Electroconvulsive Therapy Introduction to Clinical

1
Electroconvulsive Therapy

• Introduction to Clinical Psychology
• Discussion Section 3

2
ECT A Successful Treatment witha Bad Reputation

• Acknowledge paper by Carrie Schubert

3
Forerunners of ECT

• Ancient Romans used electric fish to treat
  headaches
• In early 1930s insulin therapy was used to
  induce seizures

4
First ECT Treatment

• In 1938, Urgo Cerletti and Lucio Bini used
  electric current to induce seizures in a
  schizophrenic man
• The patient fully recovered after 11 treatments
• Use of ECT spread rapidly

5
ECT

• Procedure is primarily used in the treatment of
  depression

6
Early ECT Procedures

• Archaic procedures were used (Cuckoos Nest
  movie)
• Restrained patients
• No anesthesia
• Strong electrical current

7
Current ECT Procedure

• Todays procedure has low risk of injury
• Strict procedural guidelines
• Informed consent
• Complete medical history
• Physical exam, blood test and electrocardiogram
• Done by psychiatrists, nurse and anesthesiologist

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ECT Procedures

• Patient is first anesthetized to relax muscles
  and prevent violent seizures
• Patients heart rate and vital signs are
  monitored
• Electrodes are placed either on one temple (for
  unilateral treatment) or both temples for
  bilateral treatment
• A small amount of electrical current is passed
  through the brain to produce a seizure of less
  than 60 seconds

9
ECT Procedures (cont)

• Patients are given two to three treatments a week
• The number of tratments varies between patients

10
ECT Side Effects

• Immediate memory impairment that clears
• Risk of medial complications like any procedure
  involving anesthesia
• Headaches, nausea and muscle pain can occur on
  treatment days

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ECT Effectiveness

• ECT results are quicker than anti-depressants
• High relapse (like anti-depressant treatment)
• Follow-up treatments needed
• ECT has response rates of 80 to 90 as a
  first-line treatment
• 50-60 for patients who have not responded to 1
  or more trials of antidepressant medication
• American Psychiatric Association Committee on
  Electroconvulsive Therapy. The Practice of
  Electroconvulsive therapy Recommendations for
  Treatment, Training, and Privileging. 2nd ed.
  Washington, D.C. American Psychiatric
  Association 2001

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ECT Informed Consent Tape