chapter 17 somatic therapies

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 17Somatic Therapies


Despite studies proving efficacy, it (ECT) remains the most controversial treatment in psychiatry. Hall & Bensing, 2005


Learning Objectives

After studying this chapter, you should be able to

• Compare and contrast the rationale for the use of electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), transcranial magnetic therapy (TMS) and magnetic seizure therapy (MST), and deep brain stimulation (DBS)

• Explain the ECT procedure

• Identify the indications for using ECT

• Discuss the conditions associated with increased risk during ECT

• Recognize the presence of ECT side effects

• Describe advances in ECT

• Formulate nursing interventions to prepare a client for ECT


Somatic Therapy

Present-day somatic therapies include the following:

• Psychopharmacology

• Electroconvulsive therapy (ECT)

• Vagus nerve stimulation (VNS)

• Transcranial magnetic stimulation (TMS)

• Magnetic seizure therapy (MST)

• Deep brain stimulations (DBS)


Electroconvulsive Therapy

Indications for Use

• Depression

• Schizophrenia

• Depressive phase of bipolar disorder

• Clients at risk for suicide

• Therapy-resistant depression

• Delusional depression

• Obsessive–compulsive disorder (OCD)

• Acute schizophrenia

• Schizoaffective disorder

• Intractable mania

• Catatonia

• Pseudodementia

• Neuroleptic malignant syndrome

• Individuals who cannot take antidepressants


Conditions Associated with Increased Risk During ECT

• Special considerations

• Conditions associated with increased risk


Side Effects of ECT

• Headache

• Nausea

• Disorientation

• Memory disturbance

• Postictal (seizure) agitation


Advances in ECT

• Seizure duration, characteristics, and end point

• Augmentation strategies when treatments are ineffective

– Changing the placement of electrodes

– Selecting an alternate anesthesia

– Using intravenous caffeine

– Reducing the impact of benzodiazepines by administering the antagonist flumazenil (Anexate)

– Blocking serotonin uptake by administering pindolol (Visken)


Electrode Placement(A) Bitemporal electrode placement

(B) Unilateral electrode placement


Guidelines for ECT

• ECT is a major treatment with well-defined indications, and it should not be reserved as a last resort.

• The most common use of ECT is with clients who have not responded to alternative treatments such as pharmacotherapy, exhibit a deterioration in clinical symptoms, or exhibit suicidal ideations.

• There are no absolute contraindications to ECT; however, consideration is given to the degree of risk to potential benefits of ECT.


Nursing Interventions for the Client Receiving ECT

• Client education prior to ECT

• Informed consent

• Client preparation for treatment

• Care during ECT and the recovery period

• Resources for client education


Alternative Somatic Therapies


– Epileptic seizures

– Refractory depression


– Major depression

– Auditory hallucinations

– Other psychiatric and neurological disorders


– Depression


Key Terms• Clitoridectomy

• Deep brain stimulation (DBS)

• Electroconvulsive therapy (ECT)

• Electronarcosis

• Insulin shock therapy

• Lobotomy


• Physiotherapy

• Postictal agitation

• Psychosurgery

• Somatic therapy

• Sterilization




Reflection

The chapter-opening quotes present “pro” and “con” views of ECT for debate.

• Which view would you defend?• If your answer is “con,” what additional information

would you offer to defend your choice?• If your answer is “pro,” explain the rationale for your

choice.

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chapter 17 somatic therapies

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