Tag: Electroconvulsive Therapy (Ect)

Electroconvulsive Therapy (Ect)

ELECTROCONVULSIVE THERAPY (ECT)

Q. 1

The only definite contraindication to ECT is:

 A Brain tumour
 B Glaucoma
 C Aortic aneurysm
 D Myocardial disease 
Q. 1

The only definite contraindication to ECT is:

 A Brain tumour
 B Glaucoma
 C Aortic aneurysm
 D Myocardial disease 
Ans. A

Explanation:

Brain tumour


Q. 2

ECT is contraindicated in:

 A Intracranial SOL
 B Pregnancy
 C Cardiac disease
 D Psychosis
Q. 2

ECT is contraindicated in:

 A Intracranial SOL
 B Pregnancy
 C Cardiac disease
 D Psychosis
Ans. A

Explanation:

Intracranial SOL 


Q. 3

Which of the following is NOT true about electroconvulsive therapy (ECT)?

 A

Mainly used for the treatment of major depressive disorder

 B

No absolute contraindications to the use of ECT

 C

Should not be used in pregnancy

 D

Pheochromocytoma is a relative contraindication

Q. 3

Which of the following is NOT true about electroconvulsive therapy (ECT)?

 A

Mainly used for the treatment of major depressive disorder

 B

No absolute contraindications to the use of ECT

 C

Should not be used in pregnancy

 D

Pheochromocytoma is a relative contraindication

Ans. C

Explanation:

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.

Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebert, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

Quiz In Between


Q. 4

Indications for ECT are :

 A

Paranoid schizophrenia

 B

Depression with suicidal tendency

 C

Neurotic depression

 D

All

Q. 4

Indications for ECT are :

 A

Paranoid schizophrenia

 B

Depression with suicidal tendency

 C

Neurotic depression

 D

All

Ans. B

Explanation:

B i.e. Depression with sucidal tendency


Q. 5

ECT is indicated in

 A

Neurotic Depression

 B

Auditory hallucination

 C

Schizophrenia

 D

Delusional Depression

Q. 5

ECT is indicated in

 A

Neurotic Depression

 B

Auditory hallucination

 C

Schizophrenia

 D

Delusional Depression

Ans. D

Explanation:

D i.e. Delusional Depression


Q. 6

ECT is useful in

 A

Mania (Acute)

 B

Chronic Schizophrenia

 C

Acute Depression

 D

Pannic Disorder

Q. 6

ECT is useful in

 A

Mania (Acute)

 B

Chronic Schizophrenia

 C

Acute Depression

 D

Pannic Disorder

Ans. C

Explanation:

C i.e. Acute depression

Quiz In Between


Q. 7

ECT is not useful in treatment of

 A

Chronic Schizophrenia

 B

Catatonic Schizophrenia

 C

Endogenous depression

 D

Acute psychosis

Q. 7

ECT is not useful in treatment of

 A

Chronic Schizophrenia

 B

Catatonic Schizophrenia

 C

Endogenous depression

 D

Acute psychosis

Ans. A

Explanation:

A i.e. Chronic schizophrenia


Q. 8

ECT in depressive phase ofMDP is useful because it:

 A

Produces recurrence

 B

Reduces recurrence

 C

Shortens duration

 D

Increases drug effects

Q. 8

ECT in depressive phase ofMDP is useful because it:

 A

Produces recurrence

 B

Reduces recurrence

 C

Shortens duration

 D

Increases drug effects

Ans. C

Explanation:

C i.e. Shortens durations


Q. 9

ECT is most useful in:

 A

Mania

 B

Depression

 C

OCD

 D

Schizophrenia

Q. 9

ECT is most useful in:

 A

Mania

 B

Depression

 C

OCD

 D

Schizophrenia

Ans. B

Explanation:

B i.e. Depression

Quiz In Between


Q. 10

Indications of ECT is /are :

 A

Psychotic depression

 B

Catatonic schizophrenia

 C

Cyclothymia

 D

A & B

Q. 10

Indications of ECT is /are :

 A

Psychotic depression

 B

Catatonic schizophrenia

 C

Cyclothymia

 D

A & B

Ans. D

Explanation:

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


Q. 11

Absolute contraindication to ECT is

 A

Glucoma

 B

Brain Tumor

 C

Aortic Aneurism

 D

MI

Q. 11

Absolute contraindication to ECT is

 A

Glucoma

 B

Brain Tumor

 C

Aortic Aneurism

 D

MI

Ans. B

Explanation:

B i.e. Brain tumor


Q. 12

ECT is absolutely contraindicated in

 A

Pregnancy

 B

Very ill patient

 C

Raised Intracranial Tension

 D

Severe heart disease

Q. 12

ECT is absolutely contraindicated in

 A

Pregnancy

 B

Very ill patient

 C

Raised Intracranial Tension

 D

Severe heart disease

Ans. C

Explanation:

C i.e. Raised Intracranial tension

Quiz In Between


Q. 13

ECT causes

 A

Antegrade amnesia

 B

Retrograde amnesia

 C

Both

 D

None

Q. 13

ECT causes

 A

Antegrade amnesia

 B

Retrograde amnesia

 C

Both

 D

None

Ans. C

Explanation:

C i.e. Both


Q. 14

Most common complication of ECT is

 A

Antegrade Amnesia

 B

Retrograde Amnesia

 C

Physociasis

 D

Depression

Q. 14

Most common complication of ECT is

 A

Antegrade Amnesia

 B

Retrograde Amnesia

 C

Physociasis

 D

Depression

Ans. B

Explanation:

B i.e. Retrograde amnesia


Q. 15

Memory disturbance of ECT recovers in

 A

Few days to few weeks

 B

Few weeks to few months

 C

Few months to few year

 D

Permanent

Q. 15

Memory disturbance of ECT recovers in

 A

Few days to few weeks

 B

Few weeks to few months

 C

Few months to few year

 D

Permanent

Ans. B

Explanation:

B i.e. Few weeks to few months 

Quiz In Between


Q. 16

What is contraindication for ECT ‑

 A

Arrthmia

 B

Epilepsy

 C

HIV

 D

Cerebral aneurysm

Q. 16

What is contraindication for ECT ‑

 A

Arrthmia

 B

Epilepsy

 C

HIV

 D

Cerebral aneurysm

Ans. D

Explanation:

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.

Q. 17

ECT is contraindicated in –

 A

Very ill patients

 B

Raised ICT

 C

Heart disease

 D

Pregnancy

Q. 17

ECT is contraindicated in –

 A

Very ill patients

 B

Raised ICT

 C

Heart disease

 D

Pregnancy

Ans. B

Explanation:

Ans. is ‘b’ i.e., Raised ICT


Q. 18

Indications for ECT are all except ‑

 A

Severe depression with suicidal risk

 B

Catatonic schizophrenia

 C

Severe psychosis

 D

Sever manic attack

Q. 18

Indications for ECT are all except ‑

 A

Severe depression with suicidal risk

 B

Catatonic schizophrenia

 C

Severe psychosis

 D

Sever manic attack

Ans. D

Explanation:

Ans. is ‘d’ i.e., Sever 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.

Quiz In Between



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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