General principles of ECT delivery

1
General principles of ECT delivery

• Dr Paul R Cohen
• Specialist Registrar Old Age Psychiatry
• Laureate House
• Wythenshawe Hospital

2
Aims of ECT

• To induce generalised cerebral seizure activity
• Type associated with tonic-clonic convulsion
• Sufficiently above seizure threshold
• Maximise clinical efficiency with minimal
  cognitive effects

3
Assessment of Patients before ECT

• Recent complete medical history
• Recent full physical examination
• Previous anaesthetics or operations
• Full list drugs and allergies
• Clinical assessment cardiovascular status e.g.
  Exercise tolerance
• Investigations recent FBC/ UE/ CXR( if
  suspected respiratory disease)/ ECG( gt40 or DM)/
  relevant others e.g. Lithium levels

4
Flow chart for delivery

• Preliminary checks before patient arrives
• Preparation and electrode placement
• Stimulus dosing policy and schedule seizure
  threshold
• Recovery
• Measuring response