I. Convulsion-free electroconvulsive therapy (MECT)
It is the use of intravenous anesthetics and muscle relaxants to make the patient fall asleep quickly and relax the muscles of the whole body. By giving the body a short time limited current of electrical stimulation, certain biochemical changes occur in the body, thus causing the mental symptoms to reduce or disappear.
Second, MECT efficacy
MECT is the most effective, fastest-acting and/or safest for patients with certain psychiatric disorders, especially when used as an alternative to drugs that are both ineffective and unsafe, and is effective in 50-90% of patients with major depression. 80% of manic patients improve significantly after MECT. It is effective for some schizophrenic patients.
Three, MECT treatment before preparation
1. Be familiar with the patient’s general disease status (including medical history, physical examination, vital signs, necessary laboratory tests and auxiliary examinations) and understand whether the patient has any contraindications.
2.Do a good job of psychological care of the patient, explain to the patient and family members the purpose, process, efficacy and course of treatment, in order to relieve the patient and family members of tension and fear, and strive to take the initiative to cooperate with the treatment.
3.Wash hair the night before treatment, and do not use styling gel after washing.
4.Fast food and water 8h before treatment. Normal morning treatment, so from 12:00 p.m. the day before fasting water, must take the drug, available a small mouthful of water to take.
5.Wear loose and comfortable clothes before treatment, not wearing a tattooed bra.
6.Remove the denture, hairpin and metal objects.
7.Empty the bowels and urine 30 minutes before treatment.
8.Routine measurement of T, P, R, Bp 30 minutes before treatment; T>38℃, P>100 times/minute, Bp>140/90mmHg are not suitable for this treatment.
9.Keep the treatment room quiet and the temperature at 18-26℃ is appropriate.
10.Prepare the injectable drugs, treatment supplies and various drugs and instruments needed for emergency treatment.
IV. Post-treatment care
1.After the treatment, place the patient in the observation room in a lying position with the head to the side, do not touch the throat to prevent laryngospasm. If the patient is not yet conscious or excited and agitated, the nurse should accompany the patient and pull up the guardrail to prevent falling or bruising until the patient is awake. At this time, closely observe the patient’s reaction.
2.Patients with memory impairment should be informed that memory can be restored and reminded to record the necessary things on the calendar to help memory gradually recover.
3.Outpatients must be accompanied by a responsible adult to go home after treatment, and inpatients should be accompanied by the ward nurse back to the ward.
4.Remind patients that they should eat a small amount of water and liquid food 2h after treatment, and never eat a large amount and eagerly, especially solid pasta. The second meal can be eaten as normal.
5.Remind patients not to drink alcohol (including alcoholic beverages) and drive during treatment.
6. Remind the patient and family members to contact the doctor promptly if the patient has severe headache, confusion, temperature higher than 38℃ or mental symptoms are significantly aggravated.
V. Indications for MECT: Acute stage of various mental illnesses, especially the following cases
1.Severe depression, strong self-injury, suicidal behavior or obvious self-blame and self-guilt;
2.Extreme excitement and agitation, impulsive injury;
3.Refusal of food, disobedience and nervousness and rigidity;
4.Psychotropic drug treatment is ineffective or drug treatment is not tolerated.
VI. Contraindications to MECT
There are no absolute contraindications to MECT, but some conditions are relative contraindications. Patients with relative contraindications should be consulted by internal medicine or other specialists. The purpose of the consultation is to give appropriate medical interventions for the disease so that MECT can be carried out smoothly, not to exclude the use of MECT.
VII. Frequency of MECT treatment
1. Generally, a course of treatment includes 6-12 times of treatment.
2. Patients with no or little efficacy after 6 treatments should consider changing treatment measures.