Research Paper on "Electroconvulsive Therapy"

Research Paper 13 pages (4067 words) Sources: 6

[EXCERPT] . . . .

Psychiatry

Electroconvulsive Therapy

Electroconvulsive therapy (ECT), also known as shock treatment, is an extremely safe and effective medical treatment for certain psychiatric disorders. With this treatment, a small quantity of electricity is applied to the scalp, producing a seizure in the brain. The process is painless because the patient is asleep under general anesthesia. ECT has a tremendously high success rate for the treatment of major depressive disorder, catatonia, mania and various psychotic symptoms. While ECT has been in use for more than sixty years, the way it is administered and the conditions under which it is used to treat patients has changed radically in recent years. Currently, about one hundred thousand individuals are thought to receive ECT every year in the United States (History and use, n.d.).

Although ECT has been used since the 1940's and 1950's, it remains misunderstood by the general public. A lot of the procedure's risks and side effects are connected to the misuse of equipment, incorrect administration, or inappropriately trained staff. It is also a misconception that ECT is used as a quick fix in place of long-term therapy or hospitalization. It is also not true that patients are painfully shocked out of the depression. Adverse news reports and media coverage have contributed to the controversy surrounding this treatment (Electroconvulsive Therapy and Other Depression Treatments, 2011).

Mechanism of Action

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, intentionally activating a brief seizure. Electroconvulsive therapy appears to cause alterations in brain chemistry that can instantly reverse symptoms of certain mental illnesses. It frequently works when other treatments are ineffective (Electroconvulsive therapy (ECT), 2011).

With ECT, electrodes are put on the patient's scalp and a finely controlled electric current is applied. The current causes a short seizure in the brain. ECT is one of the quickest ways to relieve symptoms in severely depressed or suicidal people. It's also very effective for those who suffer from mania or other mental illnesses. ECT is normally used when severe depression is unresponsive to other forms of therapy. Or it might be used when patients pose a severe threat to themselves or others and it is unsafe to wait until medications take effect (Electroconvulsive Therapy and Other Depression Treatments, 2011).

ECT treatments typically begin by having an IV line started and sensors for recording brain activity are placed on the head. Other sensors are placed on the chest for monitoring the heart and a cuff is wrapped around the arm for blood pressure. When everything is connected and in order, a medication is injected through the IV line that will cause the patient to sleep for five to ten minutes. Once asleep, another medication is given to relax the patient's muscles. This medication will prevent the patient's muscles from moving throughout the treatment and will decrease the possibility of injury. This same medication also relaxes the muscles that help a patient breathe, so oxygen will be provided through a mask until the medication wears off and the patient recommences breathing on their own (History and use, n.d.).

Once the patient is entirely asleep and the muscles are well relaxed, the treatment is administered. A brief electrical charge is applied to electrodes that have been placed on the scalp. This stimulates the brain and produces a seizure, which lasts for about one minute.

During the seizure, the patient may experience an elevated heart rate, the patient's toes may twitch, fists may clench or chest may heave. The patient's body will not convulse and they will not feel any pain (History and use, n.d.).

When the treatment is completed, the patient will be brought to the recovery area. Typically, patients will wake up about ten to fifteen minutes later and in many cases will be able to go home within an hour. Once the patient wakes up, they may experience headache, nausea, and temporary confusion and muscle stiffness. These symptoms normally go away in a matter of about sixty minutes (History and use, n.d.).

Guidelines for Treatment

The choice to administer ECT is based on an assessment of the risks and benefits for the individual person and involves a mixture of factors, including psychiatric diagnosis, type and severity of symptoms, prior treatment history and response, identification of possible alternative treatment options, and consumer preference. ECT may be considered as a primary treatment or first-line treatment for people having severe major depression, acute mania, mood disorders with psychotic features, and catatonia. A choice to use ECT as the primary therapy should be based on an assessment of the nature and the severity of acute symptoms in conjunction with an evaluation of risks and benefits. ECT may be the initial treatment of choice when a quick or a higher probability of response is essential. ECT may also be considered as a primary treatment when there is a history of good response to ECT treatment or poor response to alternate treatments during prior episodes (Electroconvulsive therapy review guidelines, 2011)

ECT is most frequently used as a secondary treatment when a patient has shown inadequate improvement with prescribed treatment, which usually includes pharmacotherapy. In addition to lack of considerable clinical response, other reasons to use ECT include intolerance to side effects of medication or other treatments, deterioration in condition, or appearance of suicide tendencies or marked lethargy. In the context of referral for ECT, patients who have not responded to psychotherapy alone should not be considered as having a treatment resistant mental illness, regardless of their diagnosis (Electroconvulsive therapy review guidelines, 2011)

Providers should address patient monitoring during the ECT process. Seizure length should be observed to make sure that a sufficient ictal response takes place, to detect extended seizure activity, and to control stimulus dosage. Since EEG and motor durations of seizures are not always the same, it is recommended that seizure duration be documented by motor ictal duration as well as by EEG. At a minimum, EEG monitoring should be carried out on a one-channel basis. The location of EEG monitoring leads should make the most of the detection of ictal EEG activity. ECG monitoring should begin prior to anesthesia and continue until spontaneous respiration resumes. ECG machines should be able of producing a paper printout. Vital signs including blood pressure and heart rate should be measured and documented before anesthesia and at intervals throughout the procedure, continuing until any ECT related changes have become stable. Oximetry should be carried out throughout the procedure to ensure that oxygenation is sufficient. Other monitoring may be necessary based on an individual's medical condition and during pregnancy (Electroconvulsive therapy review guidelines, 2011)

Providers should address the process to obtain informed consent, including procedures to follow when it is not clear whether the patient has sufficient capacity to give consent. Circumstances under which informed consent is necessary includes: previous to initial acute treatment, when additional treatments are necessary beyond the number originally proposed, and before beginning continuation or maintenance ECT. Informed consent should be obtained by the patient's attending physician, treating psychiatrist, or another physician who is knowledgeable about the patient and about ECT treatment procedures. To limit risks to patients and to make sure of continuity care, it is recommended that consent be obtained directly by a physician responsible for the care and treatment of the patient. Some hospitals may require separate consent for ECT anesthesia. If this is the case, this consent should be obtained by the designated anesthesia provider (Electroconvulsive therapy review guidelines, 2011)

Information describing ECT should be conveyed to the patient in a consent document that can be easily understood by the patient. Copies of documents should be given to the patient. In areas where facilities serve large numbers of people who speak a language other than English, whenever possible documents should be written in the primary language of the patient. This is not to mean that consent forms have to be available in every conceivable language. Each facility should evaluate on an individual basis their need for consent forms in languages other than English (Electroconvulsive therapy review guidelines, 2011)

Providers should make sure that patients sign a written consent document and should include specific information provided to the consenter, including but not limited to: the reason for the recommendation of ECT, a description of alternative treatments, a description of ECT procedure, a discussion of the benefits and risks of the different stimulus electrode placements and the rationale for the electrode placement being recommended, the range of the number of treatments the consenter is approving, a statement that there is no guarantee that ECT will be effective, a statement regarding the need for continuation/maintenance somatic treatment, a description of major risks and their likelihood of occurrence, a description of common side effects, a statement that consent for ECT also includes consent for clinically necessary emergency treatment, a description of restrictions on patient behavior before, during, and after treatment, any evidence of an opportunity for patient to ask questions and a statement that ECT is voluntary and… READ MORE

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