Psyche Reels

Thursday, November 11, 2010

Electroconvulsive therapy (ECT) is used to treat depression in select groups, such as clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses.

Other clients who may be subjected to ECT are:

Catatonic schizophrenia
Mania
Pregnant clients (it can cause no harm to the fetus)
Suicidal clients

Electroconvulsive therapy involves the application of electrodes to the head of the client to deliver electrical impulse to the brain; this causes a seizure (grandmal). It is believed that the shock stimulates the brain chemistry to correct the clinical imbalance of depression. Firing of neurotransmitters, specially serotonin, can increase the mood of depressed clients.

In the early use of ECT, clients do not receive any pre-medications such as muscle relaxants, anesthetics, and anticholinergics to decrease body secretions. This practice created a brutal image of the procedure. Clients who had experienced ECT were traumatized. This was the unmodified version of ECT. Presently, modified type of ECT is being implemented to minimize seizure experience on clients. Medications are now given before the procedure:

succinylcholine (Anectine) - a muscle relaxant
methoxital - mild anesthetic
atropihine sulfate - anticholinergic

Aside for the medications, oxygen supplementation is also provided to the client to ensure adequate oxygenation during the course of the treatment. The client is also attached to ECG and EEG machines to monitor any abnormalities to the heart and brain activities. The blood pressure monitored as well to detect any deviations in the circulatory condition of the client.

Prior to the procedure, the nurse has to check the following:

Consent for procedure.
Make sure that the client has urinated.
NPO 4 hours before the procedure to prevent aspiration.
Examine for any dentures, and remove them prior to the procedure.
Position the client in supine (flat on bed), with extremities guarded.
Place a mouthguard on the mouth of the client to prevent from biting his/her lips/tongue.
Vital signs are obtained to assess if the client is fit to receive ECT. Increase or decrease in the vital signs are indications that ECT is not to be given.

During th procedure, the nurse and other members of the team should ensure the safety of the client particularly during the seizure event. Assist the extremities in a way that it cannot create a fractures or injury, but do not hold down the client extensively.

After ECT, tilt the client's head towards the side to facilitate drainage of any oral secretions present in the oral cavity. Promote return of cardiovascular functioning by rubbing the anterior chest and provide adequate oxygen inhalation.

The client may experience temporary memory loss after ECT. Orient the client to time, place, and person immediately and what just happened to him/her.

For the Incurable Insane

History of Psychiatric Illness

Mental Illness has evolved from the harsh treatment of asylum and brutal criticisms of the public to managing symptoms with miracle drugs and empowering patients. Looking back on the manner how mentally ill persons received (supposedly) the right medical treatment, we reflect on our present practices. Have we really overcome the stigma of mental illness? Or, are we still living in the dark ages?