ECT Session | Prior to ECT | Post ECT in recovery | Progress on the ward |
---|---|---|---|
1 | Settled, anxious at times, joined in with activities. Able to hold a conversation Consented to ECT. Quiet on arrival, but did answer 4/5 orientation questions correctly | Anxious, quiet, but pleasant on approach. Compliant with medications | Reported to be highly anxious, kept saying ‘no’ or ‘I don’t know’ – unable to give capacitous consent. Moderate evidence of psychomotor retardation and evolving mutism. Did not appear to be responding to unseen external stimuli. She required full support for her personal care |
2 | Unable to consent | On return to the ward, she refused medications, spitted them out and had her mouth closed | Poor oral and fluid intake, received IV fluid treatment due to dehydration and deteriorating renal function |
3 | |||
4 | Very anxious and unable to answer any of the orientation questions | Able to drink full cup of squash and ate 2 biscuits. Completed 4/5 orientation questions | Upon returning to the ward, she became very anxious and hardly communicative. She was visibly shaking and humming |
5 | Very anxious and unable to answer any of the orientation questions | Intermittent compliance with prescribed oral medication | |
6 | Remained anxious and reluctant. Unable to answer any questions | Had half a beaker of squash and IV Hartmann’s. Unable to obtain MMSE | Minimally interactive, and will respond with single words (no, no, no) |
7 | Had to be brought on a trolley due to high level of anxiety, distress and agitation | Had some tea and biscuits – couldn’t answer orientation questions afterwards | She was having minimal conversation and continued to say ‘no, no, no.’ |
8 | Very anxious and was reluctant. Unable to answer any of the orientation questions | Had a mug of tea 280mls as well as 500 ml of Hartmann’s Fluid IV | She has been keeping tablets in her mouth at times. Staff had to escort her to the toilet using a wheelchair |
9 | After the session, had tea, toast and biscuit. Conversed with staff about dieting, exercise and dogs | She returned to the ward with a smile. Then in the afternoon, she returned to the anxious state. She did manage all her meal | |
10 | She had been variable in presentation. When she is less anxious, she could feed herself. Other times, she refused to eat and drink | She had been sat in the communal area post-ECT. | She was reasonably settled but gradually got anxious and had been repetitive and making sounds |
11 | SOAD applied for 6 further ECT sessions | She was very calm, however did not interact with staff other than with short answers. She accepted a mug of tea and one and half slices of toast and marmalade. She was unable to answer any of the orientation questions | She has been out in the garden for a walk. She joined in the colouring group and participated well. Accepted medication with less prompting |
12 | After the treatment, she was much calmer, however appeared confused at times. She had tea, cheddars and toast | She engaged well in physiotherapy strength and balance sessions | |
13 | Calm. Did not answer any of the orientation questions. The only thing she said was ‘what is my name.’ She walked calmly back to the ward with staff | Eating and drinking well. Taking food in the canteen now, despite eating slowly. Minimal assistance required with personal care | |
14 | Accepted tea and toast. She was able to answer 2/5 of the orientation questions, however did say ‘my name used to be …’ | She had been settled and calm, spent time in communal area with others. She engaged well when spoken to and has not been making any noise. | |
15 | She was able to tell us her name, date of birth, however followed each answer by ‘well it used to be’ | When staff talked to her, she would always respond back with talking to staff. At times, she did smile to staff | |
16 | She was able to walk to the clinic with a member of staff and answered 3/5 of the orientation questions. She became increasingly anxious when being prepared for ECT, however remained cooperative throughout | She was able to tell us her name and date of birth, but responded ‘I have no idea’ when asked where she currently is | Walked back to the ward with no concerns |
17 | She was able to answer 3/5 of the orientation questions | She had cheddars and tea after the treatment. She completed 4/5 orientation questions and initiated the conversation briefly | She joined drama therapy group for the first time. Although she appeared quiet throughout the session, she contributed vocally and artistically to group exercises |
18 | ECT cancelled due to temperature of 37.7 °C | She was bright in mood, smiling more, playing dominoes with other service users. Eating and drinking well. She could reflect on how severely unwell she was |