Description and features of electroconvulsive therapy. What are the main indications and contraindications for the procedure. Complications of the use of electroshock in the treatment of mental illness. Electroconvulsive therapy, or electroshock, is a fairly well-known method of treating mental illness that was invented in the last century. The peak of its popularity falls in the middle of the 19th century. It was then, in the absence of a sufficient base of pharmacological psychotropic drugs and other alternative methods of treatment, that electroshock was a success. Over time, this method began to be considered too radical to be used in normal practice, and a two-sided opinion was formed regarding the appropriateness of its application.
Description of the method of treating psychiatric diseases with electric shock
Electroconvulsive therapy was invented in the 30s of the last century. Then the doctrine of schizophrenia as such was just developing. It was believed that with this disease, the brain is not able to produce localized bursts of electrical potentials, and, using such in artificial conditions, remission can be achieved.
To do this, a voltage from 70 V to 120 V was applied to the patient's head through the attached electrodes. The device measured the fraction of a second that was necessary to influence the human brain. The procedure was repeated 2-3 times a week for months. Over time, the theory of such a treatment for schizophrenia has become a little outdated, but the method has found its application in other areas.
Already in the 40s, this method spread to the USSR. Soviet scientists have successfully used it both for the treatment of schizophrenia and for bipolar disorder and other affective diseases. After some time, it was found that the highest efficiency of electroconvulsive therapy is observed in the treatment of depression.
In fact, for schizophrenia, this method has been and is still used only as a necessary powerful factor that helps in cases of resistance of the disease or ineffectiveness of other methods of treatment. It has been shown that after a course of electroshock, the susceptibility of the paranoid form of schizophrenia to drug therapy increases. Thus, this method was used only in extreme and severe cases. Until the 50s of the last century, this procedure was performed without anesthesia, most often the electrical potentials on the EEG were not monitored and muscle relaxation was not used. Because of this, a one-sided thinking was formed regarding the inhumanity and inhumanity of the method. A social movement has developed to eliminate electroconvulsive therapy as a way to treat mentally ill people. The popularization of this opinion has provoked a wave of distrust in the electroshock. At the same time, psychiatrists successfully used electroconvulsive therapy, and they do so to this day.
The degree of risk to the human body during the procedure is reduced by constant monitoring, anesthesia and muscle relaxation. In this state, any unpleasant sensations that can be observed during the passage of nerve impulses into the substance of the brain are excluded.
Indications for the use of electroconvulsive therapy
Electroconvulsive therapy is used exclusively in the setting of inpatient treatment of the patient. In this case, there must be medical personnel who understands the specifics of this treatment method and is ready to provide emergency assistance if necessary.
The course of this therapy can be prescribed by the attending physician, according to the list of recommendations in the protocols. Let's consider the main indications for electroconvulsive therapy:
- Bipolar disorder … Usually used for severe depressive episodes.
- Paranoid schizophrenia … It is prescribed in case of resistance to psychotropic pharmacological drugs and their ineffectiveness.
- Catatonic schizophrenia … It is used during the period of catatonic excitement or stupor.
- Febrile schizophrenia … It is an absolute indication for the use of electroconvulsive therapy.
- Major depressive disorder … It is used in case of severe suicidal symptoms, fears, hypochondriacal and nihilistic delusions.
Contraindications to electroshock therapy
Naturally, electroshock is a burden for the whole body, as well as anesthesia, which is performed at the same time. Therefore, it is imperative to take into account all aspects of human health, the state of vital organs and systems. To prevent the development of negative consequences of electroconvulsive therapy, absolute and relative contraindications to its implementation were developed. If there is at least one item from the first category, this method is not applied to a specific person. If there are relative contraindications, in such cases, a commission of doctors assesses the degree of risk and expected effect of this procedure and makes an individual decision.
Absolute contraindications for electroconvulsive therapy in psychiatry:
- Severe heart disease … This should include various heart defects in the phase of decompensation, hypertension of 2-3 degrees, serious myocardial diseases.
- Pathology of the musculoskeletal system … The use of electroconvulsive therapy in patients with osteomyelitis, deforming osteoarthritis and osteoporosis is prohibited.
- Diseases of the nervous system … Do not use electroshock in people with multiple sclerosis and Parkinson's disease.
- Infections … Also, this method is not used in the presence of acute infectious inflammation in the body, purulent foci.
- Respiratory system diseases … This group of contraindications includes bronchiectasis, emphysema, asthma and acute bronchitis.
- Diseases of the gastrointestinal tract … The presence of peptic ulcer disease in humans, severe diseases of the liver and pancreas, diabetes mellitus is an absolute contraindication to electroconvulsive therapy.
- Pregnancy … The procedure is not performed on pregnant women due to the possible negative impact on the child.
Relative contraindications for the use of electroconvulsive therapy:
- Hypertension of the 1st degree;
- Heart disease in a compensated state;
- The presence of hernias;
- History of fractures that healed long ago.
Features of the electroconvulsive therapy procedure
Electroconvulsive therapy is a rather serious manipulation for which you need to properly prepare. It is imperative that all standard laboratory tests, electrocardiography, chest x-ray and, if necessary, other procedures are carried out before this.
Preparing the patient for electric shock
Before an electric shock, a person should be examined by a neurologist, surgeon and cardiologist. It is necessary to exclude the presence of any pathology from the absolute contraindications. The cardiovascular system is especially thoroughly investigated.
A person needs to prepare for this procedure. To do this, you need to follow a few simple rules:
- Do not eat food in the morning on the day of the procedure … Often, electrical impulses can cause a patient to vomit, so it is recommended to have it on an empty stomach.
- Horizontal position of the body … The patient lies down on a comfortable bed, which is not surrounded by any objects, so that he does not get hurt during convulsions.
- Clothes and accessories … You need to unfasten the belt, buttons, remove all jewelry or hairpins. It is recommended to take off your shoes. If a person uses a denture, it is necessary to remove it during therapy.
It is imperative that before performing the procedure, the patient or his guardian, if any, signs a voluntary informed consent to conduct electroconvulsive therapy. The doctor should familiarize him with the main aspects of this method, the possible risks and side effects. Only upon receipt of such consent can the implementation proceed.
Preliminary procedures before electroconvulsive therapy
In order to reduce the side effects of electroconvulsive therapy, some drugs are administered, which adapt the body to such a load, and perform other actions that register a person's condition.
List of preliminary procedures:
- Administration of anticholinergic drugs … Most often, Atropine is used as the most common representative. It is used to increase the heart rate, as a means of preventing bradycardia. It also reduces salivation, thus preventing a person from choking.
- Monitoring … Pulse oxygenometry is mandatory. It shows the concentration of oxygen in the blood and registers the onset of hypoxia. If possible, use an EKG (electrocardiograph) and EEG (electroencephalograph).
- Preoxygenation … Artificial saturation of red blood cells with oxygen is carried out using a mask and a 100% solution.
- Muscle relaxation … Introduction to anesthesia is carried out using muscle relaxants. The most commonly used are Suxamethonium, Ditilin. The necessary dosage of the drug should be calculated to provide the desired relaxation, but not too deep anesthesia, since it can muffle all the effects of the electric shock. Suxamethonium relaxes a person, but during the passage of the impulse, slight twitching of the facial muscles of the face should be observed.
How is your electroconvulsive therapy session going?
The procedure is carried out in a separate room with the ability to quickly provide resuscitation assistance. Electroshock is strictly prohibited in common wards. An anesthesiologist-resuscitator, an emergency kit with a defibrillator and pharmacological drugs in syringes for emergency administration must be present in the room where the electroshock will be performed.
Electroconvulsive therapy is performed using a special apparatus that converts energy from the network into the required dosage. It also has a sensitive exposure time limiter that allows you to adjust the exposure in a fraction of a second. The required dosage is set using a voltmeter. Electrodes are applied through which electricity will pass.
During the first session, the dose of the electrical impulse and the duration (exposure) are selected. Start with a minimum of 70 V, which acts for half a second. If convulsions are not observed, the tension should be increased. When the desired voltage / exposure ratio has been found, these values should also be applied to all future sessions. The maximum allowable values should not exceed 120 V and 0.9 seconds. Most often, sessions are prescribed three times a week for up to 1 month. Usually 6 to 12 treatments. It is recommended to repeat the course no more than twice a year, and the period between them should be more than 4-5 months.
The electrodes are placed on the temporal region of the head on small pieces of gauze soaked in isotonic solution. Then the voltage is applied. During convulsions, a person should not be restrained or restricted in his movements. This can cause injury and even fractures. Normally, when electrical voltage passes through the body, the pulse slows down. To prevent the occurrence of life-threatening bradycardia, Atropine is preliminarily administered as a premedication. The pressure rises during the procedure, but then returns to normal. Retention of breath is sometimes observed.
After the procedure, the person falls asleep for 30-40 minutes, then wakes up. The period of the electroshock is forgotten, so patients do not remember it. This reduces anxiety before the next session and promotes better health.
Complications of electroshock therapy
The consequences of electroconvulsive therapy can be very undesirable and unpleasant. In some cases, there are significant health impairments, so the procedure must be carried out in compliance with all safety rules.
All complications are usually classified depending on the area of the lesion:
- Musculoskeletal system … The most common are dislocations, strains of muscles and tendons, fractures of tubular bones. Vertebral fractures are very rare. This should also include the violation of the integrity of the teeth with subsequent aspiration. Any of the listed pathologies is an absolute indication for the termination of electroconvulsive therapy and the provision of appropriate medical care.
- Heart and blood vessels … Rhythm disturbances in the form of bradycardia or arrhythmias can sometimes be observed. Blood pressure also rises. These disorders are treated with the administration of specific drugs of choice. The most commonly used are Atropine, Digoxin, Strofantin.
- Respiratory system … The most common complication of electroconvulsive therapy from the respiratory system is apnea. This is a short-term breath holding, which is observed after the end of the exposure to electrical voltage. Artificial ventilation is used.
- Mental complications … On the part of the human psyche, amnesia is most often observed, which can be of a different nature. An easy option is manifested by confusion, inability to concentrate and remember routine events. Severe cases are anterograde or retrograde amnesia. They are treated with nootropic drugs.
What is electroshock therapy - see the video:
Electroconvulsive therapy is a relatively old method of treating mental disorders, but by no means less effective. It is used in difficult cases as heavy artillery, and its effectiveness is quite high, despite the existence of an active movement against the use of electric shock.
