Critical Role of ECT in Contemporary Mental Health Care

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ELECTROCONVULSIVE THERAPY AND NURSING CARE MANAGEMENT
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Table of Contents
Contents Page
Introduction....................................................................................................................3
A brief history of ECT...................................................................................................3
Epidemiology of ECT....................................................................................................6
Indications of ECT.........................................................................................................8
Major depression........................................................................................................8
Mania..........................................................................................................................9
Bipolar Disorder.........................................................................................................9
Schizophrenia...........................................................................................................10
Theories on Mechanism of Action...............................................................................10
Nursing Role................................................................................................................10
Pre-ECT....................................................................................................................11
Post ECT..................................................................................................................12
Conclusion....................................................................................................................12
References....................................................................................................................14
Appendices...................................................................................................................17
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Introduction
Electroconvulsive therapy (ECT) is the deliberate inducing of a modified generalized
seizure in an anaesthetized patient under medically-controlled conditions to produce a
therapeutic effect (Kavanagh & McLoughlin, 2009). To achieve this, an electric
charge is passed through the brain between two electrodes that are placed on the scalp
of the anaesthetized patient. Electroconvulsive therapy is used to cause changes in the
chemistry of the brain so as to reverse the symptoms of some mental conditions. It is
often referred when other treatments are unsuccessful. When compared to
pharmacotherapy, ECT has evidenced as an effective treatment for depression. It is
actually preferred as an effective treatment option for the acute treatment of
depression with psychotic symptoms (Petrides, et al., 2001). ECT plays a critical role
in contemporary mental health care, and nurses play a very pivotal role in which they
have to deliver on when a patient undergoes electroconvulsive therapy.
This resource reviews ECT and its developmental history, epidemiology, indications
and its mechanism of action.
A brief history of ECT
The history of electroconvulsive therapy can be traced back to the 1500s on the basis
of the practice in which mental illness was treated with convulsions. The initial
practice involved inducing convulsions by orally taking camphor. The Swiss
physician Paracelsus successfully induced seizures through oral administration of
camphor to treat psychiatric illness (Sadock & Sadock, 2007). The first report to
published on the use of camphor to induce seizures for the treatment of mania was in
1785. Oral camphor was later replaced with intramuscular injection as demonstrated
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by the Hungarian neuropathologist Ladislas Joseph von Meduna in 1934 for the
treatment of catatonic schizophrenia (Sadock & Sadock, 2007). Treating mental
conditions with chemically-induced seizures came along with an equal share of
distressing and prolonged preictal effects which served as a precursor for the
exploration of new methods to induce therapeutic seizures.
Modern ECT can be traced back to 1938 when electricity was used to induce seizures
for the successful treatment of a catatonic patient by the neurologist Ugo Cerletti and
psychiatrist Lucio Bini (Kalapatapu, 2015). In 1939, ECT was introduced in the US
(Pandya, et al., 2007). However, the lack of adequate anaesthetic procedures or
muscle relaxation measures during ECT procedures led to dislocations and fractures,
and also the lack of adequate knowledge pertaining to dose parameters of electrical
stimulation to severe cognitive adverse effects (Pandya, et al., 2007). To counter such,
curare was used as a muscle relaxant during ECT procedures (Sadock & Sadock,
2007). Insulin shock therapy and lobotomy were the only viable alternatives to ECT
until the 1950s when effective antipsychotic drugs were developed.
Electroconvulsive therapy as a procedure was first scientifically researched in the
1950s. psychiatrist Max Fink applied rigorous scientific research methods to study the
efficacy and the ECT procedure (Taylor, 2007). It is in the same year in which
succinylcholine, a depolarizing muscle relaxant was introduced and used alongside a
short-acting anaesthetic during ECT procedures so as to prevent injuries and also
numb the patient from feeling the ECT procedure. According to Sadock and Sadock
(2007), randomised clinical trials conducted on the efficacy of ECT compared to other
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