Rates of electroconvulsive therapy use in Hungary in 2002

OBJECTIVE: In Hungary there has been no systematic evaluation of ECT use since 1992. Nine years ago, the legal regulation of ECT practice changed. Since 1994, the collaboration of a specialist in anesthesiology is a legal obligation. However, the introduction of the new antipsychotic and antidepressant drugs expanded the possibilities in psychopharmacological treatment. These events basically influenced ECT use. The aim of this study was to obtain an overview of ECT practice in Hungary after these changes. METHODS: A 13-item containing questionnaire was sent to all psychiatric departments. RESULTS: All departments except 1 replied by mail, by phone, or by e-mail. Forty-three departments indicated the use of ECT, but in clinical practice only 34 departments applied ECT in 2002. The average number of treated inpatients was 9 on ECT using departments. Altogether 0,6% of all hospitalized psychiatric inpatients received ECT in 2002. The indication for ECT was schizophrenia in 55.6% of the patients and affective disorder in 40% of the cases. Mostly bitemporal electrode placement was used usually thrice weekly. Most commonly used sleep induction agents were thiopental and propofol. CONCLUSION: The rate of ECT use in Hungary is significantly lower than in the United States, in the United Kingdom, or in the Scandinavian countries and similar than in Hong Kong. The indication of ECT was schizophrenia in 55.6% of the cases.     

Electroconvulsive therapy in Slovakia

The aim of the study was to review and describe contemporary practice of electroconvulsive therapy (ECT) in Slovakia. A 30-item containing questionnaire was sent to all inpatient psychiatric institutions in Slovakia. Electroconvulsive therapy was offered in 33 of 36 psychiatric departments and ECT wards that responded. All the psychiatric services except 1 replied to the questionnaire (n=32; 97%). Sixteen departments (50%) used a sine wave device. Bitemporal or bifrontotemporal electrode placement is evidently preferred option in 93.8% of all departments. The main diagnostic indication for ECT in Slovakia is depression. Both national guidelines and continuing education are missing.     

Survey of the practice of electroconvulsive therapy in teaching hospitals in India

OBJECTIVES: We sought to obtain an overview of electroconvulsive therapy (ECT) practice in teaching hospitals in India. METHOD: From September 1, 2001, to August 31, 2002, a 29-item questionnaire enquiring about ECT practice during the past year was sent to 188 teaching institutions and psychiatric hospitals. RESULTS: Seventy-four institutions (39.4%) completed the questionnaire. ECT was available in 66 institutions. A total of 19,632 patients received 114,111 instances of ECT from 316 psychiatrists, of which 13,891 patients (70.8%) received 89,475 treatments (78.4%) from 128 psychiatrists in the psychiatric hospitals. The male-to-female ratio was 1.56 to 1. Brief-pulse device was used in 39 institutions. EEG monitoring was used routinely in only 8 institutions. Bilateral ECT was used in almost all institutions. Patients with schizophrenia received ECT most frequently (36.5%), followed by patients with major depression (33.5%), mania (17.9%), catatonia (6.2%), and dysthymia (2.8%). Patients who received ECT were in age group of 45-64 years (43.9%), followed by 25-44 years (34.5%), 65 years and older (14.7%), 18-24 years (5.6%), and younger than 18 years (1.4%). A total of 10,234 patients (52%) received unmodified ECT 52,450 treatments (46%) at 33 institutions. There was one case of ECT-related death during a survey. Continuation ECT was performed in 29 institutions and maintenance ECT in 17. CONCLUSIONS: More than 70% of ECT administrations in India were performed in the psychiatric hospitals. Approximately half of ECT use was unmodified ECT. The majority of patients who received ECT were diagnosed with schizophrenia and major depression. ECT training programs for psychiatry residents were acceptable.     

Electroconvulsive therapy practice in Thailand

OBJECTIVES: To obtain an overview of electroconvulsive therapy (ECT) practice in Thailand. METHODS: Questionnaires were sent to all institutions providing psychiatric care; data were collected from September 1, 2001, to August 31, 2002. RESULTS: Fifty-three responses were received from 67 institutions (79.1%). ECT is available in 26 hospitals. Approximately 6,914 patients received 51,565 ECT treatments, of which, 6,469 patients (93.56%) received 48,240 treatments (93.55%) in the psychiatric hospitals. The ECT utilization rate was 11.15 patients treated per 100,000. Twelve institutions used MECTA (Spectrum or SR1) or Thymatron DGx. Bilateral ECT was used exclusively in all institutions. In 2 medical schools, all patients received double ECT throughout their treatment courses. Unmodified ECT was always used in nine psychiatric hospitals and five general hospitals, and occasionally used in 2 university hospitals comprising 94.2% of all ECT usage. Patients with schizophrenia most frequently received ECT (74%), followed by mania (8%) and major depression (7%). The nurse alone administered ECT in four psychiatric hospitals. Although the death rate was estimated at 0.08%, there was no ECT-related death during the survey period. Continuation ECT was performed in 11 and maintenance ECT in 6 institutions. Five institutions had acceptable training programs for psychiatry residents but none had training syllabus, 2 institutions had teaching schedule for medical students. CONCLUSIONS: ECT use in Thailand is high. Nearly all ECTs (93.6%) were performed in the psychiatric hospital and 94.2% of all treatments were unmodified ECT. Lacking of proper training in ECT is evident.     

Electroconvulsive therapy in the Nordic countries, 1977-1987.

In 1977 a questionnaire was sent to all psychiatric departments in the Nordic countries: Sweden, Norway, Denmark, Finland and Iceland, concerning indications for electroconvulsive therapy (ECT) and the use of unilateral and bilateral treatment, respectively. The inquiry was repeated in 1987 and the answers compared with those obtained in 1977. In addition, the answers from Denmark were compared with previously performed inquiries. The use of exclusively unilateral treatment (U) and of both unilateral and bilateral treatment (UB) has increased in most of the countries and exclusively bilateral treatment (B) has decreased drastically. In Denmark the situation has not changed for ECT in endogenous depression and acute delirium, and the use in reactive psychosis, mania and schizophrenia decreased somewhat during the 1970s and then again stabilized or increased during the 1980s. Nearly all departments in the Nordic countries used ECT in endogenous depression in 1977 and were still doing it in 1987. In mania, about 50% of all departments have found ECT indicated occasionally or exceptionally both in 1977 and 1987. Manic-depressive mixed states have been regarded as an indication in somewhat more than two thirds of departments, increasing during the period. The use of ECT in schizophrenia has been rare and somewhat decreasing, but still about half of the departments apply it once in a while. In reactive psychosis the use of ECT decreased slightly, but in 1987 it was still in use for this indication in about 50% of all departments. In acute delirium there has been an overall increase in the use of ECT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Electroconvulsive therapy for schizophrenia in Ontario: a report on therapeutic polymorphism

The authors used a computerized data bank from 208 general hospitals and 3 community psychiatric hospitals, as well as reports from 10 provincial psychiatric hospitals, to analyze ECT use for schizophrenia in Ontario. In the year reviewed, 1977 courses of ECT were administered, 481 (24.3%) to schizophrenic patients. Of 57 hospitals with ECT capacity, 41 used ECT for schizophrenia. Utilization rates varied widely among hospitals. From 0.6% to 32.8% of discharged schizophrenics received ECT. Schizoaffectives had significantly higher ECT rates than all other subtypes. No subtype had a significantly lower rate. Females received more ECT than males. While ECT use peaked in the fifth and sixth decades, age was not a significant determinant of ECT use. ECT was used when drugs failed to achieve a satisfactory response. Its use generally resulted in discharge from hospital. Our findings indicate that there is very little uniformity or standardization in the utilization of ECT for schizophrenia.     

Electroconvulsive Therapy: A German Perspective

A survey was undertaken in 1986 to provide reliable information on the present status of electroconvulsive therapy (ECT) in the Federal Republic of Germany (FRG). ECT was used in 26% of the state mental hospitals, 40% of the psychiatric departments of general hospitals, and in 78% of university hospitals. The number of treatment courses applied was low, with about 500 patients receiving ECT in 1985. The indications for ECT and patterns of administration appeared similar to those of other countries, although unilateral electrode placement was prescribed infrequently. The low use of ECT in the FRG (0.08/10,000 population) cannot be related to the attitudes of senior psychiatrists toward ECT, because the attitudes appear to be rather favorable. The majority maintained that indications for ECT exist and that every psychiatric hospital with comprehensive treatment facilities should offer this treatment. ECT usage seems to be partly determined by nonmedical factors, in particular, the recent attacks against psychiatry and ECT in the media. To correct the consequences of such attacks, the merits of ECT should become better known.     

The use of ECT within the veterans administration hospital system

Survey data describing present patterns of ECT use within the VA hospital system is presented, with particular focus on ECT technique. Seventy-four percent of the VA psychiatric services possessing an ECT capability responded. The results show that during 1977, most VA hospitals with inpatient psychiatric services (56%) still utilized ECT, with an estimated 3.1% of depressed psychiatric inpatients treated with this modality, versus 0.21% for schizophrenics. As of the summer of 1978, one-third of ECT treatment series were being given with unilateral electrode placement, and there is growing acceptance of ECT equipment that utilizes low-energy brief pulse stimuli and other technical refinements. All respondents reported the use of muscle relaxation and general anesthesia.     

ECT in metropolitan New York hospitals: a survey of practice, 1975-1976

Of New York psychiatric facilities surveyed, 83% used ECT. Five percent of patients in university and private nonprofit hospitals, less than 1% in public hospitals, and 21% in private for-profit hospitals received ECT. Practices and procedures were remarkably uniform, except that less than 17% of units used unilateral ECT. Training programs were minimal and unplanned. Differences in incidence of use result from staff training, public antipathy, and economic factors.     

Electroconvulsive therapy practice in Western Australia

OBJECTIVES: Despite the continued wide use of electroconvulsive therapy (ECT), there is little empirical research documenting numbers and characteristics of recipients of ECT, or the number of ECT administrations in various jurisdictions. This study aimed to further develop an Australian perspective on the practice of ECT, with particular emphasis on its use with children and older adults. METHODS: The Mental Health Information System of Western Australia (WA) and records from State psychiatric hospitals were examined for data on ECT use over the period from 1997 to 2001. RESULTS: Most Western Australia recipients of ECT were adult women who were diagnosed with affective disorders. Although the number of ECT recipients rose dramatically each year, ECT usage appeared to be a constant proportion of the psychiatric population in WA during a 5-year period in association with increased numbers of psychiatric patients. CONCLUSIONS: Use of ECT in WA was at a lower rate than previously reported for Victoria, and notably lower than for older adults in NSW. As in most recent surveys, affective disorders were the most common diagnosis among recipients of ECT. The creation of a more comprehensive State ECT register is recommended to allow more accurate estimations of the frequency of ECT administrations in future, and facilitate more effective and efficient monitoring of ECT practice.     

Attitudes towards electroconvulsive therapy among Hungarian psychiatrists

Participants of a postgraduate biologic psychiatric course were surveyed about their attitudes toward electroconvulsive therapy (ECT) with a self-administered questionnaire. Among the respondents, 65 persons were specialists in psychiatry, 32% of whom would not consider using ECT even if they were in a psychotic depressive state. According to the bias factor, which has been calculated based on the answers to the 11 questions regarding attitudes, those psychiatrists who worked in inpatient care showed a less negative attitude. Among the items concerning knowledge of ECT, incorrect answers were most frequent to questions about myocardial infarction as a contraindication, and about the identity of the person who had pioneered this treatment. The negative attitude of Hungarian psychiatrists, especially of those who work in outpatient care, may have an important role in the decrease of the application of ECT in the past decade in Hungary.     

On the application of light therapy in German-speaking countries

Many studies have investigated seasonal affective disorder (SAD; fall-winter-depression) and its treatment with light therapy (LT). However, to the best of our knowledge, no other study has investigated the usage of LT in Europe since 1994. Thus, we performed a survey in hospitals with adult psychiatric departments in German-speaking countries by questionnaire. First, a questionnaire was constructed, considering also recent developments in LT. This questionnaire was sent to all hospitals with adult psychiatric departments listed in the "Deutsches Krankenhaus Adressbuch," which contains hospitals from all German-speaking countries (Germany, Switzerland, and Austria). Non-responders were asked to answer the questionnaire by mail and by phone. We achieved a completion rate of 58%. Data show almost no relevant, non-artificial differences between countries as well as between type of hospital. LT is more frequently used in university and state hospitals than in other types of treatment facilities. Compared to 1994, the major findings are (1) a substantial increase in the use of LT from 13.0 to 69.8% with no differences between Germany, Austria, and Switzerland, (2) this increase is mostly due to treatment for various forms of depression and further possible applications are less often considered, (3) there is a shift in the usage of LT from monotherapy to combination of pharmacotherapy with LT as an adjunctive treatment, and (4) a north-south comparison showed no substantial differences. Considerably higher rates of usage of LT have been found compared to the last survey in German-speaking countries taking place in 1994. Usage almost tripled; however, possible indications for LT other than SAD and non-seasonal depression are not applied to full extent. Further efforts on the propagation of LT should therefore be undertaken, with the same rigorous studies as for pharmacotherapy.     

Ect use in the public sector: California

Availability of ECT in the United States often has been greater in the private sector than in the public sector. This is especially true in California, where ECT is heavily regulated. In 1986, ECT was available at 29.6% of the public hospitals and 42.9% of the private hospitals with psychiatric units in California. Public hospital patients accounted for 8.5% of all ECT in the state, while private hospital patients accounted for 91.5%. Of the 88 patients unable to give informed consent, 34.1% came from public hospitals vs. 65.9% from private hospitals. Two university-affiliated county hospitals accounted for 43 of 52 patients (82.7%) treated in the 6 county hospitals with psychiatric units. White patients accounted for 92.4% of ECT, leaving minorities undertreated.Private patients have a greater degree of choice regarding changing physician or hospital if ECT is needed but unavailable. The choices for public patients are limited. Possible causes and potential solutions to this problem are discussed.A version of the paper was presented at the New Research Poster Session, American Psychiatric Association Annual Meeting, May 10, 1989, San Francisco, California.     

A comparison of the ethnic distribution in the depressed inpatient population and in the electroconvulsive therapy clinic

OBJECTIVES: It is often assumed that depressed members of ethnic minorities in Western countries are more likely to be treated with electroconvulsive therapy (ECT) than white patients. The aim of this study was to test such assumption in the area of London covered by our mental health Trust. METHODS: We examined the electronic records of all admissions with a diagnosis of major depression (n = 2422) to the 3 hospitals in a London mental health Trust for a period of 4 years. Their ethnic characteristics were analyzed and compared, according to whether they had received ECT or not. RESULTS: Depressed inpatients treated with ECT were more likely to be white than depressed inpatients who were not treated with ECT (odds ratio, 7.4; 95% confidence interval, 2.3-23.3). This excess remained significant after patients aged older than 65 years were excluded from the comparison. CONCLUSIONS: This survey highlights the need to ensure that members of ethnic minorities have equal access to all effective psychiatric treatments, including ECT.     

A questionnaire survey of ECT practice in Australia

OBJECTIVE: To determine the characteristics of electroconvulsive therapy (ECT) practice in Australia. METHOD: From October 1, 2002 to February 29, 2004, a 29-item questionnaire was sent to 136 hospitals in Australia. RESULTS AND CONCLUSIONS: One hundred thirteen hospitals (83%) completed the questionnaire. Electroconvulsive therapy was available in 90 hospitals. A total of 7469 patients received 58,499 ECTs from 356 psychiatrists, which gives an average course length of 8.5 treatments. Electroconvulsive therapy use as assessed by the crude treated-person rate was 37.85 persons per 100,000 population per annum. Of the number of patients, 63.4% were women. Brief-pulse devices were used in all hospitals. Electroencephalogram monitoring was used routinely in 80 hospitals. Of the total number of ECT treatments, 82.3% were given to patients with major depression, 9.6% to patients with schizophrenia, 4.9% to patients with mania, and 1.7% to patients with catatonia. Patients who received ECT were in an age group older than 65 years (38.4%), followed by 45 to 64 years (28.3%), 25 to 44 years (26.3%), 18 to 24 years (6.9%), and less than 18 years (0.2%). Unmodified ECT was not used in any hospital. One thousand one hundred ninety-six patients received continuation ECT in 83 hospitals, and 1044 received maintenance ECT in 77 hospitals. There was no case of ECT-related death during a survey period. Only 31 hospitals rated their teaching program for medical students as acceptable to excellent, and for psychiatry residents, it was 58.     

Hungarian medical students' knowledge about and attitudes toward electroconvulsive therapy

A survey using self-administered questionnaires was conducted among fifth-year medical students beginning their psychiatry clerkships to assess their attitude toward and their basic knowledge of electroconvulsive therapy (ECT). The questionnaire, consisting of 28 questions, was completed by 127 students. Ten rated their own knowledge on ECT as mediocre, the rest of them as minimal. A total of 67% of the students would not consent to undergoing ECT themselves, not even if they had severe depression with psychotic features. ECT was believed to be used to bring violent patients under control by 35% of the students, was believed to be painful by 54%, and to be even dangerous by 50%. A total of 61% of the participants believed that ECT should only be used as a last resort, 35% found ECT outmoded, 32% thought that ECT causes permanent brain damage, and 14% would ban its use. Among the students refusing to be treated with ECT, the proportion of women was higher, and their attitude toward ECT was significantly more negative (P = 0.031) than that of those who would consent to ECT. The answers that psychiatrists often misuse ECT, that ECT is an outmoded therapy causing brain damage, and that the use of which should be forbidden were given more frequently by those who refused to be treated with ECT. Also, the attitude of those describing themselves as more knowledgeable about psychiatry was found to be significantly (P = 0.005) more negative than the attitude of those with minimal psychiatric knowledge. The frequent occurrence of incorrect beliefs about and negative attitudes toward ECT support the necessity of covering ECT in the medical school curriculum more thoroughly and in more detail.     

Accessibility,standards and challenges of electroconvulsive therapy in Western industrialized countries: A German example

Abstract

Objectives. The aim of the study was to document the present situation of electroconvulsive therapy (ECT) in Germany, compare its handling with regard to other industrialized countries and with regard to a survey 12 years ago. Methods. A questionnaire on the frequency and type of administration of ECT in 2008 was sent electronically to 423 psychiatric hospitals. As needed, up to five reminders were carried out by telephone. On this occasion, the question of whether ECT is administered, could be clarified for each hospital. Results. A total of 43% (183/423) of hospitals declared to administer ECT; 63% (115/183) reported nearly 20,000 treatments. A total incidence of 30,000 treatments performed on 2800 individual patients was estimated. This means that 3.4 patients per 10⁵ inhabitants, 0.4‰ of all depressed patients, and about 1% of depressed inpatients, are treated with ECT in Germany. Conclusions. The frequency of application has increased during the last 12 years by a factor of more than 2.5 in Germany. In Western industrialized countries, numbers vary by a factor of more than 10 amongst the countries with a slow trend of equalization. The mode of implementation and the areas of conflict in which the therapy stands seem to be similar.