has been around for over 3,000 years must have benefits. The practitioner may possibly be a bit more suspect. Then again, nothing ventured, nothing gained. If you haven’t any experience with it, how can one have a legitimate opinion?
Remember, a hundred years ago, our very own “Doctors” cured with leaches and such… it wasn’t until they pooled their resources together and lobbied the government for the right to the name of “Doctor or Medical Practitioner”. That’s it. No science, just lobbying the politicians….