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ELECTROCONVULSIVE THERAPY (ECT)

ELECTROCONVULSIVE THERAPY (ECT). Dr. Rabie A. Hawari Consultant Psychiatrist Clinical Assistant Professor. ECT. May be safer than TCA for some Pt. Reserved for Pts. Who have failed other Rx. For Pts. Who are so acutely dangerous or suicidal & need fast Rx.

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ELECTROCONVULSIVE THERAPY (ECT)

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  1. ELECTROCONVULSIVETHERAPY(ECT) Dr. Rabie A. Hawari Consultant Psychiatrist Clinical Assistant Professor

  2. ECT • May be safer than TCA forsome Pt. • Reserved for Pts. Who have failed other Rx. • For Pts. Who are so acutely dangerous or suicidal & need fast Rx. • May be used prophylactically to prevent recurrence. • Do not cure but induce remission. • Should be combined with other Rx.

  3. Indications:- - Major Depression, - Bipolar Disorder II --- Depressed, - Bipolar Disorder --- Manic, - Schizophrenia --- acute, catatonic, paranoid, with Affective s/s, - High suicidelity, - Pregnancy.

  4. Procedure:- - production of an epileptiform convulsion (35-80sec), - modified by muscle relaxant (succinylcholine), - under i.v. anesthesia (methohexitone), - by the passage of v. small current of the order of 250-500 milliamps, for up to 1 second duration, - at a voltage not exceeding 150 volts.

  5. Pretreatment Physical investigation, Medical Hx. Blood & urine chemistry, Chest X-ray, ECG, NPO.

  6. Types:- Bilateral Uilateral (nondominant( -No. of Rx. Less more - Amnesia greater less - Cognitive deficits more likely less

  7. Course:- - 3 times / wk, - depressed Pts. need = 6 – 12 treatments, - schizophrenic Pts. Need = 10 -20 treatments, - reassess Pt. between treatments, - stop when there is no evidence of improvement.

  8. Side effects:- - Ventricular Arrhythmias. - Transient Memory Impairment 1-2 wks. - Headaches. - Prolonged Seizures. - Prolonged Memory Impairment. - Brain Herniation. - side effects of Anesthesia.

  9. Contraindication:- • Relative:- - fever, arrhythmia, extreme HTN, coronary ischemia * Absolute:- - recent myocardic infarction, increased Intracranial pressure, brain ca., stroke. ( Mortality :- b/w 1-in- 1000 & 1-in- 10000).

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