If other ways of treating addictions turn out to be ineffective, a doctor's commission can appoint a patient with electroconvulsive therapy. This is a cardinal method, but studies show its effectiveness in stopping abstinence and eliminating pathological craving for drugs.
Electroconvulsive therapy in narcology
The method of electroconvulsive therapy was first tested in the 1930s.for the treatment of mental abnormalities. It was invented by the Italian professor Hugo Cherletti together with his assistant.
For a long time, the ECT method was perceived skeptically by the population of many countries and fell under legislative prohibitions and restrictions. However, by the 1970s.the situation changed, and psychiatrists managed to prove the safety of such treatment. Later it was used in neurology, and then in narcological practice.
ECT is to pass an electric current through the patient's brain. Thus, pseudoepileptic convulsions are caused.
As a result, depression and some other mental disorders that are formed when taking psychoactive substances are alleviated. There is evidence that ECT helps to stop withdrawal symptoms and reduce dependence on drugs.
However, the use of ECT is possible only with the written consent of the patient and only if other methods of treatment are unproductive.
Electroconvulsive therapy is also used in the treatment of alcohol dependence. As a result of a blitz-course ECT abstinence is stopped and pathological craving for alcohol is eliminated. In addition, this technique shows the effectiveness of maintenance therapy, helping to consolidate and prolong the period of abstinence from alcohol.
The essence of the method
The method of electroconvulsive therapy involves the use of special equipment and medications, which include:
- Convulsors with short-pulse currents.
- Anesthesia.
- Muscle relaxants.
Short-term anesthesia with intravenous administration is performed in accordance with the safety standard. Also, during the procedure, the patient is provided with myoplegia with short-acting muscle relaxants. Admission of these drugs should be accompanied by artificial ventilation.
After carrying out the necessary preparations on the patient's brain, an electric current of different intensity is produced, which is produced by convulsors. This provokes a pseudoepileptic fit.
Seizures do not occur as such, but there are various changes in the functions of the nervous system that are characteristic of paroxysmal brain activity. Monitoring the patient's condition throughout the entire ECT session eliminates the risk of injury. This makes it possible to apply the method even in the treatment of patients with severe lesions of some internal organs and the musculoskeletal system.
In modern devices for therapy, the very form and nature of the electrical effect on the brain has changed, due to which it became as close to the physiology of neurons. In the past, ECT devices generated a sinusoidal alternating current. He over-stimulated the nerve cells, which led to complications.
Convulsors, which are used now, produce a rhythmic rectangular current with a short pulse. Physicians have the ability to regulate the strength of the current, the duration of the pulse and the frequency of the effect. This allows you to maximally adapt the procedure to the individual characteristics of the patient and effectively deal with the identified deviations.
In addition, scientists have developed and implemented a dosed electrical impact. This scheme allows to minimize possible complications after the procedure of ECT.
Electroconvulsive therapy sessions are repeated at intervals of 1 day or twice a week - as decided by the doctor. During one treatment course the patient suffers about 6-8 seizures, less often - 10-12.After this, a long break is necessary, and the resumption of treatment with ECT is possible only after 2-5 months.
If before in the society there was a conviction that electroconvulsive therapy causes organic damage to the brain and creates the risk of epilepsy, now these myths are debunked. Researchers argue that the ECT method is economically viable. Every year, up to 2 million alcoholics and drug addicts worldwide are treated.
Electric current affects different synaptic systems of the brain, including:
- dopamine;
- acetylcholine;
- serotonin;
- opiate;
- GABA-ergic.
As a result, the concentration of neurotransmitters is regulated. At the same time, doctors manage to achieve changes in receptor density and sensitivity.
After passing the ECT course, the patient adjusts the electrophysiological activity of the brain. Within a month after the end of treatment in the frontal lobes slow rhythms begin to predominate. As a result, the REM-phase of sleep is shortened, and its total duration, on the contrary, increases.
In addition, electroconvulsive therapy has a neurometabolic effect. Just one procedure causes an improvement in protein production in neurons.
During the ECT session, the survival and growth of adult cells is improved in the brain. They are protected from further damage. In some cases, the atrophy of neurons as a result of exposure to chemicals becomes reversible.
The clinic for a large convulsive seizure under the influence of an electroconvulsor in some phases is similar to epileptic seizures. The patient instantly loses consciousness, and his whole body is covered with tonic convulsions. This phase lasts about 20 seconds.
For the time of attack, the pupils of the patient expand and cease to react to light. He has increased blood pressure, which comes to normal after the cramping. Pulse, on the contrary, slows down during the seizure, and after it - accelerates.
When convulsions begin, a person's breathing is fixed, but after the seizure all vegetative disorders disappear. Within a few seconds, the patient normalizes breathing, then the cyanosis of the skin passes, the heart rhythm is restored. A person begins to react to external stimuli and perform spontaneous movements.
A little later, patients often fall asleep for half an hour, after which they wake up in a clear consciousness. For some time the patient has lost memory, which only reduces the fear of the following procedures.
In addition to large seizures, during the ECT session, others are possible:
- Slow.
- Abortive.
- Uncaused.
With a delayed seizure, tonic convulsions do not start immediately. Initially, there is a latent period, which lasts an average of 10-15 seconds, but sometimes it is delayed by 1-1.5 minutes. From the impact of electric current the patient immediately loses consciousness and becomes completely immobilized, but sometimes there are rudimentary motor automatisms.
At the same time, the following are recorded:
- vegetative reactions;
- increased sweating;
- dilated pupils;
- uncontrolled salivation;
- slowing of the pulse.
Tonic convulsions gradually increase. They cover the entire body, and then pass into the clonic phase, as well as with a large fit.
If the convulsive dose is insufficient, an abortive fit develops, immediately after the current is closed to the patient. This condition is characterized by a short-term loss of consciousness. Short-term tonic convulsions appear at the end, but there is no transition to the clonic phase.
When a person under ECT is exposed to an inadequate dose of a low-voltage current, an unfavorable seizure occurs. It lasts 20-30 seconds - less than abortive. The patient loses consciousness for a short period of time, while the doctors fix myoclonic jerking of the facial muscles.
An unhealthy seizure is the most dangerous, therefore it should be avoided. It is fraught with more serious complications than other forms of seizures.
Indications
Indications for the appointment of electroconvulsive therapy are:
- Alcohol and drug addiction.
- Severe withdrawal symptoms.
- Risk of recurrence.
- Diagnosis of drug abstinence.
ECT is often prescribed for the removal of severe affective disorders, delusions, hallucinations that accompany the reception of psychoactive substances. To date, this technique is considered the safest of those that are conducted under general anesthesia. Therefore, it is prescribed even to patients from at-risk groups: the elderly, children, pregnant women, patients with severe CNS pathologies.
session Despite proven safety, the electroconvulsive therapy method is a serious intervention that is also performed under general anesthesia. Therefore, this method of treatment is appointed only after conducting thorough laboratory tests, including the heart, blood vessels and musculoskeletal system.
A whole group of specialists will examine the patient before the procedure. In addition to a psychiatrist, a therapist, a surgeon and an expert in narcology, patients sometimes have to visit a neurologist, an otolaryngologist and other specialists. The ECG and chest X-ray are mandatory, and sometimes x-rays of bones and joints are required.
The ECT session takes place in a specially equipped office, the common room is not suitable for this. Before the procedure, the patient should not eat anything, since exposure to electric current can cause nausea with vomiting.
Treatment is carried out in a supine position. The patient unbuttoned the belt and buttons on the shirt, remove their shoes. If the mouth has removable dentures, they are removed, all the invisible and hair clips are removed from the women.
In the office for ECT, syringes and devices for the procedure should be prepared, as well as medicines for emergencies:
- cardiac drugs;
- means for stimulation of respiration;
- oxygen cylinder;
- spatulas with cotton wool and gauze on the ends;
- expanders for mouth;
- holders for the tongue;
- medical alcohol;
- iodine;
- sodium chloride solution for wetting electrodes;
- pressure measuring device.
Before the procedure, the electrodes are moistened with an isotonic sodium chloride solution, and then applied to the patient's head as closely as possible to the hair growth line. The same solution is treated with the patient's head. After that, the convector is attached to the electrodes by an electric cord.
After preparation for the patient's brain, they begin to act with alternating current 127 and 220 V. Voltage is changed on the convector itself, guided by the indicators on the instrument panel. The effect of the current is prolonged from 0.1 to 1.5 s, a longer exposure may be harmful.
The doctor in each case sets the duration of the exposure to the current individually, proceed from the patient's reactions. The initial exposure is usually 0.5 seconds, the minimum voltage is set at 70-80 V. The first convulsive dose leads to a short-term loss of consciousness, cramps often do not occur.
After a couple of minutes the procedure is repeated, increasing the voltage by 10 V and increasing the exposure by 0.2 s. High voltage is less traumatic than long-term exposure to current, so first increase the voltage.
During the following sessions, voltages and exposures are used, in which the previous seizure occurred earlier. Otherwise, these parameters are increased, but it is not recommended to set the voltage above the level of 120 V, and the action of the electric current should not continue for more than 0.9 s.
Sometimes during treatment in patients the convulsive threshold decreases. In such cases, the usual convulsive dose can cause an overly intense fit. This is an indication of a decrease in previously set parameters( by 10 V and 0.2 s).
After the electric shock causes a seizure, the device is switched off and the electrodes are removed. To prevent the patient from biting his tongue or cheek, the nurse inserts a spatula between the molars to the patient. It is taken out only after the seizure is completed, and the patient breaks the jaws.
Also during the fit the patient under the back is placed a roller. In this case, you must carefully monitor that a person does not bury his face in the pillow, otherwise he may suffocate.
While the seizure lasts, the patient can not be held, because this creates a risk of dislocation or fracture. When the cramps stop, the person is lifted his head, turns it to one side, and the saliva that accumulates there is removed from the mouth.
Sometimes, after a fit, the patient stops breathing for a few seconds. To restore it, the patient is gently pressed down to the bottom of the chest.
When the attack ends, the patient immediately regains consciousness and can start performing meaningless actions:
- chaotically look around;
- tearing clothes;
- spreading the bed;
- try to escape.
Patient needs special supervision at this time. He is laid on the couch, controlled by his breathing and pulse. After a few minutes he should calm down.
The video session of electroconvulsive therapy:
Side effects and contraindications
The absolute contraindications for the use of ECT include severe cardiac and vascular pathologies;
- severe myocardial changes;
- angina;
- sclerosis of the coronary vessels;
- common atherosclerosis;
- hypertension;
- thrombophlebitis;
- heart disease in the decompensation stage.
Electroconvulsive therapy should also not be prescribed for diseases that are accompanied by a risk of a fracture. These include:
- deforming arthritis;
- osteomyelitis;
- osteoporosis;
- limited mobility of joints;
- recent fractures.
In addition, absolute contraindications to ECT include CNS lesions, including Parkinson's disease, infections, purulent diseases, stomach ulcers, kidney, liver and respiratory diseases.
ECT can be used, but it is not recommended in the following cases:
- hypertension in the initial stage;
- old fractures;
- heart disease in the stage of compensation;
- femoral or inguinal hernia
.
After the session of electroconvulsive therapy, side effects are possible, which are important to know. Among them:
- loss of orientation in time and space;
- confused consciousness;
- violation of self-perception;
- amnesia;
- dizziness;
- diffuse;
- headache;
- impaired concentration;
- general weakness;
- drowsiness;
- is a psychomotor agitation.
Weakness and drowsiness are associated with the action of anesthesia. These symptoms, like most others, usually take place within a few hours after the completion of the procedure.
It is also possible to short-term increase in pressure and heart rate. This side effect is caused by such factors as increased activity of the sympathetic-adrenal system, the effect of electrocurrent on the vasomotor center and epileptiform fit.
Efficacy of
To date, many studies have been carried out that allow one to judge the effectiveness of electroconvulsive therapy. So, in 2003, English physicians proved that ECT helps cure severe depression with suicidal tendencies and psychosis due to the abuse of stimulants. In the experiment, 3 groups of people participated: one was given a placebo, others - antidepressants, others were exposed to current and showed better results.
American scientists also conducted their research. They studied the experience of medical professionals across the country and found that the condition of 70% of patients exposed to ECT, significantly improved. At the same time from 30 to 50% of all patients achieved a stable remission.
According to experts from the United States, electroconvulsive therapy is most effective in treating "double depression", which develops against the background of dysthymia. They also argue that it is advisable to apply this method in cases when it is the depression that provoked dependence on alcohol or drugs. In this scenario, the elimination of depression will naturally lead to a decrease in the craving for stimulants.
Russian narcologists examined 92 patients with opiate addiction. Some patients were treated with ECT, and the rest with traditional methods. In the report of scientists it is said that electroconvulsive therapy eliminates pathological attraction to opioids and stops abstinence syndrome 3 times faster.
Reviews
Patients on the whole respond fairly skeptical about electroconvulsive therapy. They are initially scared by a list of side effects, as well as the procedure itself, during which a person loses consciousness, experiences convulsions, and then does not remember anything. Many even compare ECT with punitive medicine.
Patients who underwent such treatment note improvement. They have significantly alleviated the withdrawal syndrome and reduced the craving for alcohol or drugs.
However, patients indicate that after each session there is an unpleasant recovery period after anesthesia and the procedure itself. It is accompanied by weakness, amnesia, complete disorientation.
In addition, people say that before each procedure they were present with fear. Because of these factors, not all patients bring the treatment to completion.
According to Russian doctors, the course of ECT is especially effective in cases when there are following complications due to taking alcohol and drugs:
- Manic delirium.
- Severe depression with a risk of suicide.
- Catatonia.
- Psychoses with refusal to eat and drink.
Some physicians believe that the maximum effect of electroconvulsive therapy is achieved at the initial stage of the disease, so treatment with this method should be started as early as possible. However, the appointment of ECT requires a thorough examination of the patient and referral from several specialists - a psychiatrist, an expert in narcology, a neurologist and a therapist.