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Electroconvulsive therapy is a highly effective treatment for depression, with a response rate of 90%, compared to a 70% response rate for antidepressants.
ECT is effective for major depressive disorder, bipolar affective disorder (to treat mania and depression), catatonic stupor, and acute psychosis. It may be used as a first line treatment for depression, especially if associated with acute suicidal behavior or
Elderly patients tend to have a better response than to antidepressant medication. Pregnant women who are severely depressed, and who want to avoid long-term fetal exposure to antidepressant medication, can safely
Depression in Parkinson's disease responds with the added benefit of improvement of the movement disorder.
Evaluation
Before initiating electroconvulsive therapy, a complete a history and physical and routine laboratory tests (CBC, electrolytes, liver enzymes, urinalysis, thyroid function), EKG, chest X-ray, spinal X-ray series, and
Informed consent should be obtained 24 hours prior to the A second psychiatrist, not involved in the treatment of the patient, must also examine the patient and document the appropriateness of ETC, shock therapy, electro convulsive therapy and the patient's ability to give informed consent and.
Procedure
The patient should be NPO for at least eight hours and blood pressure, cardiac activity, oxygen content, and the electroencephalogram should be
A short-acting barbiturate, such as methohexital, is administered for anesthesia. A tourniquet (to prevent paralysis) is applied to one extremity in order to monitor the motor component of the seizure.
Muscle paralysis is then induced by succinylcholine. After an airway has been established, a rubber mouth block is then placed and an electrical stimulus is applied to induce the seizure.
The duration of the seizure is monitored by EEG and by the isolated extremity.
Dose
The seizure must last a minimum of 25 seconds and should last no longer than electroconvulsive therapy, ECT, shock therapy, electro convulsive therapy