I was wondering if anyone could help me with this question... I am on placement at the minute with CPN's but will be going onto an assessment unit to work 5 shifts, where I have been offered the chance to watch ECT.
I am really not sure that this is something I want to see, I am doing my adult training not MH, so I attended a basic meet and greet about what ECT is, and how it is not like the movies, yet I am not comfortable with the idea of ECT at all.
I can not really explain what I mean, I just ripped my reflections from today up, it is not the electricity that bothers me, I think it is the fact that the treatment is causing the seizure, rather than treating a seizure.
I don't know... thanks for reading this rant any way, If anyone has any ideas how I can look at this differently then I would love to hear from you, especially as many of the patients on this unit are section 3's with a second opinion, and have proved unresponsive to ECT in the past.
I hope I am whittling over nothing, but thanks for reading anyway.
Jul 5, '02
I vaguely remember the first time I escorted a patient to ect (a long time ago) and it was quite anticlimactic for me, as the seizure itself is well modified by the muscle relaxant, to a few seconds' twitching of the toes. There is even a report from the "Anti" side of the debate, that a failed machine did not pass any current for some weeks, before anyone noticed!
As it is locally used as a treatment of last resort, all other options having been explored, I would hope that this is the case with your group of patients.
Jul 6, '02
Thankyou for responding,
I will let you know after I have seen ECT, if the idea sits any better with me. I spoke with my mentor, and I am now not going to the unit for a couple of weeks so I can have more time to look up articles on ECT, becasue i think I will be happier if I know more about it.
Jul 7, '02
whisper,Ect these days is quite an anticlimax to when I first saw it done some 30yrs ago.Today it is so much more controlled the seizures are really quiet gentle now.To get a true picture of the results of ect you need to see a patient who is really depressed before ect then see then after to see its true worth
Jul 8, '02
ECT .... shock therapy... whatever you want to call it is less frightening then it used to be....It is successfully being used to treat 1st admission Schizophrenia patients with great results also these pts are treated psychotropically with meds and therapy... however the process is less scarey than it has been in the pass...
pts now are being sedated... with versed and ativan and are not aware of the procedure and the pts are experiencing less side effects, other than a short term memory loss than usually returns in a week. We have also tried this with Borderlines with self abusive behaviors like cutters and it has been very helpful in reducing the incidents of self harm....Anyway.... ECT is not a bad thing and not as archaic as it used to be. unilateral ECT seems to be as effective as bilateral ECT...as long as pts are screened for cardiac issues it is very controlled and safe. It would be contra-indicated for some one with cardiac issues such as arrythmias.....Hope this helped!!!!!
Jul 8, '02
my Dad has had it, did not report any negative feelings in regards to the treatment. All his RN's told me that a toe twitch is about all you see these days as far as seizure activity, thanks to the meds. Even his short term memory was barely impacted. We saw marked improvement in his level of depression after the 1st set of tx, but when he took a dive again about 10 months later, ECT didn't make any difference.
Jul 16, '02
I am a nursing student doing my psych rotation now and had the opportunity to see ECT last week. My instructor gave each of us the opportunity to say if we didn't want to see the procedure. I wasn't really sure if I wanted to since we had just seen One Flew Over the Cuckoo's Nest the week before, and I think I still had some preconceived ideas about what it would be like. I knew things have changed so drastically over the last 30 years, but I was still nervous. I'm very glad I saw the procedure. It was so different from the image that most people have. The patient talked with us before and told us how medication has never worked for her. The seizure was controlled, their was a doctor, nurse, and anesthesiologist with the patient the entire time. To be honest, the hardest part was the noise the machine makes. I'm really glad I had the opportunity to dispell some of the archaic ideas I had about ECT.
Jul 16, '02
I still haven't had the chance to see ECT, but thank you to everyone for replying, it is typical now I no longer have the chance to see ECT I think I would like to see it. I may get a chance at the end of the month, I couldn't see it when I am on the assesment unit as some students who are training to be mental health nurses pulled 'rank'.
Thankyou for giving me something to mull over, if I do get chance to see it I will let you know.
Jul 16, '02
I commenced psych training in the UK in 1963. I remember ECT as a session which was almost like a production line.. standard sedatives etc.. nothing calculated by weight etc. I remember modified Insulin therapy, deep narcosis and many more, it was a form of shotgun therapy. At the end of all this, if patients didn't respond they were labelled psychotic! Then we had the benzodiazepines.. equally haphazard... My moment of deepest revelation was the time an elderly(40 something!!) sociologist introduced me to the concept of psychiatry being a mismarriage of psychology (Freud et al) and Neurology (Charcot et al) whereby psychiatry opted for mental illness as a disease process instead of a process of sociological disconnection. As a disease it had labels prognoses etc. I am bound to confess after 39 years of nursing there has been relatively little change in the basic approach. I am... as always open to suggestion/enlightenment.
Jul 18, '02
ECT is not the dramatic, traumatic event it once was. In addition to sedatives, a mild paralytic agent is usually administered to prevent the extreme muscular contractions that were once part of the process. It was found that the paralytic did not endanger the patient, and prevented them from having muscle soreness after the procedure. After all, you are triggering a seizure by administering the treatment.
At a hospital I worked at in suburban Oklahoma City, we had a videotape of a 20/20 program on ECT that we showed to patients who were considering it. Besides testimonials from patients who had undergone ECT, they showed an actual treatment at the Duke University Medical Center. There was no movement by the patient on the table apart from mild foot movement, and the only evidence that a seizure had occurred was a wave on the EEG.
I once did a presentation on ECT for the patient education committee at my hospital, and I opened with the scene from "One Flew Over the Cuckoo's Nest", in which Jack Nicholson convulses violently on the table, then collapses inconherent. I said, "This is most people's conception of ECT. Now, here is what really happens." I showed the 20/20 tape, and most people were amazed.
If you get the chance, by all means go. If nothing else, it will add to your experience, and allay your fears about it being a barbaric and traumatic procedure. It will leave you better equipped to educate your patients who may be considering ECT.
I have seen dramatic results from ECT on patients who had tried every antidepressant on the market and failed. It can be a godsend.
Jul 27, '02
Well, the best laids plans have once again fell through, I haven't had the chance to see ECT, the day I was suposed to go the patients objected to a student being there, and there are no more days I can attend as they are all booked up. (the unit only likes two students per day)
So I guess I did all that worrying for nothing as I doubt I will ever get the chance again as this is my first and only Mental health placement, I still can't help feeling relived that I didn't watch though. But thank you to every one that replied to this thread.
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