Question:

Nursing Care Management and Electro Convulsive Therapy

Write about ECT.

Answer to Question: CNA741 Foundations Of Mental Health Nursing Theory 2

Introduction

Electroconvulsive therapy is the deliberate induction induction of a modified generalized epileptic seizure in an anaesthetized individual under medically-controlled conditions to produce a therapeutic effects (Kavanagh & McLoughlin (2009).

The scalp of the anaesthetized person is placed with two electrodes to pass an electric charge through their brain.

In order to reverse the effects of certain mental conditions, electroconvulsive therapies is used.

It is frequently recommended after other treatments have failed.

ECT is a better treatment for depression than pharmacotherapy.

It is preferred as an effective treatment option to treat depression with psychotic symptoms. Petrides et.al. 2001.

ECT plays a significant role in contemporary mental healthcare. Nursing is crucial in delivering ECT when a patient has to undergo electroconvulsive treatment.

This resource reviews ECT including its development, epidemiology as well indications and mechanism of action.

A Brief History Of ECT

Electroconvulsive therapies can be traced back the 1500s to the practice of treating mental illness with convulsions.

Initial practice was to induce convulsions using camphor orally.

Paracelsus, the Swiss physician, successfully caused seizures using camphor orally administered to treat psychiatric disorders (Sadock&Sadock, 2007).

1785 saw the publication of the first report on the use camphor to induce seizures in the treatment for mania.

Later, oral camphor was replaced by intramuscular injections as Ladislas Joe von Meduna, a Hungarian Neuropathologist, demonstrated it in 1934 for the treatment Catatonic Schizophrenia (Sadock & Sadock 2007, 2007).

There were many side effects to treating mental conditions caused by chemically-induced epilepsy, including distressing and prolonged preictal symptoms. This was an important precursor for exploring new methods to induce therapeutic seizures.

Modern ECT can trace its roots back to 1938, when electricity used to induce seizures to treat a catatonic patients by Ugo Celetti and Lucio Bini. (Kalapatapu – 2015).

In the US, ECT became available in 1939 (Pandya et.al., 2007).

However, ECT procedures were not properly anaesthetic or used muscle relaxation techniques. Dislocations and fractures also occurred due to insufficient knowledge about the dosage parameters for electrical stimulation.

Curare was used in ECT procedures as a muscle relaxant to counter these effects (Sadock & Sadock 2007, 2007).

Until the 1950s, ECT was not an option. Effective antipsychotic drugs began to be developed.

In the 1950s, Electroconvulsive Therapy was first scientifically tested.

Max Fink, a psychiatrist who used rigorous scientific research methods in order to evaluate the effectiveness of the ECT method (Taylor (2007)).

It was in this year that succinylcholine, a long-acting muscle relaxant and a preventive medicine, was introduced.

Sadock & Sadock (2007) concluded that ECT was more effective than other medication for the treatment of mania in randomised clinical trials.

To reduce the misuse and abuse of the procedure, the American Psychiatric Association published a Task Force Report (Task Force Report) on ECT in 1978. It outlined standard ECT methods that were compatible with scientific evidence.

This report was later updated in 1990, 2001.

The National Institutes of Health’s endorsement of ECT helped further the development of the treatment (Sadock & Sadock (2007)).

A series of randomised controlled trials comparing ECT with lithium was conducted at the end 20th century. These results proved that both drugs are equally effective in treating mania.

Sarah Lisanby (Columbia University) and her colleagues demonstrated that magnetic stimulation could induce convulsive symptoms.

Two eras shaped the development of ECT.

One was an era of therapeutic optimism within psychiatry and the other was one of almost indecent use (Glass, 2001).

The first era of therapeutic optimism began when there was no other option to ECT.

ECT was almost universally used during the middle 20th century. The result of this period was the antipsychiatry movement. They exaggerated negative aspects of ECT as well as hospital care.

These actions cast doubts on the efficacy and effectiveness of ECT.

Contemporary ECT suffers from stigmatization and fear in the present day (Dowman et.al., 2005).

There are two types of barriers that prevent effective treatment of individuals with severe mental illness.

This is first, the unwillingness of the treating teams or patients to accept the treatment.

Glass (2001), suggests that healthcare professionals must be aware of all facts regarding ECT, as well as efficacy, indications for treatment, and adverse side effects.

Epidemiology and ECT

The first use of electroconvulsive therapy in schizophrenia treatment was in 1941.

However, the use of this procedure has declined over the past 70s and 80s due to the availability of drugs for the treatment severe mental disorders (McCall et.al., 1992).

ECT was mainly used to treat patients who are resistant to medication or who have severe life-threatening conditions (Eranti & McLoughlin 2003).

This idea was changed in 2003 by the National Institutes of Health (NIMH) and National Institute of Mental Health Consensus on ECT. These guidelines recommended that ECT shouldn’t be used as a last option.

After World War II saw the expulsion of psychiatrists, ECT quickly spread from Europe to other continents.

According to Hermann, et. al. ( 1995), there are approximately one million electroconvulsive patients in the world.

Swartz (2009) says that ECT is a common treatment option for people suffering from mental disorders.

Despite the existence of common international guidelines (Enns, and others, 2011), there are significant differences in how ECT is used across different countries and regions.

Furthermore, there is variation in ECT utilization among the different divisions.

Van Waarde et.al., 2009 study on ECT usage in the US found that ECT was used in 4.9 percent of US residents (as of 1995)

In 2012, Leiknes and colleagues found evidence of sparse usage on both the African and Latin American continents.

ECT is a common practice in America, Asia, Europe.

Despite the large utilisation in Europe and America, there are still variations in the clinical practice and utilization rates between regions.

Unmodified ECT (ECT administered with or without anaesthesia), is a significant part of the ECT that is used primarily in Asia. There are over 90% prevalence rates in Latin America and Africa. Some European countries (Spain Russia Turkey, Russia and Turkey) have ECTs (Leiknes et. al., 2012).

ECT is mainly used for depressive disorders in Australia and New Zealand.

Where unmodified ECT has been administered in other parts of the planet (Africa Asia and Russia, Latin America), the most common users are older male schizophrenia patients (Leiknes et.al., 2012).

Baghai et.al. (2005) as well as Moksnes et.al. (2006) agree to this observation. Moksnes et.al. (2006) noted that the majority of patients receiving ECT from the first tier of nations are older females with affective disorder.

Saudi Arabia, Pakistan, and Saudi Arabia have similar profiles. However, their age is younger.

ECT treatment rates in Western Australia is higher for Caucasian-white ethnicity (Teh et.al., 2005).

There are significant differences when it comes to the provision of ECT within psychiatric institutions.

Asia ranks highest at 59-78%, followed in Europe by Australia at 66%, 23-51%, and 6% in USA (Leiknes et. al., 2012).

Chanpattana (2007) agrees to this observation. Chanpattana (2007) notes that the procedure in Australia is provided by 66% of institutions, whereas training for ECT is provided 73%.

A limited number of reports on side effects, adverse consequences and mortality rates relating to ECT have been analyzed.

However, Thailand (0.08%) has the highest death rate, followed by Texas (14 deaths for every 100.000 treatments) (Chanpattana & Kramer (2005); Scarano & Felthous (2000).

But, it is unclear whether these ECT-related fatalities are caused by anaesthetic complications (comorbid somatic conditions) or lethal side effect such as cardiac arthymia.

Regarding the consent of administration for ECT, the procedure can be administered largely involuntarily or under guardian consent conditions throughout all regions.

Indications for ECT

ECT is a nonpharmacologic and effective biological treatment, which has been proven to be highly effective for treating depression, schizophrenia, and other indications.

ECT is a great alternative for the treatment of treatment-resistant psychiatric disorder that result from medication failure.

Major Depression

An effective treatment for severe depression is electroconvulsive. It’s a fast-acting and efficient option.

It is recommended for severe depression, where antidepressant therapies are ineffective or unsuitable, or when the symptoms are too severe to be managed quickly (O’Reardon et al. 2011, 2011).

Patients suffering from severe or severe suicidal depression and psychotic disorders often prefer it because of its quick response.

This group of patients is not able to wait for antidepressants.

ECT is a well-recognized and safe treatment option in psychiatry.

The downside is that the effects are often temporary and require continued treatment.Mania

The popularity of ECT as a primary treatment option for mania is declining in recent years due to the availability of atypical antipsychotics as well as classical neuroleptics and lithium, which have better antimanic effects.

The effectiveness of ECT has been demonstrated in randomized controlled trials and review articles.

ECT has shown a high rate or improvement in remission (Baghai & Moller, 2008).Bipolar Disorder

Bipolar disorder’s acute depression can often be difficult to treat. These include antidepressants, mood stabilizers and mood stabilisers.

ECT is recommended to clients with bipolar disorder. Clients in depressive states should consider ECT, particularly if they are not responding to any antidepressant or mood stabilisers.

ECT does not trigger switching which makes it a better choice than antidepressants.

Contrary what many believe, ECT is a great alternative, especially for elderly patients and patients with co-morbid medical issues (Brooks 2015.Schizophrenia

Cerletti & Bini in 1938 first suggested that ECT be used in the treatment of schizophrenia.

The treatment of schizophrenia and schizoaffective disorder has been shown to be effective (Chanpattana et. al., 2010).

This is despite the fact that it was used less frequently for schizophrenia in the 1950s, when neuroleptics were introduced.

ECT stands out for its effectiveness in schizophrenia treatment. It is recommended for patients with schizophrenia and those who have shown a nil or minimal response (Phutane et. al., 2011).

Theories about Mechanism of Action

Based on animal models, studies of the mechanism of ECT action have revealed that it is necessary to repeat the procedure to entrain a number of molecular or structural changes in the brain. These are believed to be relevant for its antidepressant properties (Kavanagh & McLoughlin (2009).

These changes include the regulation of neuronal Growth Factors, which increase the survival of neurones and plasticity. It also improves the way neurones adapt to one another.

Notably, ECT can also increase the number and quality of new nerve cells within the hippocampus (Grover et.al., 2005).

The hippocampus controls mood regulation, memory, and mood regulation.

Kavanagh (2009) states that antidepressants are less effective than ECT.

Nursing Role

ECT-related psychiatric nursing care has evolved from traditional supportive and additional practice to the present practice of collaborative and autonomous nursing actions (Burns & Stuart. 1991).

The current practice in nursing in ECT includes a number of nurses, including an ECT-nurse, a ward, operating room assistant, nurse coordinator and a rehabilitation nurse.Pre-ECT

The ECT nurses are responsible for coordinating and maintaining the service.

The ECT nurses are responsible to develop protocols in accordance with best practice guidelines.

The ECT nursing team ensures that all medication, equipment, and ECT settings are consistent with best practice guidelines (Kavanagh & McLoughlin (2009)

Although the actual administration of electroconvulsive therapies is the responsibility of the psychiatrist and the anaesthetist respectively, the ECT nurses play a critical role in addressing clients’ psychological needs.

This includes but isn’t limited to: educating patients about their condition, why they have been recommended for it, how to proceed with treatment, dealing with family members’ fears and using scientific evidence and facts as a guide (Queensland Health 2017).

Once the patient has been educated, a therapeutic relationship with the nurse is established. This reduces anxiety, dispels premonitions and myths, and helps to lower anxiety.

This is where the nurse’s role is critical. She makes the process less intrusive. These encourage patients to keep going despite any negative effects.

The nurse performs a pretreatment checklist on the patient before they are allowed to proceed with the treatment.

The nurse also takes care of the patient’s legal, mental and medical status (Kavanagh & McLoughlin (2009)

Post ECT

The role of the recovery nursing assistant is critical after the ECT treatment course.

These nurses are skilled in advanced life-support techniques, as well as being familiar with all possible adverse reactions.

The nurse will continue to monitor the patient’s vitals and administer any prescribed medications.

The nurse remains in the recovery rooms until the patient regains his sense of orientation and the nurse gives a clean bill.

Conclusion

Electroconvulsive treatment (ECT) has been deemed the best method for managing severe mental illness.

Since 1938, when it was developed for schizophrenia, this process has undergone significant development.

Despite the stigma that surrounds this process, there is substantial evidence to support its efficacy.

Nurses have a key role to play in the provision of ECT.

This is in contrast with the role that nurses used to play, which was more supportive.

Nurses now play a wide variety of roles. These include the ECT nurse as well as the ward nurse, recovery nurse, and the anaesthetist’s associate.

Therefore, it is vital to put emphasis on the education and training of nurses in ECT to increase the importance of their role in the enhancement or development of the therapy.

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