• ECT is also known as electroshock therapy.
• ECT is a physical therapy in which artificial or grand mal seizure is produced in patients by applying the electrode on the temporal region between the hemispheres of the brain.
• ECT is the main and most common treatment for severe depression patients.

History of ECT

• ECT was introduced by the cerletti and Bini in 1938.
• American psychiatric association provides rights for ECT.
• In 1976, consent started before ECT.
• Consent for ECT should be collected by the patient.
• In 2005, WHO also recommended consent before ECT.
• In 2010, the Parliament of India passed the act to collect consent before ECT.

Indication of ECT   

• Major Severe depression of suicidal ideas.
• Schizophrenia types – catatonic schizophrenia

• Paranoid schizophrenia
• Unresponsive schizophrenia.
• Bipolar disorder.
• Organic brain syndrome.
• Delirium and profound mania.
• Medical condition seizures.

Contraindication of ECT

• Pregnancy, fracture patient.
• Old age patient.
• Myocardial infarction patient.
• Retinal detachment.
• Brain tumor.
• Increased ICP (1st priority option).
• Renal and lungs disorder.
• Hypertension.

• Note – ECT is contraindicated in pregnancy only in 1st trimester.

Amount of current in ECT

• 70 – 130 volt.
• If seizures are not produced or patients take lithium therapy, it can be extended up to 150 volt.
• Time duration of ECT = 0.6 – 1 second.

• Extended up to 1.2 seconds.

Method and techniques of ECT

1. Direct method – 

• The direct method applies without sedation or anesthesia.
• Only use the atropine sulfate.

2. Indirect method – 

• the indirect method also known as – modified ECT.
• The indirect method is the commonest in clinical practice.
• Anesthesia and sedation used during ECT with other associated drugs are –
• Atropine sulfate
• Thiopentane sodium
• Succinylcholine
• O2 inhalation.

Drugs during ECT

1. Atropine sulfate – Administer 30 minutes from ECT.

• Atropine sulfate is used in ECT to prevent bradycardia.

2. Thiopentone sodium – Thiopentane sodium used to provide the anaesthesia during ECT.

• Control the intensity of seizure.

3. Succinylcholine – Used as a muscle relaxant.

• During ECT succinylcholine prevents the risk of fracture.

Learning trick for – sequence of drug administration during ECT

आज तुम सब को हवा में उड़ा दूँगा ।

आज     = atropine sulfate

तुम       =  thiopentone sodium

सबको   = succinylcholine

हवा      =  O2 administer.

Types of ECT

1. Unilateral ECT –

• In unilateral ECT, electrodes are placed on a single side.

Eg. – Right side is for a right-handed person and the left side for a left-handed person.

• Unilateral ECT is less effective and less confusing and less complicated.

2. Bilateral ECT – 

• Bilateral ECT is most commonly used in clinical practice.
• Electrodes are placed on both sides of the temporal region.
• Side of bilateral ECT – Bi frontal

•  Bi temporal region

• Bilateral ECT is most effective but more confusing or more complicated.

Note – Position, where electrodes are placed unilateral.

ECT = D-Elias position.

Frequency of ECT –

In depression = Total ECT is 6 – 8 times.

In schizophrenia = Total ECT is 8 – 12 times.

In chronic schizophrenia = Total ECT 20 – 25 times.

Note – 3 times alternative days in a week.

(Only 3 ECT in a week)

Nursing role in preparation ECT

• Nurses collect lab investigations and reports. Eg. – X-ray, ECG, and blood reports.
• Select the consent of the patient.
• Physical examination of the patient before the ECT.
• The empty bowel and bladder of the patient are done.
• Inform the family member of the procedure.
• Remove all artificial dentures, metallic jewelry, and articles of lipstick and nail paints.
• Loose cloth provided to patients.
• Vital sign examination.
• Shampoo to the hair, tie to the women’s hair.
• A nurse administered pre- ECT medication.

Nursing role during ECT

• Nurses provide the supine position and apply pillows under the lumbar curve to prevent the risk of fracture in the 3rd, 4th, and 5th lumbar vertebra.
• Anaesthetic medication is to be administered.
• Restrain both legs, to prevent the risk of femur fracture.
• Provide mouth gag to prevent tongue bites.
• Hyperextension of the head with support to the chin is to be done.
• Vital sign examination and maintaining an airway.
• Observe tonic and clonic phases during ECT.
• Observe the intensity of seizures.

Nursing role after ECT

• A nurse opened the restrain.
• Place the patient in a lateral or side-lying position.
• Assess the vital sign.
• Nurses physically observe the patient for injury or any complications.
• Give a sip of water to check the gag reflex.
• Ambulation to the patient to observe the injury of fracture.

Complications of ECT

• Retrograde amnesia – unable to recall past memory.
• Most common complication.
• Respiratory distress.
• Aspiration.
• Mandible/jaw fracture (most common fracture after ECT).

Read also.

Psychotherapy Definition

Key points

• Which type of therapy is used in the ECT – Physical Therapy?
•  Electroshock therapy was introduced by – Carletti and Bini in 1938.
• WHO recommended consent before ECT – in 2005.
• ECT Consent was taken from the – Patient.
• ECT Consent act was passed by the Parliament of India in – 2010.
• ECT is the most effective management in which disease conditions – Severe depression and suicidal ideas.
• Which type of Schizophrenia where ECT is less effective – Paranoid Schizophrenia.
• Which type of Schizophrenia, where ECT is more effective – Catatonic Schizophrenia.
• what is ect power?- 70 – 130 volt.
• The most common ECT method used in clinical practice? – indirect Method.
• Another name for indirect ECT methods? – Modified ECT.
• Which drug to use to prevent bradycardia in ECT? – Atropine Sulphate.
• Which drug can cause respiratory problems during ECT? – Succinylcholine.
• The most common type of ECT in clinical practice? – Bilateral ECT.
• Advantages of unilateral ECT? – Less complication and Less confusion.
• Do nurses provide which position during ECT electrodes are placed in unilateral ECT? – D-Elias position.
• Depression patients require a total ECT ?- of 6 – 8 times.
• ECT Consent should be collected by? – Patient.
• Position of a patient, during ECT therapy? – Supine Position.
• What is the important nursing action during ECT? – Observe the intensity of seizures.
• Control the intensity of seizures during ECT by the – Thiopentane sodium.
• The most common complication occurs after ECT therapy. – Retrograde amnesia.
• Most common fractures occur after the ECT therapy. – Mandible/jaw fracture.
• What is the complication of ECT attained by nurses according to priority? – Respiratory distress.