A survey of the practice of electroconvulsive therapy in Asia.
OBJECTIVE
To describe a comprehensive survey of the practice of electroconvulsive therapy (ECT) in Asia.


METHODS
Between 2001 and 2003, a 29-item questionnaire was sent to 977 psychiatric facilities in 45 Asian countries.


RESULTS
Completed questionnaires were returned by 334 (34.2%) institutions in 29 (64.4%) countries. Electroconvulsive therapy was available in 257 institutions in 23 countries. During the year before the survey, 39,875 patients (62% men) received a mean of 7.1 ECT treatments. Most patients (73.1%) were 18 to 44 years old; few were younger than 18 years (6.0%) or older than 64 years (4.4%). Indications for ECT were schizophrenia (41.8%), major depression (32.4%), mania (14.0%), catatonia (6.9%), drug abuse (1.8%), dysthymia (1.6%), and others. Brief-pulse ECT devices were used in only 115 (58.4%) of 197 institutions. Routine electroencephalographic monitoring was conducted in only 59 (23.0%) institutions. Bilateral electrode placement was invariable in 202 (78.6%) institutions. Unmodified ECT was administered to 22,194 (55.7%) patients at 141 (54.9%) institutions in 14 countries. Continuation ECT was available in only 115 (44.7%) institutions in 17 countries. No institution had a formal ECT training program.


CONCLUSIONS
The practice of ECT in Asia may seem suboptimal: schizophrenia, not depression, is the most common indication; most institutions offer sine-wave ECT; unmodified ECT is commonly administered; bilateral electrode placement is invariable in most institutions; electroencephalographic monitoring is uncommon; continuation ECT is infrequent; and no formal training in ECT is available. We speculate that the suboptimal practices reflect felt needs and ground realities in standards of medical care in developing countries rather than a misuse of ECT.
Chanpattana
Worrawat
W
Department of Psychiatry, Samitivej Srinakarin Hospital, Bangkok, Thailand. worch54@gmail.com
Kramer
Barry Alan
BA
Kunigiri
Girish
G
Gangadhar
B N
BN
Kitphati
Rungrueng
R
Andrade
Chittaranjan
C
D000758:Anesthesia; D001208:Asia / Q000453:epidemiology; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008991:Monitoring, Physiologic; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000628:therapy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D018680:Cholinergic Antagonists; D009125:Muscle Relaxants, Central