ELECTROCONVULSIVE THERAPY (ECT)

Brain tumour

Intracranial SOL 

Ans:C-Should not be used in pregnancy.

Between 80% and 90% of all ECT treatments are performed for the treatment of major depressive disorder.

There are no absolute contraindications to the use of ECT. With appropriate preparation, ECT can be used effectively and safely in both pregnant and elderly patients. Pheochromocytoma is a relative contraindication for ECT.

Ans:B-Depression with suicidal tendency

Usually indicated in the following conditions for refractory cases, life-threatening symptoms, or if medication is contraindicated (e.g., pregnancy):

• Depression (most common)
• Schizoaffective disorder
• Schizophrenia with catatonia
• Bipolar mood disorder (e.g., manic episodes)
• Highly suicidal or pregnant depressed patients (not usually first-line)
• Neuroleptic malignant syndrome

ECT is the most effective treatment for severe major depressive disorder!

D i.e. Delusional Depression

Ans:C-Acute depression

Usually indicated in the following conditions for refractory cases, life-threatening symptoms, or if medication is contraindicated (e.g., pregnancy):

• Depression (most common)
• Schizoaffective disorder
• Schizophrenia with catatonia
• Bipolar mood disorder (e.g., manic episodes)
• Highly suicidal or pregnant depressed patients (not usually first-line)
• Neuroleptic malignant syndrome

ECT is the most effective treatment for severe major depressive disorder!

Ans:A-Chronic schizophrenia

Usually indicated in the following conditions for refractory cases, life-threatening symptoms, or if medication is contraindicated (e.g., pregnancy):

• Depression (most common)
• Schizoaffective disorder
• Schizophrenia with catatonia
• Bipolar mood disorder (e.g., manic episodes)
• Highly suicidal or pregnant depressed patients (not usually first-line)
• Neuroleptic malignant syndrome

ECT is the most effective treatment for severe major depressive disorder!

C i.e. Shortens durations

B i.e. Depression

A, B i.e. Psychotic depression, Catatonic schizophrenia

B i.e. Brain tumor

C i.e. Raised Intracranial tension

Ans:C i.e. Both

ECT is reported to cause anterograde amnesia (an inability to form new memories), but this is usually restricted to the period immediately following the ECT.

On the other hand, retrograde amnesia (loss of remote memories) has been argued to be both significant and permanent 

B i.e. Retrograde amnesia

B i.e. Few weeks to few months 

Ans. is ‘d’ i.e., Cerebral aneurysm

Contraindications of ECT

• Absolute : – Increased intracranial tension.cerebrovascular response to ECT include marked increased in cerebral blood flow and blood flow velocity. Cerebral oxygen consumption increases as well. The rapid increase in systemic blood pressure may transiently overwhelm cerebral autoregulation and may result in increased in intracranial pressure. Therefore, the use of ECT is prohibited in patients with known space occupying lesion (brain tumor) or head injury, cerebral (intracranial) aneurysm.
• Relative : – Recent myocardial infarction, severe hypertension, cerebrovascular accident, severe pulmonary disease, Retinal detachment, Pheochromocytoma.

Ans:B- Raised ICP

• No absolute contraindications. Relative contraindications include:
  • Elevated intracranial pressure and space-occupying lesions in the brain
  • Recent myocardial infarction (within the last 3 months)
  • Severe arterial hypertension
  • Narcotic intolerance
  • Acute glaucoma
  • Changes in the cerebral arteries, e.g., aneurysm, angioma

Pregnancy and pacemakers are not a contraindication for ECT.

Ans:D-Severe manic attack

Indications of ECT

• Severe depression with suicial risk or with psychotic features or with stupor.
• Some types of schizophrenia (catatonic or paranoid)
• Schizophrenic or depressive stupor
• Severe catatonia with stupor
• Severe psychoses (schizophrenia or mania) with risk of suicide or homicide or physical assault.