Electroconvulsive Therapy (Ect)

ELECTROCONVULSIVE THERAPY (ECT)


ELECTROCONVULSIVE THERAPY (ECT)

Introduction:

  • A type of convulsive therapies used for psychiatric disorders treatment.
  • Usage of electricity as an agent inducing convulsions – Referred as “electroconvulsive therapy.”

Types:

A. Direct ECT:

  • Anesthetic agents & muscle relaxants not used.
  • Generalized convulsions produced result in fractures or teeth dislocations.
  • Higher incidence of side effects – Rarely used now.

B. Modified ECT (Indirect ECT):

  • Anesthetic agents & muscle relaxants are administered before ECT.
  • Muscles relaxed → risk of bone fractures &other injures from motor activity during seizures minimized.

Technique:

  • Based on electrode placement – Bilateral ECT & Unilteral ECT.

Bilateral ECT: 

  • Most commonly used.
  • Involves electrodes placed on both sides of skull (bifronto-temporal electrode placement).

MOA:

  • Induction of bilateral generalized seizure via ECTs.
  • By down regulation of postslnaptic beta-adrenergic receptors.
  • Changes in growth factors & molecular mechanisms (increased brain derived neurotrophic factor, BDNF)
  • Neurogenesis (hippocampus).

Indications:

Depression (Major depressiue disorder): 

  • Both major depressive disorder & bipolar disorder.
  • Mainly for depression with suicide risk (Acute suicidal patients).
  • Depression with stupor.
  • Depression with psychotic symptoms (psychotic depression or delusional depression).

Manic episode:

  • Acute mania – Not 1st line treatment.
  • Only for intolerant/unresponsive to pharmacotherapy.
  • Severe maniac patients with suicide risk.

Schizophrenia:

  • Catatonic schizophrenia – 1st line treatment.
  • Note: Not effective in chronic schizophrenia.

Other indications:

  • Intractable seizures.
  • Neuroleptic malignant syndrome.
  • Delirium.
  • On-off phenomenon of Parkinson’s disease

Adverse effects:

Memory disturbances:

  • Most common side effect.
  • Retrograde amnesia more common.
  • Mild & recovery within 1-6 months after treatment.

Other side effects:

  • Delirium
  • Headache
  • Muscle aches
  • Fractures (very rare with modified ECT)
  • Nausea
  • Vomiting.

Contraindications:

  • No absolute contraindications.

Relative contraindication:

  • Raised intracranial tension (space occupying lesion in CNS).
  • Recent myocardial infarction
  • Severe hypertension
  • Cerebrovascular disease
  • Severe pulmonary disease
  • Retinal detachment

Note: Pregnancy not a contraindication.

Exam Important

  • Generalized convulsions produced during direct ECT result in fractures or teeth dislocations.
  • ECT is used for major depressiue disorder, catatonic schizophrenia, intractable seizures, neuroleptic malignant syndrome, delirium & on-off phenomenon of Parkinson’s disease.
  • ECT not effective in chronic schizophrenia.
  • Memory disturbances most commonly retrograde amnesia occur as side effect to ECT.
  • There are no absolute contraindications to ECT.
  • Raised intracranial tension (space occupying lesion in CNS) is a relative contraindication to ECT.
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