Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a physical treatment that induces grand mal convulsions by applying electric current to the head. It is also called electric shock therapy (EST).

1. Characteristics of electroconvulsive therapy:
1. Usually used in treating: major depression with severe suicide risk, extreme hyperactivity, severe catatonic stupor, or those with bipolar affective disorders not responsive to psychotropic medication.
2. Consists of a series of treatments (6 to 25) over a period of time (e.g., three times per week).
3. Person is asleep through the procedure and for 20 to 30 minutes afterward.
4. Convulsion may be seen as a series of minor, jerking motions in extremities (e.g., toes). Spasms are reduced by use of muscle-paralyzing drugs.
5. Confusion is present for 30 minutes after treat-
6. E Induces loss of memory for recent events.


2. Views concerning success of electroconvulsive therapy:
1. Posttreatment sleep is the “curative factor.
2. Shock treatment is seen as punishment, with an accompanying feeling of absolution from guilt.
3. Chemical alteration of thought patterns results in memory loss, with decrease in redundancy and awareness of painful memories.


3. Nursing care plan/implementation in electroconvulsive therapy:
1. Always tell the client of the treatment.
2. Inform client about temporary memory loss for recent events after the treatment.
3. Pretreatment care:
1. Take vital signs.
2. See to client’s toileting.
3. Remove: client’s dentures, eyeglasses or contact lenses, and jewelry.
4. NPO for 8 hours beforehand.
5. Atropine sulfate subcutaneously 30 minutes before treatment to decrease bronchial and tracheal secretions.
6. Anesthetist gives anesthetic and muscle relaxant IV (succinylcholine chloride [Anectine]) and oxygen for 2 to 3 minutes and inserts airway. Often all three are given close togetheranesthetic first, followed by another syringe with Anectine and atropine sulfate. Electrodes and treatment must be given within 2 minutes of injections, because Anectine is very short acting (2 minutes).
4. During the convulsion the nurse must make sure the person is in a safe position, to avoid dislocation and compression fractures (although Anectine is given to prevent this).
5. Care during recovery stage:
1. Put up side rails while client is confused; side position.
2. Take blood pressure, pulse (check for bradycardia) and respirations.
3. Stay until person awakens, responds to questions, and can care for self.
4. Orient client to time and place and inform that treatment is over when awakens.
5. Offer support to help client feel more secure and relaxed as the confusion and anxiety de-
6. Medication for nausea and headache, pm.
6. Health teaching: teach family members what to expect of client after ECT (confusion, headache, nausea); how to reorient the client.


4. Evaluation/outcome criteria: feelings of worthlessness, helplessness, and hopelessness seem diminished.

Glossary

affectfeeling or mood communicated through the face and body posture. Can be blunted, blocked, flat, inappropriate, or displaced.

ambivalence coexisting contradictory (positive and negative) emotions, desires, or attitudes toward an object or person (e.g., love-hate relationship).

anhedonia inability to experience any pleasure.

amnesia loss of memory due to physical or emotion trauma.

anxiety state of uneasiness or response to a vague, unspecific danger cued by a threat to some value that the individual holds essential to existence (or by a threat of loss of control); the danger may be real or imagined. Physiological manifestations are increased pulse, respiration, and perspiration, with feeling of "butterflies.”

associative looseness speaks with unconnected topics (e.g., “no one needs a bus; we all have heaven here”).

autism self-preoccupation and absorption in fantasy, as found with schizophrenia, with a complete exclusion of reality and loss of interest in and appreciation of others, catatonia type of schizophrenia characterized by muscular rigidity; alternates with periods of excitability.

circumstantiality speaks with too many unnecessary details, compulsion an insistent, repetitiye, intrusive, and unwarned urge to perform an «cl that is contrary to ordinary conscious wishes or standards.

concrete thinking difficulty with abstract concepts (e.g., "It’s raining cats and dogs”).

conflict emotional struggle resulting from opposing demands and drives of the id, ego, and superego.

coping mechanism device used to ward off anxiety or uncomfortable thoughts and feeling!; m activity of 1he ego tat operates outside of awareness to hold impulses m check tat might cause conflict (e.g., repression, regression).

cyclothymia alterations in moods of elation and sadness, with mood swings out of proportion to apparent stimuli.

delusion a false fixed belief, idea, or group of ideas tat ate contrary to what is thought of as real and that cannot be changed by logic; arise out of the individual s needs and are maintained in spite of evidence or facts (e.g., grandeur and persecution).

depression morbid sadness or dejection accompaniedI by feelings of hopelessness, inadequacy, and unworthmess. Dntinguished from grief, which is realistic and in proportion to loss.

disorientation loss of awareness of the position of self in relation to time, place, or person.

echolali automatic repetition of heard phrases or words.

echopraida automatic repetition of observed movements.

ego the "I," “self," and “person" as distinguished from “others"; that part of the personality, according to Freudian theory, that meduies between the primihve, pleasure-seeking, instinctual drives of the id and the self-critical, probative, restraining forces of the superego; that aspect of the psyche that is conscious and most in touch with external reality and is directed by the reality principle. The part of the personal itytat has m make the decision. Most of the ego is conscious and represents the ihMing-feding part of a person..The compromises worked out on an unconscious level help to resold intrapsychic conflict by keeping thoughts, interpretations, judgments, and behavior practical and efficient.

electroshock electroshock treatment (EST) or vulsive treatment (ECT) is the treatment of certain psychiatric disorders (best suited for depression) by therapeutic ad ministration of regulated electrical impulses to the brain to produce convulsions.

empathy an objective awareness of another's thoughts, freltags,^?or behaviors and their meaning and significance, intellectual identification versus emotional identification(sympathy).

euphoria exaggerated feeling of physical and emotional well-being not related to external events or stimuli.

flight of ideas a thought disorder in which one thought moves rapidly to another without reaching a main idea or point, as in manic behavior. The next sentence may be triggered by a word in the previous sentence or by something in the environment.

fugue dissociative state involving amnesia and actual physicalflight.

hallucinationfalse sensory perception in the absence of an actual external stimulus. May be due io chemicals or inner needs and may occur in any of the five senses. Seen in psychosis and acute and chronic brain disorder.

hypochondriasis state of morbid preoccupation about one’s health (somatic concerns).

id psychoanalytic term for tat division of the psyche tat is unconscious, contains instinctual primitive drives that lead to immediate gratification, and is dominated by the pleasure principle. The id wants what it wants when it wants it.

illusion misinterpretation of a real, external sensory stimulus (e.g., a person may see a shadow on the floor and think it is a hole).

insanitylegal term for mental defect or disease that is of sufficient gravity to bring person under special legal restrictions and immunities.

labile unstable and rapidly shifting (referring to emotions).

manipulation process of influencing another to meet one's own needs, regardless of the other s needs.

mental retardation term for mental deficiency or deficit in normal development of intelligence that makes inteUec tual abilities lower than normal for chronological age. May result from a condition present at birth, from injury during or after birth, or from disease after birth.

mutism inability or refusal to speak.

narcissism exaggerated self-lore with all attention focused on own comfort, pleasure, abilities, appearance, etc.

neologism a newly coined word or condensed combination ofseveral words not readily understood by others but with symbolic meaning for the person with schizophrenia.

neurosisan older term for mild to moderately severe ill ness in which there is a disorder of feeling or behavior but no gross mental disorganization, delusions, or hallucmations, as in serious psychoses. Typical reactions include disproportionate anxiety, phobias, and obsessm-compuktve behavior.

obsession persistent, unwanted, and uncontrollable urge or idea that cannot be banished by logic or will.

organic psychosis mental disease resulting from defect, damage, infection, tumor, or other physical cause that can be observed in the body tissues.

paranoid adjective indicating feelings of suspicion and persecution; one type of schizophrenia.