Definition
Convulsive therapy by inhalation of a chemical substance, indoklon or hexafluorodiethyl ether for the treatment of mental illness, which is parallel to electroconvulsive therapy (ECT) in its safety and effectiveness.
Indications for Chemical Convulsive therapy
- Acute to chronic depression.
- Schizophrenic reactions.
- Paranoid reactions.
- Manic depressive reactions.
- Fear and apprehension for ECT.
- Persistence of schizophrenia symptoms after ECT and other therapies.
Contraindications
- Upper respiratory and lung infections.
- Kidney, liver and cardiovascular diseases.
Preparation of the patient
- Complete physical examination.
- Investigations such as CBC, urinalysis, chest X-ray, EEG, if indicated.
- Withhold psychotropic drugs 48 hours before the therapy.
- Withhold fluids by mouth and cigarettes for 12 hours.
Procedure for Chemical Convulsive therapy
| Nursing Actions | Rationale | |
| 1. | Before procedure Provide adequate explanation to client and family. | Prepares patient and family to accept the therapy. |
| 2. | Obtain informed consent from responsible relative and/or patient. | |
| 3. | During procedure Administer premedication Inj: Brevital 1 percent, 10 ml. IV (Short acting anaesthetic). Inj: Succinylcholine (Quelicin) 10-15 ml IV (Muscle relaxant). Inj Atropine sulphate 0.8-1.0 mg IM (Reduces secretions in respiratory passages). Inj: Compazine IM (Prevents nausea in post-therapy period). | |
| 4. | Insert a soft plastic oropharyngeal airway. | Reduces chances of aspiration. |
| 5. | Place a face mask to which a vaporizer containing indoklon and rubber bag inflated with oxygen are attached, tightly over patient’s nose and mouth. | Compression of the bag delivers indoklon and depending on the sensitivity of the client, produces desired convulsions. Convulsions will start with small myoclonic jerks, followed by short intense tonic phase and then by a prolonged clonic phase lasting 30-90 seconds. |
| 6. | After procedure Observe for respiratory recovery which generally occurs in 10-15 seconds after the end of the clonic phase based on the dosage of indoklon. In schizophrenia patients, multiple seizures of greater intensity with higher dosage may be required. | Smaller doses produce mild convulsions, sometimes indicated by twitching of the eyelids. |
After care of the Patient
- Return the patient to his room as soon as he starts breathing normally. Patient will wake up in 2-15 minutes, without fear, as if from a pleasant dream.
- Offer food within half an hour of awakening.
Advantages of using Flurothyl (indoklon)
- Post-seizure confusion, withdrawal and memory impairment are rare.
- Produces softer convulsions.
- Respiratory difficulties such as apnoea during the procedure are rare as clients receive oxygen mixed with Flurothyl (indoklon).
- Clients are often cheerful, sometimes euphoric and show a great deal of affect following therapy.
- Client can resume normal activities within 30 minutes.
- Better acceptance and optimistic attitude are exhibited by both the client and staff.
- Client shows improved motivation, initiative, cooperation and positive interpersonal relationships.
Side effects of Flurothyl (indoklon)
- Restlessness, moaning and screaming when they wake up.
- Post-convulsive headache of short duration. Mild analgesics offer relief.
Special Considerations
- Conduct a pre-CCT assessment, including medical history, neurological status, and medication review.
- Verify NPO (nothing by mouth) status to prevent aspiration during induced seizures.
- Monitor for adverse reactions, including excessive seizure activity or cardiovascular instability.
- Assist with positioning to prevent injury during the induced seizure.
- Monitor vital signs before, during, and after the procedure.
- Ensure proper oxygenation and airway management during the convulsive episode.
- Observe for confusion, headache, or temporary memory loss, which are common side effects.
- Provide reorientation and reassurance as the patient regains consciousness.
- Monitor for complications, such as prolonged seizures or cardiovascular instability.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- R.Sreevani, A Guide to Mental Health & Psychiatric Nursing, 6th Edition, 2024, Jaypee Publishers, ISBN 978-9366161686
- Sheila L. Videbeck, Psychiatric Nursing, Seventh Edition , 2017, Wolters Kluwer Publications, ISBN: 978- 1496355911
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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