ect assignment

8/11/2019 ECT Assignment

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ELECTROCONVULSIVE THERAPY

Introduction

Electroconvulsive therap (ECT), also known as electroshoc!, is a well-established, albeit controversial, psychiatrictreatment in which seizuresare electricallyinduced in anesthetized patients for therapeutic effect. Today, ECT is most often used as atreatment for severe maor depressionwhich has not responded to other treatment, and isalso used in the treatment of mania(often inbipolar disorder), and catatonia.!"#$t was firstintroduced in the "%&'s and ained widespread use as a form of treatment in the "%'sand "%*'s+ today, an estimated " million people worldwide receive ECT every year,usually in a course of " treatments administered or & times a week.

Electroconvulsive therapy can differ in its application in three ways/ electrodeplacement, lenth of time that the stimulus is iven, and the property of the stimulus. Thevariance of these three forms of application have sinificant differences in both adverseside effects and positive outcomes. 0fter treatment, dru therapy can be continued, andsome patients receive continuation1maintenance ECT. $nformed consentis a standard ofmodern electroconvulsive therapy. $nvoluntary treatment is uncommon in countries thatfollow contemporary standards and is typically only used when the use of ECT isbelieved to be potentially life savin.

"eanin# and $e%inition

Electroconvulsive therap or ECT for short is a controversial treatment inwhich a convulsion or seizure is produced by passin an electric current throuh the

brain. ECT is primarily used for treatment-resistant depression and may also beprescribed for mania and schizophrenia. 2iven under anesthesia, ECT may be unilateral(electrodes on one side of the head) or bilateral (electrodes on both sides). The mostcommon side effect of electroconvulsive therapy is memory loss.

Histor

0s early as the "th century, aents to produce seizures were used to treatpsychiatric conditions. $n "34*, the therapeutic use of seizure induction was documentedin the 5ondon 6edical 7ournal. Convulsive therapy was introduced in "%& by 8unarianneuropsychiatrist 5adislas 7. 6edunawho, believin mistakenly that schizophrenia and

epilepsy were antaonistic disorders, induced seizures with first camphor and thenmetrazol (cardiazol). 9ithin three years metrazol convulsive therapy was bein usedworldwide. $n "%&3, the first international meetin on convulsive therapy was held in:witzerland by the :wiss psychiatrist 6uller. The proceedins were published in the0merican 7ournal of ;sychiatry and, within three years, cardiazol convulsive therapy wasbein used worldwide. $talian ;rofessor of neuropsychiatry ini developed the idea of usin electricity as a substitute for metrazol in convulsive
http://en.wikipedia.org/wiki/Psychiatryhttp://en.wikipedia.org/wiki/Seizurehttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Catatoniahttp://en.wikipedia.org/wiki/Electro-convulsive_therapy#cite_note-The_Royal_College-0%23cite_note-The_Royal_College-0http://en.wikipedia.org/wiki/Electro-convulsive_therapy#cite_note-The_Royal_College-0%23cite_note-The_Royal_College-0http://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Ladislas_J._Medunahttp://en.wikipedia.org/wiki/Camphorhttp://en.wikipedia.org/wiki/Metrazolhttp://en.wikipedia.org/wiki/Ugo_Cerlettihttp://en.wikipedia.org/wiki/Psychiatryhttp://en.wikipedia.org/wiki/Seizurehttp://en.wikipedia.org/wiki/Clinical_depressionhttp://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Catatoniahttp://en.wikipedia.org/wiki/Electro-convulsive_therapy#cite_note-The_Royal_College-0%23cite_note-The_Royal_College-0http://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Ladislas_J._Medunahttp://en.wikipedia.org/wiki/Camphorhttp://en.wikipedia.org/wiki/Metrazolhttp://en.wikipedia.org/wiki/Ugo_Cerletti


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therapy and, in "%&3, e=perimented for the first time on a person. :herwin >. ?ulandhavin discussed the matter with a first-hand observer in the "%3's ave the followindescription of the results of the first use of ECT on a person/

@They thouht, A9ell, weAll try ** volts, two-tenths of a second. ThatAs not oin

to do anythin terrible to him.A :o they did that. !...# This fellow B remember, hewasnAt even put to sleep B after this maor rand mal convulsion, sat riht up,looked at these three fellows and said, A9hat the fuck are you assholes tryin todoA 9ell, they were happy as could be, because he hadnAt said a rational word inthe weeks of observation.@

ECT soon replaced metrazol therapy all over the world because it was cheaper,less frihtenin and more convenient. Cerletti and >ini were nominated for a?obel ;rizebut did not receive one. >y "%', the procedure was introduced to both Enland and thelatchley demonstrated the effectiveness of his constant current,brief pulse device ECT. This device eventually larely replaced earlier devices because ofthe reduction in conitive side effects, althouh some ECT clinics in the


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0ssociation task force report on electroconvulsive therapy (to be followed by furtherreports in "%%' and ''"). The report endorsed the use of ECT in the treatment ofdepression. The decade also saw criticism of ECT. :pecifically critics pointed toshortcomins such as noted side effects, the procedure bein used as a form of abuse, anduneven application of ECT. The use of ECT declined until the "%4's, @when use bean to

increase amid rowin awareness of its benefits and cost-effectiveness for treatin severedepression@. $n "%4* the?ational $nstitute of 6ental 8ealth and ?ational $nstitutes of8ealthconvened a consensus development conference on ECT and concluded that, whilstECT was the most controversial treatment in psychiatry and had sinificant side-effects,it had been shown to be effective for a narrow rane of severe psychiatric disorders.

Hue to the backlash noted previously, national institutions reviewed past practicesand set new standards. $n "%34, The 0merican ;sychiatric 0ssociation released its firsttask force report in which new standards for consent were introduced and the use ofunilateral electrode placement was recommended. The "%4* ?$68 ConsensusConference confirmed the therapeutic role of ECT in certain circumstances. The

0merican ;sychiatric 0ssociation released its second task force report in "%%' wherespecific details on the delivery, education, and trainin of ECT were documented. Finallyin ''" the 0merican ;sychiatric 0ssociation released its latest task force report. Thisreport emphasizes the importance of informed consent, and the e=panded role that theprocedure has in modern medicine.

Indications

There is considerable variability in opinion amon e=perts as to whether ECT isappropriate as a first-line treatment or if its use should be reserved for patients who havenot responded to other interventions such as medication and psychotherapy.

The 0merican ;sychiatric 0ssociation(0;0) ''" uidelines ive the primaryindications for ECT amon patients with depression as a lack of a response to, orintolerance of, antidepressant medications+ a ood response to previous ECT+ and theneed for a rapid and definitive response (e.. because of psychosisor a risk of suicide).The decision to use ECT depends on several factors, includin the severity and chronicityof the depression, the likelihood that alternative treatments would be effective, thepatientAs preference, and a weihin of the risks and benefits.

:ome uidelines recommend that conitive behavioral therapy or otherpsychotherapy should enerally be tried before ECT is used. 8owever, treatment

resistance is widely defined as lack of therapeutic response to two antidepressants. The0;0 states that at times patients will prefer to receive ECT over alternative treatments,but commonly the opposite will be the case.

The 0;0 ECT uidelines state that severe maor depression with psychoticfeatures, manic delirium, orcatatoniaare conditions for which there is a clear consensusfavorin early reliance on ECT. The ?$CE uidelines recommend ECT for patients withsevere depression, catatonia,or proloned or severemania.
http://en.wikipedia.org/wiki/National_Institute_of_Mental_Healthhttp://en.wikipedia.org/wiki/National_Institutes_of_Healthhttp://en.wikipedia.org/wiki/National_Institutes_of_Healthhttp://en.wikipedia.org/wiki/American_Psychiatric_Associationhttp://en.wikipedia.org/wiki/Antidepressanthttp://en.wikipedia.org/wiki/Psychosishttp://en.wikipedia.org/wiki/Suicidehttp://en.wikipedia.org/wiki/Cognitive_behavioral_therapyhttp://en.wikipedia.org/wiki/Psychotherapyhttp://en.wikipedia.org/wiki/Major_depressionhttp://en.wikipedia.org/wiki/Catatoniahttp://en.wikipedia.org/wiki/Catatoniahttp://en.wikipedia.org/wiki/Maniahttp://en.wikipedia.org/wiki/National_Institute_of_Mental_Healthhttp://en.wikipedia.org/wiki/National_Institutes_of_Healthhttp://en.wikipedia.org/wiki/National_Institutes_of_Healthhttp://en.wikipedia.org/wiki/American_Psychiatric_Associationhttp://en.wikipedia.org/wiki/Antidepressanthttp://en.wikipedia.org/wiki/Psychosishttp://en.wikipedia.org/wiki/Suicidehttp://en.wikipedia.org/wiki/Cognitive_behavioral_therapyhttp://en.wikipedia.org/wiki/Psychotherapyhttp://en.wikipedia.org/wiki/Major_depressionhttp://en.wikipedia.org/wiki/Catatoniahttp://en.wikipedia.org/wiki/Catatoniahttp://en.wikipedia.org/wiki/Mania


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The ''" 0;0 uidelines support the use of ECT for relapse prevention, but the''& ?$CE uidelines do not.

The ''" 0;0 ECT uidelines say that ECT is rarely used as a first-line treatmentfor schizophrenia but is considered after unsuccessful treatment with antipsychotic

medication, and may also be considered in the treatment of patients with schizoaffectiveor schizophreniformdisorder. The ''& ?$CE ECT uidelines do not recommend ECTfor schizophrenia.

The ?$CE ''& uidelines state that doctors should be particularly cautious whenconsiderin ECT treatment for women who areprenantand for older or youner people,because they may be at hiher risk of complications with ECT. The ''" 0;0 ECTuidelines say that ECT may be safer than alternative treatments in the infirm elderly anddurin prenancy, and the ''' 0;0 depression uidelines stated that the literaturesupports the safety for mother and fetus, as well as the efficacy durin prenancy.

Procedure

ECT is usually iven & times a week. 0 patient may reDuire as few as & or treatments or as many as " to "*. Ince the family J patient consider that the patient ismore or less back to his normal level of functionin, it is usual for the patient to have " or additional treatments in order to prevent relapse. Today the method is painless, J withmodifications in techniDue it bears little relationship to the unmodified treatments of the"%'s.

The patient is put to sleep with a very short-actin barbiturate, J then the drusuccinycholine is administered to temporarily paralyze the muscles so they do not

contract durin the treatment J cause fractures. 0n electrode is placed above the templeof the nondominant side of the brain, J a second in the middle of the forehead (this iscalled unilateral ECT)+ or one electrode is placed above each temple (this is calledbilateral ECT). 0 very small current is passed throuh the brain, activatin it J producina seizure. >ecause the patient is anesthetized J his body is totally rela=ed by thesuccinycholine, he sleeps peacefully while an electroencephaloram (EE2) monitors theseizure activity J an electrocardioram (EG2) monitors the heart rhythm. The current isapplied for one second or less, J the patient breathes pure o=yen throuh a mask. Theduration of a clinically effective seizure ranes from &' seconds to sometimes loner thana minute, J the patient wakes up "' to "* minutes later.


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>ecause as many as ' to *' percent of the people who respond well to a course of ECTrelapse within months, a maintenance treatment of antidepressants, lithium or ECT atmonthly or week intervals miht be advisable.

:hort-term memory loss has always been a concern to patients who receive ECT,but several studies conclude that patients who received unilateral ECT performed better

on attention1memory tests than those who received bilateral ECT. 8owever, there is aDuestion as to whether unilateral is as effective. E=perts aree that chanes in memoryfunction do occur J persist for a few days followin treatment, but that patients return tonormal within a month. 0 "%4* ?$68 Consensus Conference concluded that while somememory loss is freDuent after ECT, it is estimated that one-half of " percent of ECTpatients suffer severe loss. 6emory problems usually clear within 3 months of treatment,althouh there may be a persistent memory deficit for the period immediatelysurroundin the treatment.

Non&clinical patient characteristics

0bout 3' percent of ECT patients are women. This is larely, but not entirely, dueto the fact that women are more likely to receive treatment for depression. Ilder andmore affluent patients are also more likely to receive ECT. The use of ECT treatment is@markedly reduced for ethnic minorities.@

E%%ectiveness

The "%%%


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treatment. The review also found that many of these studies failed to find a differencebetween real and placebo ECT even durin the period of treatment. >ased on theseobservations, Hr. Koss concludes that @claims in te=tbooks and review articles that ECTis effective are not consistent with the published data@, and that consent forms for theprocedure should state that @real ECT is only marinally more effective than placebo.@

The review was hihly critical of other published reviews concludin that ECT waseffective, because these reviews often relied primarily on studies that were not placebo-controlled.

Adverse e%%ects

0side from effects in the brain, the eneral physical risks of ECT are similar tothose of brief eneral anesthesia+ the


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:tudies have found that patients are often unaware of substantial conitive deficitsinduced by ECT. For e=ample, in 7une ''4, a Huke ased on their findins, the authorsissued the followin recommendation/

@9hen ECT is provided to adolescents, the potential impact of such conitivechanes should be discussed with the patients and their parents or uardians in terms of

implications for not only the patientNs emotional functionin but conitive functionin aswell, particularly upon his or her academic performance. $n summary, we arue that anindividual cost-benefit analysis should be made in liht of the implications of thepotential benefits versus costs of ECT upon improvin emotional functionin and theimpact that potential memory chanes may have on real-world functionin and Duality oflife.@

Controvers over lon#&ter' e%%ects on #eneral co#nition

0ccordin to prominent ECT researcher8arold :ackeim, @despite over fifty yearsof clinical use and onoin controversy@, until ''3 there had @never been a lare-scale,

prospective study of the conitive effects of ECT.@ $n this first-ever lare-scale study(&3 subects), :ackeim and colleaues found that at least some forms (namely bilateralapplication and sine wave currents) of ECT @routine!ly#@ lead to @adverse conitiveeffects,@ includin lobal conitive deficits and memory loss, that persist for at least si=months after treatment, suestin that the induced deficits may be permanent. Theauthors also warned that their findins did not suest that riht-unilateral ECT did notalso lead to chronic conitive deficits.

8arold :ackeim can be seen in a videotaped depositionbriefly discussin thefindins of this study and why, in his opinion, earlier studies had failed to find evidenceof lon-term harm from ECT. Hespite over fifty years of clinical use, :ackeim states that

prior to ''", @the field itself never really had an opportunity to have a discussion aboutpatients who have complaints about lon-term memory loss.@ $n this video clip, :ackeimalso reveals that at a California ECT conference with '' practitioners present, whenpolled as to whether they think ECT can lead to chronic conitive deficits, two-thirdsraised their hands. :ackeim says this was @almost a watershed moment for the field@, andwas the @first time publicly that the field itself said AnoA to the position that it canAthappen.@
http://en.wikipedia.org/wiki/Electro-convulsive_therapy#cite_note-duke_study-26%23cite_note-duke_study-26http://en.wikipedia.org/wiki/Harold_Sackeimhttp://www.youtube.com/watch?v=hvwVRn91bAUhttp://en.wikipedia.org/wiki/Electro-convulsive_therapy#cite_note-duke_study-26%23cite_note-duke_study-26http://en.wikipedia.org/wiki/Harold_Sackeimhttp://www.youtube.com/watch?v=hvwVRn91bAU


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$n 7uly ''3, a second study was published concludin that ECT routinely leadsto chronic, substantial conitive deficits, and the findins were not limited to anyparticular forms of ECT. The study, led by psychiatrist 2lenda 6acOueen and colleaues,found that patients treated with ECT for bipolar disorder show marked deficits acrossmultiple conitive domains. 0ccordin to the researchers, @:ubects who had received

remote ECT had further impairment on a variety of learnin and memory tests whencompared with patients with no past ECT. This deree of impairment could not beaccounted for by illness state at the time of assessment or by differential past illnessburden between patient roups.@ Hespite the findins of chronic, lobal conitive deficitsin post-ECT patients, 6acOueen and colleaues suest that it is @unlikely that suchfindins, even if confirmed, would sinificantly chane the riskbenefit ratio of thisnotably effective treatment.@

:i= months after the publication of the :ackeim study documentin routine, lon-term memory loss after ECT, prominent ECT researcher 6a= Finkpublished a review inthe ournal"sychosomaticsconcludin that patient complaints of memory loss after ECT

are @rare@ and should be @characterized as somatoform disorders, rather than as evidenceof brain damae, thus warrantin psycholoical treatment for such disorders.@ >ased onhis findins, Fink suests that, @$nstead of endorsin these reports as the directconseDuence of ECT, especially in patients who have recovered from their depressiveillness, lost their suicidal drive, and have improved social functionin, is it not moreuseful to accept the complaint as a somatoform disorder, e=plore the basis in theindividualNs history and e=perience, and offer appropriate supportive treatment@

6ost recent reviews of the literature and other articles continue to characterizeECT as safe and effective. For e=ample, in 7une ''%, ;ortuuese researchers published areview on the safety and efficacy of ECT in an article entitled, Electroconvulsive

Therapy# $yths and Evidences.$n their review, the researchers conclude that ECT is an@efficient, safe and even life savin treatment for several psychiatric disorders.@ $n ''4,ale researchers published a review on the safety and efficacy of ECT in elderly patients.0ccordin to the authors, @ECT is well established as a safe and effective treatment forseveral psychiatric disorders.@ 0nd in a 7une ''% article published in the %ournal ofECT, $ranian researchers observe that, @Hespite the wide consensus over the safety andefficacy of electroconvulsive therapy (ECT), it still faces neative publicity andunfavorable attitudes of patients and families.@

;sychiatrist ;eter >rein, chief editor of the ournalEthical &uman "sychologyand "sychiatry, is a leadin critic of ECT who believes the procedure is neither safe noreffective. $n a published article reviewin the findins of 8arold :ackeimAs ''3 study onthe conitive effects of ECT, >rein accuses 6a= Finkand other pro-ECT researchersof havin a history of @systematically coverin up damae done to millions of !ECT#patients throuhout the world.@ 8e disarees with the position that findins of chronic,lobal conitive deficits should have no bearin on the risk-benefit ratio of ECT, and hebelieves itAs important to address the @actual impact of these losses on the lives ofindividual patients.@ $n a section of his paper entitled estroying (ives, Hr. >reinwrites, @Even when these inured people can continue to function on a superficial social
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basis, they nonetheless suffer devastation of their identities due to the obliteration of keyaspects of their personal lives. The loss of the ability to retain and learn new material isnot only humiliatin and depressin but also disablin. Even when relatively subtle, theseactivities can disrupt routine activities of livin.@

0 study published in '' in the %ournal of $ental &ealth reported that &* toM of patients said ECT resulted in loss of intellience. The study also reported, @Thereis no overlap between clinical and consumer studies on the Duestion of benefit.@

0 recent article by a neuropsycholoist and a psychiatrist in Hublin suests thatECT patients who e=perience conitive problems followin ECT should be offered someform of conitive rehabilitation. The authors say that the failure to attempt to rehabilitatepatients may be partly responsible for the neative public imae of ECT.

E%%ects on (rain structure

Considerable controversy e=ists over the effects of ECT on brain tissue despitethe fact that a number of mental health associations, includin the 0merican ;sychiatric0ssociation, have concluded that there is no evidence that ECT causes structural braindamae. 0 "%%% report by the rein has published books andreviews of the literature purportin to show that ECT routinely causes brain damae asevidenced by a considerable list of studies in humans and animals. $n particular, Hr.>rein asserts that animal and human autopsy studies have shown that ECT routinelycauses Pwidespread pinpoint hemorrhages and scattered cell death.N 0ccordin to Hr.>rein, the "%%' 0;0 task force report on ECT inored much of the scientific literaturepointin out the neative effects of electroshock therapy. For e=ample, in "%* 8ans8artelius conducted and published an animal study on cats entitled Cerebral ChangesFollowing Electrically *nduced Convulsions in which a double-blind microscopicpatholoy e=amination showed that it was possible to distinuish the 4 shocked animalsfrom the 4 non-shocked animals with remarkable accuracy based on statistically

sinificant structural chanes to the brain, includin vessel wall chanes, liosis, andnerve cell chanes. >ased on the detection of shadow cellsand neuronophaia, 8arteliusdetermined that there was irreversible damae to neurons associated with electroshock.

;roponents arue that the addition of hyper o=yenation and refinement intechniDue in the last thirty years has made ECT safe, and a maority of published reviewsin recent decades have reflected this position. $n a '' study desined to evaluatewhether modern ECT techniDues lead to identifiable brain damae, twelve monkeys
http://en.wikipedia.org/wiki/Peter_Bregginhttp://en.wikipedia.org/wiki/Gliosishttp://en.wikipedia.org/w/index.php?title=Shadow_cell&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Neuronophagia&action=edit&redlink=1http://en.wikipedia.org/wiki/Peter_Bregginhttp://en.wikipedia.org/wiki/Gliosishttp://en.wikipedia.org/w/index.php?title=Shadow_cell&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Neuronophagia&action=edit&redlink=1


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underwent daily electroshock for si= weeks under conditions meant to simulate humanECT+ the animals were then sacrificed and their brains were compared to monkeysunderoin anesthesia alone. 0ccordin to the researchers, @?one of the ECT-treatedmonkeys showed patholoical findins.@

There are recent animal studies that have documented sinificant brain damaeafter an electroshock series. For e=ample, in ''*, Kussian researchers published a studyentitled, Electroconvulsive +hock *nduces euron eath in the $ouse &ippocampus#Correlation of eurodegeneration with Convulsive ,ctivity. $n this study, the researchersfound that after an electroshock series, there was a sinificant loss of neurons in parts ofthe brain and particularly in defined parts of the hippocampus where up to "'M ofneurons were killed. The researchers conclude that @the main cause of neuron death isconvulsions evoked by electric shocks.@ $n ''4, ;ortuuese researchers conducted a ratstudy aimed at answerin the Duestion of whether an electroshock series causes structuralchanes in vulnerable parts of the brain. 0ccordin to the authors, @This study answerspositively the Duestion of whether repeated administration of EC: seizures can cause

brain lesions. Iur data are consistent with findins from other animal models and fromhuman studies in showin that neurons located in the entorhinal corte= and in the hilus ofthe dentate yrus are particularly vulnerable to repeated seizures.@

6any e=pert proponents of ECT maintain that the procedure is safe and does notcause brain damae. Hr. Charles Gellner, a prominent ECT researcher and former chiefeditor of the %ournal of ECT states in a recent published interview that, @There are anumber of well-desined studies that show ECT does not cause brain damae andnumerous reports of patients who have received a lare number of treatments over theirlifetime and have suffered no sinificant problems due to ECT.@ Hr. Gellner citesspecifically to a study purportin to show an absence of conitive impairment in eiht

subects after more than "'' lifetime ECT treatments. Ine of the authors of the citedstudy, 8arold :ackeim, published a lare-scale study less than a month after thisinterview concludin that the type of ECT used in the eiht patients receivin the "''lifetime treatments, bilateral sine wave, routinely leads to persistent, lobal conitivedeficits (discussed supra). Hr. Gellner states that, @Kather than cause brain damae, thereis evidence that ECT may reverse some of the damain effects of serious psychiatricillness.@

E%%ects in pre#nanc

$f steps are taken to decrease potential risks, ECT is enerally accepted to be

relatively safe durin all trimesters of prenancy, particularly when compared topharmacoloical treatments. :uested preparation for ECT durin prenancy includes apelvic e=amination, discontinuation of nonessential ant cholineric medication, uterinetocodynamometry,intravenous hydration, and administration of a no particulate antacid.Hurin ECT, elevation of the prenant womanAs riht hip, e=ternal fetal cardiacmonitorin, intubation, and avoidance of e=cessive hyperventilation are recommended.6uch of the medical literature in this area is composed of case studies of sinle or twin
http://en.wikipedia.org/wiki/Harold_Sackeimhttp://en.wikipedia.org/wiki/Pelvic_examinationhttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/w/index.php?title=Tocodynamometry&action=edit&redlink=1http://en.wikipedia.org/wiki/Antacidhttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Hyperventilationhttp://en.wikipedia.org/wiki/Harold_Sackeimhttp://en.wikipedia.org/wiki/Pelvic_examinationhttp://en.wikipedia.org/wiki/Anticholinergichttp://en.wikipedia.org/w/index.php?title=Tocodynamometry&action=edit&redlink=1http://en.wikipedia.org/wiki/Antacidhttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Hyperventilation


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prenancies, and althouh some have reported serious complications, the maority havefound ECT to be safe.

Ad'inistration

$nformed consent is souht before treatment. ;atients are informed about the risksand benefits of the procedure. ;atients are also made aware of risks and benefits of othertreatments and of not havin the procedure done at all. Hependin on the urisdiction theneed for further inputs from other medical professionals or leal professionals may bereDuired. ECT is usually iven on an in-patient basis. ;rior to treatment a patient is ivena short-actin anesthetic such as methohe=ital, propofol, etomidate, or thiopental, amuscle rela=ant such as su=amethonium(succinylcholine), and occasionally atropine toinhibit salivation.

>oth electrodes can be placed one on the same side of the patientAs head. This isknown as unilateral ECT.


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Ectron 5td, althouh in recent years some hospitals have started usin 0mericanmachines. Ectron 5td was set up by psychiatrist Kobert Kussell, who toether with acolleaue from the Three Counties 0sylum, >edfordshire, invented the ;aeKusselltechniDue of intensive ECT.

Variations in international practice

There is wide variation in ECT use between different countries, differenthospitals, and different psychiatrists. $nternational practice varies considerably fromwidespread use of the therapy in many western countries to a small minority of countriesthat do not use ECT at all, such as :lovenia. 2uidelines on the use of ECT are strinent inthe H?F) in dru resistant depressed patients.

Le#al status

In%or'ed consent
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$t is widely acknowleded internationally that obtainin the written, informed consentofthe patient is important before ECT is administered. The 9orld 8ealth Iranization, inits ''* publication @8uman Kihts and 5eislation 98I Kesource >ook on 6ental8ealth,@ specifically states, @ECT should be administered only after obtainin informedconsent.@!4#

$n the


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seen as another form of treatment that may be iven involuntarily as lon as lealconditions are observed.

$n most states in the


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Patient e)perience

The 0;0 ECT taskforce uidelines report findins that most patients find ECT noworse than oin to the dentist, and many found it less stressful than the dentist. Theyreport that other research finds that most patients would voluntarily receive ECT aain if

needed.

?$CE ECT uidelines report that some individuals consider ECT to have been abeneficial and lifesavin treatment, while others reported feelins of terror, shame anddistress, and found it positively harmful and an abusive invasion of personal autonomy,especially when administered without their consent.

Individual positive depictions

Gitty Hukakis, wife of politician 6ichael Hukakis, reports in aewsweekarticlemostly positive effects from electroconvulsive therapy, and reards memory loss as an

acceptable price to pay for relief from depression.

For me, the memory issues are real but manaeable. Thins $ lose enerally comeback. Ither memories $ prefer to lose, includin those about the depression $ wassufferin. >ut there are some memoriesBof meetins $ have attended, peopleAs homes $have visitedBthat $ donAt want to lose but $ canAt help it. They enerally involve thins $did two weeks before and two weeks after ECT. Iften they are ust wiped out....$ havelearned ways to partly compensate for whatever loss $ still e=perience. $ call my sister7inny, 6ichael and my kids, askin what my niece >etsyAs phone number is, what we didyesterday and what we are plannin to do tomorrow. $ apoloize prior to askin. $ wonderwhen they are oin to run out of patience with @Gitty bein Gitty.@ $ hate losin

memories, which means losin control over my past and my mind, but the control ECTives me over my disablin depression is worth this relatively minor cost. $t ust is.

0merican psychotherapist 6artha 6anninAs autobioraphicalndercurrentsacknowledes the downside of treatment/ @$ felt like $Ad been hit by a truckfor a while, but that was, comparatively speakin, not so bad,@ as well as the upside/@0fterwards, $ thouht, do reular people feel this way all the time $tAs like youAve notbeen in on a reat oke for the whole of your life.@

$n his autobioraphical book Electroboy, 0merican writer 0ndy >ehrmandescribes underoin ECT as a treatment for bipolar disorder while under house-arrest/ @$

wake up thirty minutes later and think $ am in a hotel in 0capulco. 6y head feels as if $have ust downed a frozen mararita too Duickly. 6y aws and limbs ache. >ut $ amelated.@

Curtis 8artmann, a lawyer in western 6assachusetts, stated/ @ECT, a treatment oflast resort for severe, debilitatin depression, is all that has ever worked for me. $ awakenabout ' minutes later, and althouh $ am still roy with anesthesia, much of thehellish depression is one. $t is a disease that for me, literally steals me from myselfBa
http://en.wikipedia.org/wiki/Katharine_D._Dukakishttp://en.wikipedia.org/wiki/Michael_Dukakishttp://en.wikipedia.org/wiki/Newsweekhttp://en.wikipedia.org/w/index.php?title=Martha_Manning&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Undercurrents_(autobiography)&action=edit&redlink=1http://en.wikipedia.org/wiki/Andy_Behrmanhttp://en.wikipedia.org/wiki/Katharine_D._Dukakishttp://en.wikipedia.org/wiki/Michael_Dukakishttp://en.wikipedia.org/wiki/Newsweekhttp://en.wikipedia.org/w/index.php?title=Martha_Manning&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Undercurrents_(autobiography)&action=edit&redlink=1http://en.wikipedia.org/wiki/Andy_Behrman


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disease that e=ecutes me and then forces me to stand and look down at my corpse.Thankfully, ECT has kept my monster at bay, my hope intact@.

Individual ne#ative depictions

?eative effects of ECT have been reported by noteworthy individuals.

Ernest 8eminway, 0merican author, committed suicide shortly after ECT at the6enniner Clinic in "%". 8e is reported to have said to his biorapher, @9ell, what isthe sense of ruinin my head and erasin my memory, which is my capital, and puttinme out of business $t was a brilliant cure but we lost the patient....@

$n ''*, @;ey :. :alters, ', sued ;almetto >aptist 6edical Center inColumbia, as well as the three doctors responsible for her care. 0s the result of anintensive course of outpatient ECT in ''', she lost all memories of the past &' years ofher life, includin all memories of her husband of three decades, now deceased, and the

births of her three children. 6s. :alters held a 6asters of :cience in nursin and had alon career as a psychiatric nurse, but lost her knowlede of nursin skills and wasunable to return to work after ECT.@ The ury awarded :alters Q&*,"33 in compensationfor her inability to work. The udment was upheld upon appeal.

Keistered nurse >arbara C. Cody reports in a letter to the /ashington "ostthather life was forever chaned by "& outpatient ECTs she received in "%4&. @:hockAtherapyA totally and permanently disabled me. EE2s !electroencephalorams# verify thee=tensive damae shock did to my brain. Fifteen to ' years of my life were simplyerased+ only small bits and pieces have returned. $ was also left with short-term memoryimpairment and serious conitive deficits. !deletion# :hock AtherapyA took my past, my

collee education, my musical abilities, even the knowlede that my children were, infact, my children. $ call ECT a rape of the soul.@

$n ''3, a ude canceled a two year old court order that allowed the involuntaryelectroshock of :imone H., a psychiatric patient at Creedmoor ;sychiatric Centerin thestate of ?ew ork. 0lthouh :imone spoke only :panish, she rarely received access tostaff fluent in her lanuae. :imone previously had '' electroshocks. 8owever, shecommunicated that she did not want more electroshock. :imone stated, @Electroshockcauses more pain. $ suffer more from shock treatmentR @

$n ''4, Havid Tarloff, a psychiatric patient who had received electroshock,

assaulted two therapists in the city of ?ew ork. Tarloff inured one therapist and killedthe other. Ine of the therapists was Gent :hinbach, a psychiatrist who had an interest inelectroconvulsive therapy. @$t is not clear whether Hr. :hinbach played any role in 6r.TarloffAs shock therapy@. 8owever, Tarloff told investiators that :hinbach had ivenTarloff psychiatric treatment at a psychiatric facility initially in "%%".

$n an interview with&ouston Chroniclein "%%, 6elissa 8olliday,a former e=traon -aywatchand model for"layboystated the ECT she received in "%%*, @ruined her
http://en.wikipedia.org/wiki/Ernest_Hemingwayhttp://en.wikipedia.org/wiki/Washington_Posthttp://en.wikipedia.org/wiki/Creedmoor_Psychiatric_Centerhttp://en.wikipedia.org/wiki/Houston_Chroniclehttp://en.wikipedia.org/wiki/Melissa_Hollidayhttp://en.wikipedia.org/wiki/Baywatchhttp://en.wikipedia.org/wiki/Baywatchhttp://en.wikipedia.org/wiki/Playboyhttp://en.wikipedia.org/wiki/Ernest_Hemingwayhttp://en.wikipedia.org/wiki/Washington_Posthttp://en.wikipedia.org/wiki/Creedmoor_Psychiatric_Centerhttp://en.wikipedia.org/wiki/Houston_Chroniclehttp://en.wikipedia.org/wiki/Melissa_Hollidayhttp://en.wikipedia.org/wiki/Baywatchhttp://en.wikipedia.org/wiki/Playboy


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life.@ :he went on to state, @$Ave been throuh a rape, and electroshock therapy is worse.$f you havenAt one throuh it, $ canAt e=plain it.@

5iz :pikol, the senior contributin editor of "hiladelphia /eekly, wrote of herECT in "%%, @?ot only was the ECT ineffective, it was incredibly damain to my

conitive functionin and memory. >ut sometimes itAs hard to be sure of yourself wheneveryone @credible@Bscientists, ECT docs, researchersBare tellin you that your realityisnAt real. 8ow many times have $ been told my memory loss wasnAt due to ECT but todepression 8ow many times have $ been told that, like a lot of other consumers, $ mustbe perceivin this incorrectly 8ow many times have people told me that my feelins oftrauma related to the ECT are misplaced and unusual $tAs as if $ was raped and peoplekept tellin me not to be upsetBthat it wasnAt that bad.@

Pu(lic perception and 'ass 'edia

0 Duestionnaire survey of &3% members of the eneral public in Australia

indicated that more than 'M of respondents had some knowlede about the mainaspects of ECT. ;articipants were enerally opposed to the use of ECT ondepressed individuals with psychosocial issues, on children, and on involuntarypatients. ;ublic perceptions of ECT were found to be mainly neative.

Nursin# Care

There are four components of nursin care in ECT/ (") providin emotional andeducational support to the patient and family1career+ () assessin the pre-treatment planand the patientNs behavior, memory, and functional ability prior to ECT+ (&) preparin andmonitorin the patient durin the actual procedure+ and () recoverin patient, observin

and interpretin patient responses to ECT with recommendations for chanes in thetreatment plan as appropriate. These elements of nursin care should be reflected in thenursin care plan for patients receivin ECT.

;rovidin Educational 0nd Emotional :upport

?ursin care starts as soon as the patient and family 1 career are offered ECT as apossible treatment option. 0t first, a vital role of the nurse will be to ive the patient andfamily 1 carer an opportunity to e=press their feelins, includin any myths ormisconceptions about ECT. ;atients may describe fear of pain, dyin from electrocution,sufferin permanent memory loss, or e=periencin impaired intellectual functionin. 0s

the patient e=presses these fears and concerns, the nurse can clarify misconceptions andemphasise the therapeutic value of the procedure. These first interactions allow for thebuildin of trust and rapport necessary to maintain a therapeutic nurse-patientrelationship. :upportin the patient and family 1 career in their need to discuss, Duestion,and e=plore their feelins and concerns about ECT should be an essential part of nursincare before, durin and after treatment.
http://en.wikipedia.org/wiki/Philadelphia_Weeklyhttp://en.wikipedia.org/wiki/Australiahttp://en.wikipedia.org/wiki/Philadelphia_Weeklyhttp://en.wikipedia.org/wiki/Australia


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Continuin on from this initial meetin the nurse can bein SECT teachin.Hependin on the patientNs presentin mental state, this should allow for the patientNsan=iety, readiness to learn, and ability to comprehend.

9here ever possible, family 1 career teachin should take place at the same timeas patient teachin, and the amount of information iven should be individualized for

each patient and family 1 career. The nurse should review the information the patient andfamily 1 career have received from the doctor reardin the procedure, and try to answerany Duestions the patient and family 1 career miht have about this information. Hurinthis assessment process, the nurse should also try to find out what specific patientbehaviors the family 1 career associates with the patientNs illness, and ascertain whetherthe patient or a family member has had ECT in the past. 0ny information about thefamilyNs previous e=perience with ECT will help the nurse identify familial beliefs aboutthe patientNs illness, the ECT treatment, and the e=pected pronosis. ;atient and family 1career should also be asked what other e=posure they may have had to ECT, such asthrouh friends who have received it, or by readin about it, or by seein it portrayed in afilm such as Ine flew over the cuckoos nest. Ipen ended Duestions can ive the nurse

the opportunity to identify and correct misinformation and deal with specific concerns thepatient or family 1 career may have about the procedure. E.. 9hat concerns do you haveabout receivin the anesthetic 8ow do you think you will feel after the first treatment9hat do you know about ECT These nursin actions may then promote the familyNsability to provide support to the patient durin the treatment and so further allay thepatientNs an=iety.

0n information booklet and video presentation may be used to supplementteachin the patient and family 1 career about ECT. 0 tour of the treatment suite itselfmay help familiarize the patient with the area, procedure, and eDuipment. Encourainthe patient to talk with another patient who has benefited from ECT may be an additionalsource of information.

The nurse should facilitate fle=ibility in family 1 career visitin arranements,particularly durin the patientNs first few treatments, allowin for family visitation beforeand after ECT if the patient and family 1 career desire. This allays the familyNs an=ietiesand concerns about the patientNs treatment, while encourain the family 1 career toprovide support for the patient. The nurse should also encourae the family 1 career tovisit the patient freDuently throuhout the course of treatment. The nurse should ascertainthe chanes family members observe in the patient and answer Duestions that arise. $nsome instances the patient may reDuest that a member of their family or career be presentin the treatment room whilst they receive ECT. They should discuss this with their doctor.The appointed family member 1 career should be assessed and prepared, usin suchresources as a trainin video which shows someone havin ECT. The multi disciplinaryteam must be informed of the pendin presence of the family member 1 career in thetreatment room.


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$nformed Consent For ECT

$n ?ovember ''" the HI8 published the 2ood practice in consentimplementation uide / consent to e=amination or treatment.

>efore beinnin ECT, an informed consent should be sined by the patient. $nEnland and 9ales, if the patient does not have the capacity to consent, a form for section*4 of the 6ental 8ealth 0ct must be completed by a second opinion approved doctor, orin an emerency and with a view to a section *4 bein arraned a form for a section ofthe 6ental 8ealth 0ct can be completed by the Kesponsible 6edical Ifficer. The patientshould be provided with 6ental 8ealth 0ct leaflet & in these cases. The consentacknowledes the patientNs rihts to obtain or refuse treatment. The consent form mustcomply with the recent Hepartment of 8ealth uidelines on consent documentation. Eventhouh it is the doctorNs ultimate responsibility to provide an e=planation of the procedurewhen obtainin consent, the nurse plays an interal role in the consent process.

$nformed consent is a dynamic process that is not completed with the sinin of aformal document, but it implies a process that continues throuhout the course oftreatment. $t suests a number of nursin activities. $t is helpful if a nurse is present atthe time when the information for consent is presented to the patient. The mostappropriate nurse is one who has established a trustin and therapeutic relationship withthe patient and who is best able to assess whether the patient comprehends thee=planation. The presence of a nurse at this time may facilitate the patientNs confidence inaskin Duestions, and the nurse may be able to simplify the lanuae if necessary. Thenurse can also ensure that the patient has been provided with a full e=planation+understands the nature, purpose, and implications of the treatment, includin the option towithdraw consent at any time+ and has had all his or her Duestions answered beforesinin the consent form. 0fter sinin the informed consent, but prior to beinnintreatment, the nurse should aain thorouhly review this information. The nurse shoulddiscuss the treatment in an open and direct manner, so communicatin that ECT is anaccepted and beneficial form of treatment.

$t is the responsibility of the psychiatrist to obtain the patientNs consent. Hepressedpatients freDuently e=perience impaired concentration and so are less likely tocomprehend and retain new information. For these patients, it is essential that the nurserepeat the information iven by the psychiatrist at reular intervals, because newknowlede is seldom fully absorbed after only one e=planation. Throuhout the patientNstreatment course, the nurse should reinforce what the patient already understands, (note,the level of understandin varies from patient to patient, and some patients may neverunderstand the information iven to them). 9here applicable, the nurse should remindthe patient of anythin he or she has forotten, and provide the patient with theopportunity to ask new Duestions. 9ritten information also available in other lanuaesshould be provided to the patient and their family 1 career. 0n interpreter should bearraned if reDuired. The patient should be informed about how to obtain additionalinformation and access to an independent advocate.


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;retreatment ?ursin Care

The ECT treatment nurse should ensure that the treatment suite is properlyprepared for the ECT procedure. The eDuipment needed to provide optimal ECT patientcare, as recommended by the Koyal Collee of ;sychiatrists is stipulated in their ECT0:

standards. 0n adustable heiht stretcher trolley should be available for the less ambulantpatients. Ither movin and handlin aids should also be accessible.

$n order to provide best practice nursin care for the ECT patient, a pre-treatmentchecklist should be completed as desinated by local hospital policy. 0rranementsshould be made for the safekeepin of the patientNs valuables. The ECT nurse shouldcheck that all relevant documentation has been completed. The nurse should e=plain theprocedure to the patient aain and ask whether they have any more Duestions or Dueries,providin reassurance.

>ecause eneral anesthesia is reDuired for ECT, the patient should fast from food

and fluids, ( as per local policy) before treatment to prevent possible aspiration. Thee=ceptions could be the patients who are takin cardiac medications, anti hypertensive, or8 blockers routinely. These medications should be administered before treatment asdirected by the doctor, with a sip of water. Hay patients should avoid a heavy meal theevenin before the treatment. In the mornin of treatment the patient should be asked toremove make up, nail varnish, body piercin etc. The nurse should ask the patient whenhe or she last ate and last drank. The patientNs hair should be clean and dry to allow forelectrode contact. 8airpins, hairnets and other hair ornaments should also be removed forthe same reason. The patient should be encouraed to pass urine before the treatment toavoid incontinence durin the procedure and to minimize the likelihood of bladderdistension and damae durin treatment. ;rostheses, dentures, lasses, hearin aids,contact lenses, should be removed at the latest possible moment, prior to theadministration of the anesthetic, to prevent problems of communication with the patient.The patientNs identity is checked and the patient wears an identity bracelet. 0 protocol forday 1 out patients should be in place which covers their needs, inclusive of / preparinthem for leavin hospital after treatment, and a written 1 verbal contract that they will notdrive and have a responsible adult to care for them for hours after treatment,arranements for further appointments.

The patient must be escorted to the ECT clinic waitin area, throuh ECT andrecovery and back to the ward by a Dualified nurse or eDuivalent. (%) $n the case of in-patients, the ideal escort is the patientNs ?amed ?urse, while in the case of out-patients,the patientNs community nurse, key-worker, a member of the ECT team or out-patientdepartment team should perform a similar function. The escort should be known to thepatient and be aware of the patientNs leal and consent status and have an understandinof ECT. To further minimise an=iety the escort nurse should consider the use of an=ietymanaement techniDues, ensurin as short a wait as possible in the treatment waitinroom, offerin reassurance and support. The doctor may prescribe a pre-med as per localprotocol.


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:pecial arranements should be made when patients are iven ECT in a clinicremote from a hospital base, i.e. the patient should have an individual trained nurseescort, and commutin patients should be treated at the beinnin of the session to allowma=imum time for recovery. Keardin anesthesia outside hospital, the view of the0ssociation of 0nesthetists is that the standards of monitorin used durin eneral

anaesthesia should be e=actly the same in all locations.

?ursin Care Hurin The ;rocedure

>ecause there will be several people in the treatment room, includinpsychiatrists, the treatment nurse and the anesthesia staff, the patient should beintroduced to each member of the team and iven a brief e=planation of the memberNsrole in the ECT procedure. The patient should then be assisted on to a trolley and asked toremove his 1 her prostheses, dentures, lasses etc. Kemovin the patients shoes willallow for the clear observation of the patientNs e=tremities durin the treatment.

Ince comfortably on the trolley, a member of the anesthetic staff will insert acannulae, while the treatment nurse and other members of the team place leads forvarious monitors. Ine member of the team should provide e=planation of the procedureas it occurs. Hual channel EE2 monitorin is recommended by the Koyal Collee of;sychiatrists (KC;). Ine electrode is placed to the side of the forehead and the other isbehind the ear, on either side. EC2, pulse o=imeter and blood pressure monitorin arealso recommended by the KC;. Capnoraph is also recommended by the KC;, in theevent of a patient needin to be intubated. 0 peripheral nerve stimulator and a means ofmeasurin the patientNs temperature should also be available for use. :ome ECTmachines incorporate monitorin eDuipment for movement when the seizure is induced.0n initial recordin of the patientNs blood pressure, pulse and o=yen saturation should be

made at this stae.

The psychiatrist or nurse cleans areas of the patientNs head with alcohol swabs and1 or el at the sites of electrode contact as per local protocol. This is to reduce impedanceand improve the contact of the electrodes with the patientNs head. The areas bein cleanedshould be either both the temples for bilateral ECT, or the temple on the non-dominantside of the brain for unilateral ECT. E=act placement of electrodes for unilateral ECT isdependent on KC; uidelines and local policy. The anesthetic, muscle rela=ant ando=yen are administered. 0 disposable or autoclavable bite block is inserted into thepatientNs mouth prior to the delivery of the stimulus to prevent tooth, tonue or umdamae or oint dislocation. Ine member of the treatment team records the time elapseddurin the seizure. 0 local stimulus dosin policy should be in use. 5ocal protocols formissed seizures and termination of proloned seizures should be adhered to.

$f reDuired and in the absence of the psychiatric trainee, the nurse can assist thetreatin psychiatrist by pressin the test 1 treat button on the ECT machine, whilst thepsychiatrist holds the electrodes on the patientNs head. The nurse must have been trainedand deemed competent by the consultant psychiatrist responsible for ECT. 0 localprotocol, to ensure the psychiatrist is aware of the nurseNs actions at each stae of the


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procedure and to check the dose iven, should be adhered to. This protocol must havebeen approved by the consultant psychiatrist responsible for ECT.

Ince the anesthetist is satisfied that the patient is breathin aain andmaintainin their own airway or able to do so with assistance, he 1 she will be transferred

to the recovery area.

;ost treatment ?ursin Care

The recovery area should be ne=t to the treatment room to allow access for theanesthetic staff in the event of an emerency. I=yen should be administered routinely tothe patient. The area must contain, suction, monitorin and emerency eDuipment asrecommended by the KC;. The nurse should maintain the patientNs airway and monitor 1record vital sins at reular intervals or more freDuently if complications arise. Thepatient should be observed by a staff member in close pro=imity until he or she awakens.The number of staff in the recovery area should e=ceed the number of unconscious

patients by one. 0 post-operative checklist prompts nurses to check for the presence orabsence of common or worryin side-effects at reular intervals after treatment. Thepatient may not remember havin the treatment, and their thinkin may be somewhatconcrete. The nurse should provide freDuent reassurance and reorientation until thepatient retains the information. 9hen interactin with the patient, brief distinct directionis best. ?ote, in some instances the patient may never retain some information. :impleconitive testin pre and post treatment should ive some indication of any abnormalityas a result of ECT.

The patient may become restless, aitated, aressive (post-ictal confusion) and 1or disorientated for a short period of time. The nurse should maintain the patientNs safety.

Lerbal interaction is usually ineffective. 9hen the episode has resolved the patient shouldbe reoriented. 0 small dose of a benzodiazepine may be effective. 9hen the patient isready he or she should be escorted to a final stae area for refreshments and rest until therecovery staff deem him or her fit to return to the ward.

The recovery nurse should pass on information to the ward nurse 1 escort aboutthe patientNs condition, medication administered, patientNs behavior, untoward proceduresor treatment response. This information should be recorded in the ECT notes. 0 lenthyseizure may cause an increase in time of patient bein disorientated or confused. 0 lonertime for rest and reorientation may be reDuired. Closer observation may be reDuired. Thepatient should be assessed on return to the ward reardin level of observation reDuiredand deree of orientation. $f the patient complains of a headache, muscle soreness,analesia such as paracetemol may be administered. The patient should be encouraed torest. ?ausea may be treated with an anti-emetic. 9ard staff should continue to providesupport, reminders to the patient of the treatment and reorientation to eliminate patientdistress from post treatment amnesia. The conitive impairments associated with ECTtreatment mostly reflect chanes in memory i.e. temporary anterorade amnesia andretrorade amnesia. 6emory deficits do not seem to be restricted to personalautobioraphical memory. 6emory loss may be distressin to the patient. The nurse


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should reinforce that the maority of the memory difficulties will pass within severalweeks, with a minimal amount of memory problems lastin up to months.

:taffin

0 trained nurse with relevant e=perience must be present at each stae of thetreatment. ECT should be administered only in a suitably eDuipped unit byprofessionals who have been trained in its delivery and in the anesthetic techniDuesreDuired for the administration of ECT. $n busy ECT clinics it is advisable to usenursin assistants to assist the Score team with low skill tasks. E.. 0ssistin withmovin a patient, ensurin the patient receives refreshments post ECT, telephonecommunication. 0ll nursin staff workin in the ECT team should receive >asic5ife :upport trainin (monthly), 6ovin and handlin trainin (annual), 6ental8ealth 0ct competency (annual). Kecovery nursin staff should receive localrecovery skills trainin inclusive of airway manaement, aspiration and suctiontechniDues ( monthly). Their competency in recovery must have been assessed.

0ll staff should be familiar with ECT policies and procedures. The same teamshould work in the clinic every week for the purposes of continuity. 0 budet forstaff trainin specific to ECT, should be available. :taff should be encouraed tokeep up to date with best practice and their trainin needs should be formallyassessed by appraisal. ECT nursin staff should attend appropriate trainin andconference events, e.. reional ECT nurse roup meetins, ECT nurse traininconferences and the KC; ECT trainin course.

The ECT Clinic ?urse 6anaer (ECT ?urse)

This nurse (minimum rade F K6? or eDuivalent) is responsible for the

development and implementation of a cohesive ECT service actin as a clinical andfunctional lead. Therefore, he 1 she should have appropriate ECT related knowlede 1e=perience and have underone an induction proramme coverin ECT policies andprocedures, medical eDuipment safety and clinical manaement. 8e 1 she should have anup to date ob description with clearly defined roles and responsibilities.8e 1 she should ensure that the patients, eDuipment and personnel are prepared andoranised for the session. Emerency resus eDuipment and drus should be checkedweekly, or as per local policy. The ECT machine output and electrodes should bechecked. The ECT nurse should ensure that the ECT machine functionin andmaintenance is checked and recorded at least every year or accordin to machineuidance. 0 record of ECT administration should be maintained for Duality assurance. 0ne=ample of ood practice in this area is the :cottish ECT 0udit ?etwork. 0ppropriateinduction and on-oin trainin of staff should be maintained, e.. ECT policies andprocedures, C;K, 6ovin and 8andlin, 6ental 8ealth 0ct, Control and Kestraint. Thenurse should offer clinical advice to services across the Trust and assist with liaisonbetween the ECT clinic team and the patientNs own team..

The nurse should have desinated sessional time for the clinics, auditin, teachinstudent nurses, risk assessments, administration, supervisin and research into best


24/27

practise in ECT. 8e 1 she should support the ECT consultant with the trainin of uniordoctors. The ECT nurse should be able to spend time with patients and relatives in orderto provide support and information. ut for a public influenced by Gen GeseyAs Ine Flew Iver theCuckooAs ?est, whose associations with ECT start with the electric chair J move on tolihtnin bolts, electric eels J third rails, it makes for Dueasy conversation. For all of us.5etAs replace a few of the myths with facts.

ECT has a hiher success rate or severe depression than any other form of

treatment. $t can be life-savin J produce dramatic results. $t is particularly useful forpeople who suffer from psychotic depressions or intractable mania, people who cannottake antidepressants due to problems of health or lack of response J prenant womenwho suffer from depression or mania. 0 patient who is very intent on suicide, J whowould not wait & weeks for an antidepressant to work, would be a ood candidate forECT because it works more rapidly. $n fact, suicide attempts are relatively rare after ECT.


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*i(lio#raph

". :cott 0$F (ed) et al. (''*). @The ECT 8andbook :econd Edition/ The ThirdKeport of the Koyal Collee of ;sychiatristsA :pecial Committee on ECT@(;HF).Koyal Collee of ;sychiatrists.http/11www.rcpsych.ac.uk1files1pdfversion1cr"4.pdf. Ketrieved ''4-'3-.

. ;sycholoy Frontiers and 0pplications :econd Canadian Edition (;asser, :mith,0tkinson, 6itchell, 6uir)

&. @Electroconvulsive therapy discussion hosted at the [email protected]/11www.masseneral.or1pubaffairs1issues''1"'"&'ect.htm. Ketrieved''3-'-'*.

. Carla Curran (''3-'%-"3). @:hock Therapy 6akes a Comeback/ :tatesKespond@. ?csl.or. http/11www.ncsl.or1prorams1health1shn1''31sn%%c.htm.Ketrieved ''%-"'-"3.

*. 6ental 8ealth/ 0 Keport of the :ureon 2eneral Chapter . Ketrieved ''3-"-%.

. Task Force on Electroconvulsive Therapy. The practice of electroconvulsivetherapy/ recommendations for treatment, trainin, and privilein. nd ed.9ashinton, HC/ 0merican ;sychiatric ;ublishin, ''".

3. 5isanby, :.8. (''3) Electroconvulsive Therapy for HepressionLolume &*3, ?o."%, pp. "%&%"%*

4. @2uidance on the use of electroconvulsive therapy@(;HF).?ational $nstitute forClinical E=cellence. ''*-""-'".http/11www.nice.or.uk1nicemedia1pdf1*%ectfulluidance.pdf. Ketrieved ''4-'3-.

%. Kudorfer, 6L, 8enry, 6E, :ackeim, 80 (''&). @Electroconvulsive therapy@. $n0 Tasman, 7 Gay, 70 5ieberman (eds) "sychiatry! +econd Edition. Chichester/7ohn 9iley J :ons 5td, "4*"%'".

"'. Keid 98, Geller :, 5eatherman 6, 6ason 6 (7anuary "%%4). @ECT in Te=as/ "%months of mandatory reportin@.% Clin "sychiatry*% (")/ 4"&. ;6$H%%"'*%.

"". Euba K, :aiz 0 (''). @0 comparison of the ethnic distribution in the depressedinpatient population and in the electroconvulsive therapy clinic@. % ECT++ ()/&*. doi/"'."'%31'".yct.''''&*%4.&%3%.*. ;6$H"3"&"*".

". :ureon 2eneral ("%%%). $ental &ealth# , 0eport of the +urgeon 1eneral,chapter .

"&. ;rudic 7, Ilfson 6, 6arcus :C, Fuller K>, :ackeim 80 (''). @Effectiveness of

electroconvulsive therapy in community settins@. -iol. "sychiatry,,(&)/ &'"". doi/"'."'"1.biopsych.''&.'%.'"*. ;6$H"33&.

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