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E.C.T Theory & Practice

E.C.T Theory & Practice. Dr.V.Mohanchandran Consultant Psychiatrist. E.C.T. Most effective modern treatment for severe persistent emotional disorders. Safe for patients of all ages. -people with debilitating illness -pregnant women

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E.C.T Theory & Practice

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  1. E.C.TTheory & Practice Dr.V.Mohanchandran Consultant Psychiatrist.

  2. E.C.T • Most effective modern treatment for severe persistent emotional disorders. • Safe for patients of all ages. -people with debilitating illness -pregnant women • Relieves more symptoms in a brief span of time. • But…..yet controversial & underutilized.

  3. E.C.T …..history • Wagner – 1928 Nobel Prize Neurosyphilis relieved by Malarial therapy – treating one illness with another. • Von Meduna – Hungary -24th Jan 1934 Camphor in oil. • Cirletti & Bini 1938 – Italy electrically induced seizure

  4. Diagnoses where E.C.T is effective. • Major depression: Single/Recurrent episode • Bipolar major depression: Depressed/Mixed/NOS • Mania (bipolar): Mania/Mixed/NOS • Schizophrenia: Catatonia/Schizophreniform/Schizoaffective • Catatonia: Schizophrenia-catatonic type/Due to med causes/malignant catatonia/NMS • Delirium : due to gen med condition / substance intoxication

  5. E.C.T not recommended in… • Dementia and amnesic disorders. • Substance related disorders. • Anxiety. • Somatoform disorders. • Factitious disorders. • Dissociative disorders. • Sexual dysfunctions. • Sleep disorders. • Impulse control disorders. • Adjustment disorders. • Personality disorders.

  6. E.C.T in depressive disorders • Treatment of choice: Severe depression Attempted suicide Strong suicidal plans Life threatening illness - refusal of food or fluids. • To be considered Stupor Marked psychomotor retardation Delusions & hallucinations When no adequate response to medications

  7. E.C.T as first line in depression?! • Speed & efficacy • Response in treatment resistant • Medication intolerance • Previous positive response • Patients medical status

  8. E.C.T in Mania • To be considered - Life threatening and physical exhaustion. -Treatment resistance.

  9. E.C.T in Schizophrenia • When Clozapine is ineffective intolerable.

  10. E.C.T in Catatonia • When Lorazepam is ineffective.

  11. E.C.T in special groups • Elderly • Pregnancy • In children

  12. E.C.T in neuro psychiatric disorders • Parkinson's disease. • Experimental -NMS. -Huntington's disease. -Resistant epilepsy.

  13. E.C.T….. Any place for Maintenance E.C.T?

  14. Mortality (APA 2001) 1 per 10,000 patients 1 per 80,000 patients. Prolonged seizures Status epilepticus Cognitive adverse effects - retrograde amnesia -anterograde amnesia Headaches Muscle aches Drowsiness Weakness Nausea Anorexia Adverse psychological reaction: Fear….Rare. E.C.T Adverse effects…

  15. E.C.T….Contraindications • Raised intra cranial pressure. • Untreated cerebral aneurysm. • Recent myocardial infarction. • Uncontrolled cardiac failure. • Deep Vein Thrombosis. • Acute respiratory infection. • Recent CVA. • Unstable major fracture. • Untreated phaeochromocytoma. *** ECT a low risk procedure***

  16. Guidelines of prescribing • A set course should not be prescribed • Assess after every treatment • Abandon the course if there is no improvement after 6 bilateral treatment. • Worth continuing upto 12 bilateral treatment if definite improvement shown early. • If no improvement with unilateral , then switch to bilateral.

  17. N.I.C.E • Effective treatment for certain subgroups of patients • Adverse effects – opinion varied • Wishes of the patient – paramount importance!! • All efforts to obtain valid and informed consent. • Always use with caution and restricted circumstances.

  18. E.C.T - MHA’83 (Amended) • Ascertainment of a patients capacity. • If the patient initially consents but then withdraws the consent or looses capacity treatment needs to be reviewed. • In emergencies – can treat according to the circumstances appropriate (upto a maximum of 2 treatments) ***to save the patients life!!

  19. Thank you.

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