Electroconvulsive Therapy Practice in Spain: A National Survey.
OBJECTIVE
The use of electroconvulsive therapy (ECT) in Spain has not been systematically evaluated since 2000 to 2001. The aim of this study is to assess the current use of ECT in Spain.


METHODS
A cross-sectional survey was conducted covering every psychiatric unit in Spain as of December 31, 2012.


RESULTS
About 93.2% of the centers answered the questionnaire. About 54.9% of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. Wide variations existed among the different autonomous communities and provinces. Written informed consent was obtained in all the facilities. About 38.2% of ECT-treated patients were 65 years or older. About 55.7% were women. Depressive episodes were the main indication for ECT (80.2%). All the facilities applied modified ECT. No sine wave current devices are currently used in Spain. Bifrontotemporal ECT was elective in 85% of the hospitals, bifrontal in 13.3%, and unilateral in 1.8%. Stimulus titration methods were elective in 8.6% of the centers. The decision to end ECT relied on the psychiatrist's clinical impression in 89.4% of the centers and on rating scales in 10.6%. The ECT training was mandatory in 56.5% of the centers.


CONCLUSIONS
The ECT practice has significantly improved in Spain in recent years. Overall, Spanish facilities seem to comply with established clinical guidelines; however, specific concerns were identified, meaning there is still further scope for improvement.
From the *Acute Inpatient Psychiatric Unit, Infanta Cristina University Hospital; †Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre, University Complutense of Madrid; ‡Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid; §Department of Psychiatry, Bellvitge University Hospital, IDIBELL; ||Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona; ¶Jiménez Díaz University Foundation, Madrid; #Depression and Anxiety Unit, Mental Health Department, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí, Sabadell, Universitat Autònoma de Barcelona; **Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona; ††Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Ignacio
I
Vera
Javier
J
Sanz-Fuentenebro
Mikel
M
Urretavizcaya
Ernesto
E
Verdura
Virginia
V
Soria
Erika
E
Martínez-Amorós
Miquel
M
Bernardo
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome