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ECT: A TREATMENT FOR THE 21st CENTURY
Topics covered
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Staff present in our suite
When the patient is brought into the treatment room
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After the monitoring equipment is applied
When relaxed
RIGHT UNILATERAL PLACEMENT
BITEMPORAL PLACEMENT
The psychiatrist at the first ECT
Seizures are monitored using EEG
After the seizure ends
How do you set the level of the electrical stimulus at the second session?
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The main side effect our patients are concerned about with ECT
Retrograde amnesia
However, we now know...
Columbia University Autobiographical Memory Interview
Other than using a right unilateral stimulus electrode placement
Can you remember what you learnt in neurophysiology about depolarisation of neurones?
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So it would be logical to reduce this 1 msec pulse width to 0.3 msec to see if this is a more efficient way of generating a seizure
By reducing the pulse width to 0.3 msec
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And by using a much smaller electrical stimulus..
Retrograde Amnesia for Autobiographical Information
And 0.3 msec pulse right unilateral ECT is as effective as standard 1 msec pulse width bitemporal & right unilateral ECT
AND INTERESTINGLY
rCBF In Patients Responding & Not Responding To ECT
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Now let’s rummage through the back shed for a really big magnet
MICHAEL FARADAY
BUT OF COURSE ON THE FLIP SIDE
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And by…..
HAM D & BDI
EEG morphology often less robust than ECT
AND ON [99mTc}-HMPAO SPECT
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HOW DO YOU DO IT?
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AND IN REAL LIFE
Nội dung
Bruce Boman Director of Training South West Sydney Psychiatry Training Network How is ECT administered in Australia? Are there irreversible cognitive impairments resulting from ECT? What new techniques are available for minimising cognitive impairments? What experimental techniques are being trialled in convulsive therapy? How is ECT administered in Australia? ECT is administered either in operating theatre recovery rooms, operating theatres or in specialised ECT suites set up like an operating theatre recovery room Consultant anaesthetist Consultant psychiatrist Psychiatry trainee Senior nurse coordinator Assistant nurse The following monitoring equipment is applied: EEG ECG Pulse oximeter Sphygmomanometer End tidal CO2 monitor Anaesthetic monitor EEG monitor on ECT apparatus Computational modelling electric field generated by FEAST & standard ECT stimulus electrode placements Lee et al, 2012 If you place a coil in a changing magnetic field then you’ll induce an electric current If you send an electric current through a coil then you’ll generate a magnetic field And putting it all together Current in coil from capacitator Induces changing magnetic field Induces current in neuronal “coils” Transcranial magnetic stimulation (TMS) Harold Sackeim & Holly Lisanby then had the bright idea of linking up a whole bunch of TMS machines like this array in their lab at the NY State Institute of Psychiatry Racking up the frequency to 40-60Hz & sending the pulses through for up to secs Generate current of sufficient intensity in the brain to depolarize enough neurons to Trigger a seizure Increased blood flow fronto parietal cortex & basal ganglia Pretty much same as ECT General anaesthetic Muscle relaxant Oxygenation Titrate seizure threshold Performed times a week ... events before a course of ECT- RETROGRADE AMNESIA This is what patients find most distressing Not being able to recall important events in their life before the course of ECT ECT can result... months after completion course of ECT (Sackeim et al, The cognitive effects of ECT in community settings, Neuropsychopharmacology, 200 7) Associated with: bitemporal electrode placement high stimulus... months post ECT Is there anything else we can to minimise ECT related cognitive impairments? Let me tell you about a new form of ECT & how it came about The most efficient electrical stimulus