Electroconvulsive Therapy
General Considerations
Uses an electrical current to depolarize the brain, inducing a generalized seizure.
Mechanism of action unclear.
Positive predictors include increasing age, sudden onset and short duration of illness, presence of psychotic and catatonic symptoms.
Negative predictors include medication resistance, personality disorders.
Indications
Typical indications include:
Depression, particularly delusional depression
Mania
Schizoaffective disorder, particularly mood symptoms
Acute psychosis in schizophrenia
Suicidal behavior
Catatonia
Pregnancy
Neuroleptic malignant syndrome
Obsessive compulsive disorder
Intractable seizures
Parkinson disease
Not generally used as a first-line treatment unless rapid response to symptoms desired in conditions such as:
Malnutrition
Severe agitation, such as manic excitement
Elderly patients who cannot tolerate the cardiovascular, genitourinary, or central nervous system side effects of antidepressant or antipsychotic agents
Contraindications
No absolute contraindications, including pregnancy and age limitations.
Relative contraindications include:
Recent infarction, coronary artery disease, hypertension, arrhythmia
Conditions associated with increased intracranial pressure (e.g., intracerebral bleed/tumor)
Conditions with increased risk for aspiration, such as gastroesophageal reflux disease
Contraindications to anesthesia, including pulmonary conditions (e.g., chronic obstructive pulmonary disease, asthma)
Diseases of the spinal column
Complications
Memory deficits:
Acute confusional state—occurs after each treatment and is a consequence of both the seizure and the anesthetic administration. Usually lasts approximately 5 to 50 min.Related posts:
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