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ECT - Coggle Diagram
ECT
DIagnostic Indications
Major Depressive Episode
Main Indication for ECT, severe treatment-resistant
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Mania
Most mania can be treated with medications, but useful for treatment resistant mania
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Schizophrenia
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Useful for positive symptoms, catatonic features, mood symptoms may predict response
Synergistic with antipsychotics, useful for treatment-resistant schizophreania
Others
Parkinsons Disease: Depression, improves depressive and motor symptoms
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Contraindications
Anxiety, Substance use, Eating, Personality
Primary
Urgent need for rapid response, less risky than alternatives, history of good response, patient preference
Secondary
Poor Response to alternatives, intolerant to alternatives, deterioration required
What is it?
A treatment which consists of inducing a generalized seizure by running an electrical current through the brain
Typiucally delivered 2-3x per week, and in total 6-12 times
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Electrode Plasements: Bitemporal, Right Unilateral, Bifrontal
Effective Treatment for depression, superior to sham ECT, and effective for other indications
Mechanism of Action
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Enhancement of GAB, regulation of receptors, anticonvulsant activity overall
BDNF, other neuroendocrine factors
Physiologic CHanges
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Sympathetic response: 1-5 min: Increased BP,HR cardiac demand, increased risk of MI, HF
Side Effects
Headache, muscle soreness, disorientation, Jaw pain
Memory Loss
Common side effect, more treatment more memory loss, can have permanent gaps in memory, difficulty forming new memories
Procedure
Done in hospital, psychiatrist, anesthesiologist and nurse, anticholinergic medication given
Older adults
More effective than younger patients, limited evidence for neuropsychiatric symptoms of dementia, increased complicaitons
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Work Up
CBC, Bedside cognitive te3st, measure of clinical symtpoms, Na,K, Creatinine, ECG