1. DODOMA INSTITUTE OF HEALTH AND ALLIED
SCIENCES (DIHAS)
MODULE NAME: MENTAL HEALTH NURSING
MODULE CODE: NMT 06211
TOTAL CREDITS:20
FACILITATOR: SIR. SIMON A. MOREMBWA

2. SESSION 08: MANAGEMENT OF
PATIENT USING
ELECTROCONVULSIVE
THERAPY

3. Learning Tasks
At the end of this session a learner is expected to be able:
 Define electroconvulsive therapy
 Explain the mode of action of Electroconvulsive Therapy
(ECT)
 Identify the indication and contraindications of ECT
 Prepare patient for Electroconvulsive Therapy (ECT)
 Provide care to patient with mental disorders during ECT
 Provide care to patient with mental disorders after ECT
 Monitor complications of ECT

4. Definition of ECT
 ECT (Electroconvulsive Therapy) is a treatment
that involves sending of briefly electrically
stimulating current to the brain to trigger seizures
in order to relieve the symptoms of some mental
health problem.
 The treatment is given under a general anesthetic
agents and using muscle relaxants, so that your
muscles only twitch slightly, and your body does
not convulse during the seizure

5. Mode of action of Electroconvulsive
Therapy (ECT)
 It is a type of somatic treatment in which electric
current is applied to the brain through electrodes
placed on the templates. A grand mal (generalized)
seizure produces the desired effect.
 It is given under a general anesthetic agents and
using muscle relaxants, so that your muscles only
twitch slightly, and your body does not convulse
during the seizure
 Exact mechanism of action of ECT is still unknown
though there are several theories which are trying

6.  The most popular theories include Neurotransmitter
theory suggests that ECT acts like tricyclic
antidepressants by enhancing deficient
neurotransmission in monoaminergic systems.
Specifically it is through to improve dopaminergic,
serotonergic, and adrenergic neurotransmission.
 ECT is effective for the following clients who are
currently suicidal and in the treatment of severe
depression, particularly in those clients who are also
experiencing psychomotor retardation and
neurovegetative changes such as disturbances in
sleep, appetite and energy.
 The ECT is usually given twice per week and a course

7.  NOTE:-ECT is often considered for
treatment only after a trial of therapy with
antidepressant medication has proved
ineffective or when the patient is resistant to
medication or when the patient is refractory
to antidepressant medications

8. Indications and contraindications of
Electroconvulsive Therapy (ECT)
The indications for ECT are:
 Major Depressive disorder
 Suicidal thoughts or homicidal
 Puerperal depressive illness
 Mania
 Marked agitation, marked vegetative symptoms or
Catatonic schizophrenia
 Schizoaffective disorder

9. The contraindications of ECT include;
 Raised intracranial pressure,
 High blood pressure,
 Any physical disorder- like cardiac and chest
infections
 Epileptic patients

10. Preparation of Patient before Electroconvulsive Therapy
(ECT)
Preparation needed for a patient undergoing ECT include the
following:-
 Educate regarding ECT, including the procedure and expected
effects
 Teach family about the treatment
 Encourage expression of feelings by patient and family
 Obtain informed consent either from the patient or next of kin
 Help family members understand behavior related to amnesia
and confusion
 Inform the patient not to eat anything from the midnight and

11.  Give atropine and muscle relaxant to reduce
secretions and movement of the patient
during the therapy
 Check emergency equipment before
procedure
 Check vital signs
 Remain available to offer support before and
during treatment

12. Care of Patient with Mental Disorder
during ECT
 The ECT is administered either by placing
one electrode on each side of the skull
(bilateral) or by placing both electrodes
(Unilateral ) on the side of head containing
non dominant hemisphere (the right side)
 Patient need to be supported firmly by about
4- 6 people during the procedure to avoid
excessive jerking movements which may
cause fractures.
 The nurse whom the patient feels at ease

13. The following are care of patient during ECT:
 Introduced all members of the treatment team and their specific
roles in the ECT procedure to the patient
 Remove potentially harmful objects such as jewelry and dentures
 Place a bite in the patient’s mouth to prevent damage from biting
during the convulsion
 Observe closely and record the effects of the ECT procedure and
the patient’s reaction
 Monitor brain waves using electroencephalogram (EEG)
 Monitor cardiac responses using electrocardiogram (ECG)
 Monitor blood pressure throughout the treatment
 Maintain patent airways
 Offer analgesia or antiemetic as needed

14. Care of Patient with Mental Disorder After ECT
 Patients normally wake up about 15 minutes after ECT
procedure.
 After awaking from ECT, the patient is often confused and
disoriented for several hours
 Prepare equipment in the recovery area which must be
adjacent to the treatment area. Equipment include oxygen,
suction, pulse oximeter, vital sign monitoring, and emergency
equipment.
 Observe the patient until awaking
 Monitor vital signs frequently until they return to normal
 Reorient the patient frequently

15.  Provide close observation to prevent falls
 Assessment for gag reflex return, if present an
analgesic may be administered, if headache is a
recurrent problem a standing order for analgesic to be
given as soon as possible after each treatment may be
obtained.
 Change activity schedule and environment by
providing a darkened room or quite area as possible
 Administer Cry therapy or a frozen gel band as an
alternative approach due to its different mechanisms
by which it relieves pain in patients with post –ECT
headache

16. Monitoring of Complications of ECT
The side effects of ECT
 Head ache,
 Temporary confusion,
 Loss of short-term memory,
 Fractures.
 The most common side effects of ECT are temporary
memory loss and confusion

17. END
 THANKS FOR YOUR ATTENTION

18. Session Evaluation
 What are the indications for ECT?
 What are contraindications for ECT?
 What are the preparations needed for a
patient undergoing ECT?