Ect 1em4v

SOMATIC THERAPY

Somatic therapy → is the treatment of mental illness by physical means (such as medication, electroconvulsive therapy, or psychosurgery) rather than psychotherapy.

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Also known as electroshock therapy(EST) 1938 by Ugo Cerlettti and Luciano Bini, two Italian Psychiatrist Induce the grand mal seizure by ing an electrical current thru electrodes that are attached to the temple.

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It is believed that the shock stimulates brain chemistry to correct the chemical imbalance of depression

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However, the mechanism of action of ECT is unclear at present

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Major depression Prophylaxis Mania Schizophrenia Post partum psychosis Patients experiencing motor disorder cause by treatment

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Very high risk: Recent cerebrovascular accident Recent myocardial infarction Intracranial mass lession Elevation of intra cranial pressure

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High risk:

Angina pectoris Congestive heart failure

•Severe

osteoporosis •Major bone fracture •Glaucoma •Retinal detachment •Thrombophlebitis •Pregnancy •Severe pulmonary disease

•Anxiety

disorder •Behavioral disorder •Mild depression •Personality depression •Phobic disorder •Somatoform disorder •Substance use

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Modified ECT(Modern ECT)-with medication • Atropine sulfate  To decrease secretions • Anectine (Succinylcholine)  To promote muscle relaxation • Methohexital Sodium (Brevital)  Serves as an anesthetic agent

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Unmodified ECT- no medication

6 to 12 treatments, given 2- 3 times per week

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ECT machine with electrodes Wooden bed with mattress Mouth protector or gag Small pillow Electrodes jelly Towel Restraints Hypo tray with emergency stimulants Inhalator 3-4 assistants

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An electrode is placed above the temple of the nondominant side of the brain another in the middle of the forehead (Unilateral ECT)

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Or one electrode may be placed above the temple on each side of the brain (Bilateral ECT)

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Complete thorough physical, neurological and laboratory exam. Consent for therapy to be signed by a responsible relative Explain to the px what is to be done.

Before • • • • •

NPO 6-8 hours before the scheduled hour Omit AM dose of medication if any. Empty the bladder Check Vital signs. Remove all metal object

•Electrodes

are attached •Bite block is inserted •Ventilate with 100% Oxygen •Electric impulse is given up 70 to 150 volts for 0.5- 8 secs •The seizure must last 30-60 secs

•Ventilate

with 100% oxygen •Monitors for respiratory problems. •Reorient the patient •Document all aspect of treatment

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Apnea Fracture Loss of memory Headache

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Respiratory depression

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