ELECTROCONVULSIVE THERAPY 电休克治疗.pptVIP

ELECTROCONVULSIVE THERAPY ELECTROCONVULSIVE THERAPY Mental Health Care Pre-1930’s History of ECT Von Meduna (1934)- Autopsies of patients w/ Seizure disorders and of patients w/ Schizophrenia. Difference in Glial cell proliferation Chemically induced seizures- (camphor, pentylenetetrazol) Insulin Shock Therapy In the 1930’s , Dr Sakel developed Insulin Shock Therapy Cerletti and Bini (1934): Electricity Early ECT Assylums Few effective medications Many often severe side effects 1950’s- ether, and curare extract developed (Abram Bennett- a psychiatrist helped develop a method for extracting curare). In 1950’s antidepressant and antipsychotic meds introduced- significantly decreased utilization of ECT Electrophysiological Principles Ohm’s Law: I=E/R (I=current, E=voltage, and R=resistance) Dose of electricity in ECT= 100-500 milliCoulombs Brain has low impedance (resistance), skull has very high impedance. Only 20% of applied charge actually enters the brain. Seizure involves propagation of action potentials in a large percentage of neurons. Mechanism of Action Neurotransmitter levels all increased in CSF after seizure. Results in down regulation of Beta adrenergic receptors. During seizure- PET studies show an increase in BBB permeability and in cerebral blood flow and metabolism. After seizure, blood flow and metabolism is decreased especially in the frontal lobes. Research shows this correlated w/ response. Indications Major Depression w/ or w/o psychotic features Bipolar disorder - manic or depressed phase Acute or Catatonic Schizophrenia Some studies have shown efficacy in treating OCD, Delirium, NMS, Chronic pain syndromes, and intractable seizure disorders Major Depression Efficacy vs antidepressants When is it a first line treatment consideration? Length of Antidepressant effect Maintenance ECT Bipolar Mania Efficacy vs Lithium Indications for First Line Treatment: -Recent Myocardial Infarction w/ Acute Mania -Pregnancy w/ Acute mania