ECT Exam 2

How much of the patient's seizure threshold may increase? what does the ECT act as and why? what are the movements of the patient during treatment and why? what occurs during the tonic phase and clonic phase? what does monitoring of the ECG provide evidence of? how many treatments are usually required? how often are they administered?

- A patient's seizure threshold may increase 25 to 200 percent during the course of ECT treatments. - ECT itself acts as an anticonvulsant, because the seizure threshold increases as treatment progresses. - Movements are minimal because of the administration of a muscle relaxant before treatment. - Tonic phase: usually lasts 10-15 seconds & is identified by a rigid plantar extension of the feet. - Clonic phase: follows and is usually characterized by rhythmic movements of the muscles that decrease in frequency and finally disappear. - Because of the muscle relaxant, movements may be observed merely as a rhythmic twitching of the toes. o Monitoring electroencephalogram activity during the treatment provides evidence of grand mal seizure activity. - Most require 6-12 ECT treatments; some require up to 20 - then afterwards once a month for maintenance ECT - Treatments administered every other day—3 times per week

During ECT treatment, what can be used to facilitate the patients airway? what will the nurse assist with the anesthesiologist? where are electrodes placed? what is the role of the nurse during the ECT treatment (3)?

- An airway/bite block is used to facilitate the patient's airway patency - ensure patency of airway & provide suctioning if needed - Assisting anesthesiologist with oxygenation as required - Electrodes are placed on the temples (bilaterally or unilaterally) to deliver the electrical stimulation. - The nurse provides support to the patient, both physically and emotionally. o Observing readouts on machines monitoring vital signs and cardiac functioning o Providing support to the patient's arms and legs during the seizure o Observing and recording the type and amount of movement induced by the seizure

Post-treatment ECT, what will the anesthesiologist continue and until when? what is going to be monitored every 15 minutes? how should the patient be placed? how long does it take for the patient to wake up (2)? when the patient awakens, what is the role of the nurse (4)? how long will the nurse stay with the patient (3)? what will be provided to minimize confusion?

- Anaesthesiologist continues to oxygenate patient with pure oxygen until spontaneous respirations return. o Monitoring pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the patient should remain in bed (SECOND INTERVENTION) - Positioning the patient on side to prevent aspiration - Most patients awaken within 10 or 15 minutes after the treatment and are confused and disoriented; some patients will sleep for 1 to 2 hours following the treatment - Orienting the patient to time and place (FIRST INTERVENTION) · Because the procedure can induce retrograde amnesia, temporary memory loss and confusion - Describing what has occurred - Providing reassurance that confusion and memory loss will subside, and memories should return following the course of ECT therapy - Allowing the patient to verbalize fears and anxieties related to receiving ECT - All patients require close observation in this immediate posttreatment period. o Staying with the patient until he or she is fully awake, oriented, and able to perform self-care activities without assistance o Providing the patient with a highly structured schedule of routine activities to minimize confusion

What is the MOA of ECT? what parts of the CNS are affected by ECT (3)? what happens to the neurotransmitters and which ones are affected (5)?

- Both therapeutic and adverse effects may result from inducing a bilateral generalized seizure, but the exact mechanism by which ECT effects a therapeutic response is unknown. - Many parts of the central nervous system (CNS) are affected by ECT. - Hormones, neuropeptides, neurotrophic factors, and nearly every neurotransmitter - Affected neurotransmitters (that have significant increases in circulating levels) include: Serotonin (research still has mixed results and remains controversial) Norepinephrine & Dopamine - Same biogenic amines affected by antidepressant drugs o Additional evidence suggests that ECT may also result in increases in glutamate and gamma-aminobutyric acid GABA.

Is there brain damage with ECT? In regards to nursing assessment, What physical examinations must be conducted prior to therapy (3)? nursing assessment (Read over)

- Brain damage o The subject has been studied using a variety of brain imaging modalities and virtually all conclude there is no evidence of brain damage (in brain structure or functioning) caused by ECT treatments. o Previously cited studies on the neurorestorative effects of ECT have argued that this, too, is evidence in contradiction to ideas about brain-damaging effects of ECT. - Assessment - Nursing process is method of delivery of care & provides a systematic approach to the provision of care for the client receiving ECT. - Nurses play an integral role in education, preparation for, and administration of ECT. - They provide support before, during, and after the treatment to the patient and family and assist medical professionals conducting the therapy. - Pt must receive a thorough Physical examination prior to therapy: - Cardiovascular and pulmonary status - Laboratory blood and urine studies collected - Skeletal history and x-ray assessment may also be performed

ECT Indications, which type of schizophrenics use this therapy (4) and which don't (1)? is this therapy effective for schizophrenia? what may be the leading cause of use of ECT?

- ECT can induce remission in some patients with acute schizophrenia. - Especially pts w/ marked positive, catatonic, or affective (depression or mania) symptomatology - Does not appear effective with chronic schizophrenic illness o Several researchers present evidence that while ECT is safe and effective for patients with schizophrenia, it is underutilized. o Keller advocates that globally, schizophrenia may be the leading indication for ECT but, again, in current practice, it is not commonly used.

ECT Indications, what other conditions is ECT used to treat (4)? what medical conditions may it treatment (4)? can pregnant and elderly patients take this? what is the recovery in the pregnant individual? Which conditions are NOT effective with ECT (4)?

- ECT has been reported as useful in treating other conditions such as: Episodic psychosis, atypical psychosis, obsessive-compulsive disorder, and delirium, schizoaffective disorder - Medical conditions such as neuroleptic malignant syndrome, hypopituitarism, intractable seizure disorders, and Parkinson's disease, particularly when there's' comorbid depression - Pregnant women and elderly individuals unable to take medications (ECT may be safer alternative) o Literature on safety of ECT in pregnancy is scarce, their research supported others' findings that it can be used safely. o They also note that 40% of pregnant patients treated with ECT in their study demonstrated full recovery. - ECT is not effective in treating: Somatization disorders (unless there is comorbid depression), Personality disorders & anxiety disorders, Neuroses

ECT Indications, which types of depression are indicated for this treatment (3)? what psychotic symptoms would require this treatment (3)? when is this treatment considered (4)? what type of patients would require urgent treatment (2)?

- ECT has been shown to be effective in the treatment of severe depression, particularly among depressed patients who are also experiencing psychotic symptoms, catatonia, psychomotor retardation, and neurovegetative changes, such as disturbances in sleep, appetite, and energy. - These symptoms are associated with the diagnoses of major depressive disorder, major depressive disorder with psychotic or melancholic symptoms, and bipolar disorder depression. - ECT not treatment of choice for depressive disorders BUT ECT is typically considered only after a trial of therapy with antidepressant medication has proven ineffective. - Or bc of some other health problem in which they can't take their meds, or if they've had the treatment before and has worked - ECT may be considered the treatment of choice when need for treatment response is urgent - Such as in pts who are extremely suicidal or refusing food and are nutritionally compromised.

What is the reputation of ECT (2)? what did the FDA classify ECT? what disorder usually is prescribed the ECT (2)? what are the special controls needed for this therapy (4)? how long has this therapy been used and is it effective?

- ECT has long had a negative reputation & One of the most controversial treatments for psychological disorders o The FDA affirmed the safety of ECT in the treatment of depression and catatonia by downgrading the risk classification of ECT devices from Class III (highest risk) to Class II (lower risk) for those indications. o The change in classification also stipulates several "special controls" that include requirements about the technical parameters for devices, labeling about adverse effects, practitioner training, and some aspects of clinical practice o FDA identifies appropriate indications for use of ECT ("a severe major depressive episode associated with major depressive disorder or bipolar disorder in patients aged 13 years and older who have treatment resistance or who require a rapid response due to the severity of their psychiatric or medical condition") closely approximates the majority of its use in clinical practice in the United States. o Despite its controversial image, ECT has been used continuously for more than 50 years, longer than any other physical treatment for mental illness. o It has achieved this longevity because when administered properly, for the right illness, it can help as much as or more than any other treatment.

What time of day/days of the week is ECT usually performed? what is the requirements the day before and of? what does the treatment team consist of (3)? Before ECT treatment, what does the physician need to have on hand (5)?

- ECT treatments are usually performed in the morning. - Patient is NPO (nothing by mouth) 6 to 8 hours before treatment or midnight prior to treatment day. - Treatment team usually consists of psychiatrist, anaesthesiologist, and two or more nurses. - Usually performed very early in the morning, typically done on MWF o Both the physician and anesthesiologist must obtain informed consent and a signed permission form. o Most recent laboratory reports should include a complete blood count, urinalysis, results of electrocardiogram (ECG) and x-ray examinations - these should be available on hand o Presurgical work up is completed - such as CBC, blood work, cervical thoracic spine x-ray (not very commonly done tho)

Evaluation (read over)

- Effectiveness of nursing interventions is based on the achievement of the projected outcomes. - Careful documentation is important part of evaluation process. - Some routine observations may be evaluated on flow sheets specifically identified for ECT. - Continual reassessment, planning, and evaluation ensures adequate and appropriate nursing care throughout course of therapy. o Reassessment may be based on answers to the following questions: o Was the patient's anxiety maintained at a manageable level? o Was the patient/family teaching completed satisfactorily? o Did the patient/family verbalize understanding of the procedure, its side effects, and risks involved? o Did the patient undergo treatment without experiencing injury or aspiration? o Has the patient maintained adequate tissue perfusion during and following treatment? Have vital signs remained stable? o With consideration to the individual patient's condition and response to treatment, is the patient reoriented to time, place, and situation? o Have all of the patient's self-care needs been fulfilled? o Is the patient participating in therapeutic activities to his or her maximum potential? o What is the patient's level of social interaction?

What is ECT? what is the dose of stimulation based on? how long is the duration of the seizure? where is this type of therapy performed (2)? what type of setting is this performed and who is present (2)? what is the status of the patient during the procedure (2)? who is ECG contraindicated (4)?

- Electroconvulsive therapy (ECT) is the induction of a grand mal (generalized) seizure through the application of electrical current to the brain - Dose of stimulation is based on the client's seizure threshold, which is highly variable among individuals. - The duration of the seizure should be at least 15 to 25 seconds (the longer the seizure, the better) - Performed on an inpatient basis for those who require close observation and care (clients who are suicidal, agitated, delusional, catatonic, or acutely manic). - Performed in an OR type setting, anesthesiologist and psychiatrist is present, the patient is unconscious and their hooked up to monitors (BP, HR monitors and EEG) - Contraindicated in seizure prone individuals, recent cardiac issue, stroke, brain lesions - Those at less risk may have the option of receiving therapy at an outpatient treatment facility.

What is the role of the nurse in regards to consent? who obtained the consent? who can agree and sign to consent (2)? what must the patient and family be informed about (3)? can consent be withdrawn at any moment? if the patient is having second thoughts, what is the role of the nurse?

- Ensure informed consent has been granted - Nurses do not actually obtain informed consent, which is the duty of the physician conducting the treatment. - "No patient who has the capacity to give voluntary consent should be given ECT without his or her written consent" and clinicians should be aware of local, state, and federal laws governing the use of ECT - If the patient is clearly unable to consent to the procedure due to the severity of condition (severe depression), permission may be obtained from family or person legally responsible for the patient so long as relevant laws allow. · The patient and family must understand the procedure, possible side-effects, potential risks, that ECT is voluntary, and that consent may be withdrawn at any time. o If the patient is having 2nd thoughts about the procedure, investigate their concerns further because it requires absolute agreement from the patient. It is only up to the patient to have the procedure done, not the family

Why is evaluation of changes in the patients behavior important (2)?

- Evaluation of changes in client behavior is made to determine mood improvement and provide assistance in deciding the number of treatments that will be administered (that's how you would know if the treatment has worked) o Nursing input into the ongoing evaluation of client behavior is an important factor in determining the therapeutic effectiveness of ECT.

When did ECT first become performed? what is the insulin coma therapy and is it still used today? What is pharmacoconvulsive therapy? when did the physician change the medication? what did the physician base his theory on? what did the hope to achieve? is this still used today?

- First treatment performed in 1938 in Rome; other types of somatic therapies tried are described as follows: - Insulin coma therapy: was used for clients with schizophrenia. - The insulin injection treatments induced a hypoglycemic coma, which Manfred Sakel claimed was effective in alleviating schizophrenic symptoms. - Therapy required vigorous medical and nursing intervention through the stages of induced coma. - Some fatalities occurred when clients failed to respond to efforts directed at termination of the coma. The efficacy of insulin coma therapy has been questioned, and its use has been discontinued in the treatment of mental illness. - Pharmacoconvulsive therapy - Ladislas Meduna induced convulsions with intramuscular injections of camphor in oil in clients with schizophrenia. · He switched to the use of pentylenetetrazol (Metrazol) when camphor was found to be unreliable for inducing seizures. - He based his treatment on clinical observation and theorized the existence of a biological antagonism between schizophrenia and epilepsy. - Thus, by inducing seizures he hoped to reduce schizophrenic symptoms. - Some successes were reported in terms of reduction of psychotic symptoms, and until the advent of ECT in 1938, pentylenetetrazol was the most frequently-used method used to produce seizures in psychotic clients - Pharmacoconvulsive therapy is no longer used in psychiatry.

Evaluation, what type of documentation is important? what may occur 6 months after ECT treatment? what may continuation ECT treatment include (3)? what is maintenance ECT?

- Including progress notes with detailed descriptions of patient behavioral changes are essential to evaluate improvement and help determine the number of treatments that will be administered. - Continuation treatment: (6 months after remission from an acute episode of illness) is important since at least half and upwards of 85 percent of ECT responders in some samples will relapse without continuation treatment, particularly in the first several weeks posttreatment - Continuation treatment may include psychotropic medication, medication and continuation ECT, or cognitive therapy. - Maintenance ECT: (treatments following the 6-month continuation treatment period) may be administered weekly, biweekly, or monthly for relapse prevention.

Which individuals are high risk for ECT (10)? how can intracranial lesions be controlled prior to ECT (1)? how can increased ICP be controlled prior to ECT?

- Individuals at high risk with ECT: - Myocardial infarction or cerebrovascular accident within preceding 3 to 6 months - Aortic or cerebral aneurysm, Severe underlying hypertension & Congestive heart failure - Intracranial lesions - Patients with intracranial lesions may be at risk for edema or brain herniation after ECT, but these risks can be decreased by pretreatment with dexamethasone in cases where the lesion is small. - Increased intracranial pressure - Patients at increased risk related to increased cerebral blood flow during seizures, but that risk can be lessened by controlling the patient's blood pressure during the treatment. - Severe osteoporosis - Acute and chronic Pulmonary disorders - High-risk or complicated pregnancy

What are the general indications for ECT (7)?

- Major Depression / Acutely suicidal - Mania - bipolar disorders - Schizophrenia - Episodic psychosis, atypical psychosis, - obsessive-compulsive disorder, and delirium - schizoaffective disorder

What occurs to memory after ECT? after how many months does the patient return to their cognitive baselines? what factor contribute to persistent memory loss in ECT? what has been reported by patients (2)? what patients have reported persistent memory impairment? should patients be informed of this potential side effect and by who? are Sine wavefroms used? the risk of cognitive defects post ECT are increased when (2)?

- Memory impairment (loss) almost always occurs to some degree during ECT treatments. - But follow-up studies indicate that most patients return to their cognitive baselines after 6 months. One factor that has been identified as contributing to persistent memory loss is the number of bilateral treatments - Most individuals report no problems with memory aside from the time immediately surrounding the treatments; however, some have reported retrograde amnesia extending back to months before treatment. - Some patients showing little improvement with ECT report persistent memory impairment. - All patients receiving ECT should be informed of possible permanent memory loss. - While the overall risks of enduring memory loss are minimal, the physician should discuss this risk factor with all patients when obtaining informed consent. o Sine waveforms are no longer recommended and have primarily been replaced by brief, and more recently ultra-brief pulse stimulations. o The risk of cognitive deficits post-ECT is also increased when there are baseline impairments in global cognitive functioning and concurrent use of lithium or medications with anticholinergic effects.

What is the mortality rate from ECT? what is thought to be the cause of the death (2)? what is important to monitor prior to treatment to decrease risk of mortality?

- Mortality rate from ECT: Less than that of childbirth; very rare thought to occur bc of a reaction to the anesthesia - About 0.002 percent per treatment (2 per 100,000 treatments) and 0.01 percent for each patient - Although death is rare, it is usually related to cardiovascular complications (acute MI or CVA) and usually in individuals with previously compromised cardiac status o Assessment and management of cardiovascular disease prior to treatment is vital in the reduction of morbidity and mortality rates associated with ECT.

What are the most common side effects of ECT (2)? are these symptoms reversible? why does ECT not affect long term memory? which memories does it affect (2) and why? studies have shown that what type of ECT may decrease the loss of memory but what is the downside?

- Most common SE are temporary memory loss and confusion (long term memory remains intact) o These changes represent irreversible brain damage. Proponents insist they are temporary and reversible. o Note: Because ECT disrupts new memories that have not been incorporated into long-term memory stores, ECT can cause anterograde and retrograde amnesia that is most dense around the time of treatment. - The anterograde component usually clears quickly, but the retrograde amnesia can extend back to months before treatment. - It is unclear if the memory loss is due to the ECT or to ongoing depressive symptoms. o Studies have shown that unilateral placement of the electrodes decreases the amount of memory disturbance. o However, unilateral ECT often requires a higher stimulus dose or a greater number of treatments to match the efficacy of bilateral ECT in the relief of depression.

Nursing assessment prior to ECT (read over, kinda); nursing diagnosis related to ECT

- Nurse must assess: - Assess mood and level of interaction with others - Evidence of suicidal ideation, plan, and means - Level of anxiety and fears associated with receiving ECT - Thought and communication patterns & Baseline memory for short- and long-term events - Knowledge of patient and family of indications, potential ECT risks, and side effects - Current and past use of medications - Baseline vital signs and history of allergies o The patient's ability to carry out activities of daily living - Diagnosis/outcome criteria - Nursing diagnoses are based on continual assessment before, during, and after treatment. - Example of potential nursing diagnosis and outcome criteria: - Nursing diagnosis: Anxiety (moderate to severe) related to impending therapy - Outcome criteria: Patient verbalizes a decrease in anxiety following explanation of procedure and expression of fears

During ECT treatment, how is the patient positioned? what medications will be administered to the patient (2)? what does the muscle relaxant paralyze (2)? what is administered during and after treatment and why and when is it not?

- Patient is placed on the table in a supine position in OR type setting - Anesthesiologist intravenously administers a short-acting anesthetic (general anesthesia) - Most commonly used anesthetic agents for ECT are methohexital (Brevital) and propofol. o A muscle relaxant, usually succinylcholine chloride, is given intravenously to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fractured or dislocated bones. - This paralyses straited muscle, NOT SMOOTH MUSCLE such as the heart o Because succinylcholine paralyzes respiratory muscles as well, the patient is oxygenated with pure oxygen during and after the treatment, except for the brief interval of electrical stimulation, until spontaneous respirations return.

What is the ABSOLUTE contraindication for ECT (1) and why? patients that are at high risk will require what type of monitoring (2)? what is the most high risk condition when using ECT (2) and why (2)?

- There are no absolute contraindications for ECT. - The only absolute contraindication for ECT is increased intracranial pressure KNOW! (from brain tumor, recent CVA, or other cerebrovascular lesion) because it could lead to brainstem herniation. - Some patients may be at higher risk for adverse events that require attention and closer monitoring o High-risk conditions are chiefly cardiovascular and are due to the body's response to the seizure itself. o The initial vagal response results in a sinus bradycardia and drop in blood pressure. o This is followed immediately by tachycardia and a hypertensive response. o These changes can be life threatening to an individual with an already compromised cardiovascular system.

ECT Indications, what type of mania is this used for? what does ECT compare to? is ECT commonly used for manic pt's why or why not? when is ECT effective for manic patient (2)? if the manic patient is receiving ECT, what medication can they NOT take and why? what type of bipolar disorder is this used for? when is this therapy used for bipolar disorder pt's (1)?

- Treatment of acute manic episodes; at least as effective as lithium - At present, it is rarely used for this purpose because lithium and other pharmocotherapies are usually effective in the short- and long-term treatment. - However, ECT has been shown to be effective in the treatment of manic patients who do not tolerate or fail to respond to lithium or other drug treatment, or when life is threatened by dangerous behavior or exhaustion. - Electroconvulsive therapy should not be used while a patient is receiving lithium since it lowers the seizure threshold and may cause prolonged seizures when combined with ECT - Treatment of bipolar disorders with mixed states (concurrent depressive and manic features) - This type of bipolar disorder is often more severe, with lower inter-episode remission, and higher risk for suicide. - Treatment of mania in patients who are refractory to antimanic drug therapy (lithium not working) - Only used when patient has failed to respond to medication

In ECT, how is the seizure induced (2)? what is the right unilateral ECT associated with? what is the efficacy of ECT ensured with? why did they decide the right unilateral treatment was better? how is the dose of electrical current controlled and explain? the dose of electrical stimulation is based on? is observing the patient for seizure activity the best indicator?

- With ECT, seizure is induced by administering a dose of electrical current through electrodes placed either bilaterally (in the bifrontal or bifrontotemporal area) or unilaterally on the right side of the frontotemporal area (when done unilaterally its typically on the same side as the dominant hand) - Right unilateral ECT is associated with fewer cognitive side effects, and its efficacy can be ensured with adequate dosing strategies - mostly used for elderly - While unilateral treatments were once conducted on the hemisphere of the nondominant hand, Sadock and associates (2015) note that the right hemisphere is involved in sustaining depressed mood regardless of handedness. - The dose of electrical current is carefully controlled using an ECT machine - it runs a preliminary strip, and it measures the electoral current; the machine determines how much electrical stimulus is needed - The dose of electrical stimulation must be strong enough to reach the patient's seizure threshold, but this threshold is highly variable among individuals. - Observing the patient for seizure activity is not always the best indicator. - Amount of electrical stimulus applied is controversial.

During ECT treatment, what may be placed on the clients leg? what will the patient be hooked up to? how long should the seizure last? what may be given prophylactically and why? what are the important nursing interventions for ECT (3)?

o A blood pressure cuff may be placed on the lower leg and inflated above systolic pressure prior to the injection of the succinylcholine. o This is to ensure that the seizure activity can be observed in one limb that is unaffected by the muscle relaxant. o Client is hooked to an ECG machine to count for an accumulation of seizure seconds. The duration of the seizure should be at least 15 to 25 seconds o There must be a psychiatrist and anesthesiologist present o They are given prophylactic pain medication because seizure can give them headaches - Side note: Important nursing interventions include ensuring client safety, managing client anxiety, and providing adequate client education.

What effects does ECT support (2)? which include what effects on the brain (3)? one study revealed that ECT does what to the white matter of the brain in regards to major depression? what is the overall cause of the effectiveness of ECT?

o A longitudinal study of imaging research shows that the therapeutic response to ECT is associated with several effects on the brain, all of which support anticonvulsant and neurotrophic effects of ECT, including: o Decreased frontal perfusion o Changes in metabolism o Functional connectivity, volume, and neuronal chemical metabolites o One recent study revealed that the therapeutic response from ECT may be related to the modulation of white matter microstructure in pathways connecting frontal and limbic areas, which are altered in major depression. o The results of studies relating to the mechanism underlying the effectiveness of ECT continue to be mixed and controversial. o Its effectiveness may be a complex dynamic of several effects interacting with one another.

What is the role of the nurse approximately 1 hour before ECT treatment (6)?

o Approximately 1 hour before treatment is scheduled, taking and recording vital signs (prepare patient) o Have the patient void and remove dentures, eyeglasses or contact lenses, jewelry, and hairpins. o Following institutional requirements, the patient should change into a hospital gown or, if permitted, into his or her own loose clothing or pajamas. o At this point, it is best for the patient to remain in bed. o Side rails may be raised unless prohibited by institutional policy or assessed as unsafe for the individual patient.

Approximately 30 minutes before ECT treatment, what is the role of the nurse (2)? what attitude should the nurse have?

o Approximately 30 minutes before treatment, administering the pretreatment medication as prescribed by the physician. o The usual order is for atropine sulfate or glycopyrrolate (Robinul) given intramuscularly. o Either of these medications may be ordered to decrease secretions (to prevent aspiration) and counteract the effects of vagal stimulation (bradycardia) induced o Maintain a positive attitude about the procedure and encourage the patient to verbalize feelings - staying w/ patient to help allay fears and anxiety

Long-term outcomes in bipolar I disorders was (3)? what other cognitive defects are in the immediate-post ECT period (5)? how long does is take to resolve the side effects of ECT (3)?

o In one recent study that looked at long-term outcomes of ECT in patients with bipolar I disorder, the evidence supported that 2 years following ECT, cognitive skills and short-term memory were not impaired, while mood symptom recurrence had improved regardless of the level of mania. o Other cognitive defects in the immediate post-ECT period include: o Processing speed, Attention, Verbal and visual memory, & Spatial problem-solving o Executive functioning deficits o Semovska and McLoughlin's meta-analysis demonstrated that most of those resolve within 3 days after treatment and some improve beyond baseline after 15 days

What is the time frame in which ECT was beginning to be accepted (2)? is there alot of people who have used ECT therapy and use? why is ECT not highly accessible in certain hospitals (2)?

o Periodic recognition of the important contribution of ECT in the treatment of mental illness has been evident - ECT was widely accepted around 1940-1960 --> This was followed by a 20-year span when ECT was considered objectionable by the psychiatric profession and the public. - The second wave of acceptance began around 1980 and has been increasing to the present. - An estimated 100,000 people in the United States and about 2 million worldwide receive ECT treatments yearly. o Some individuals showed improvement with ECT after failing to respond to other forms of therapy. o Mainly because of the expense involved and the need for a team of highly skilled medical specialists, many public hospitals are unable to offer this treatment to their patients. o It is estimated that only 2 percent of psychiatrists in the United States actually practice ECT.