Table C4.
Europe N= 33.
| Country | Reference | Study | Demographics | Other data | Rate* | Technical parameters |
|---|---|---|---|---|---|---|
| Land (L) | First autdor (reference) | Study design | Diagnoses | Side effects | TRP* | Modified/Unmodified |
| Region (R) | N | Indication | Outcome | EAR* | Anesthesia | |
| City (C) | Date | Gender | Conditions | iP* | Devices | |
| Hospital (H) | Time span | Age | Training | AvE* | Current type | |
| Ethnicity | Guidelines | Electrode placement | ||||
| Legal regulations | C-ECT** | Dosage | ||||
| Other | A-ECT** | (Monitoring) | ||||
| Belgium (L) | Sienaert P (Sienaert et al. 2006) | Study: Questionnaire (30 items) survey to psychiatric hospitals and wards of general hospitals N= 149 (Response rate 100%), only 32 (21.5%) provided ECT Date: 2003–2004 Time span: One year | Diagnoses: 81% depressive episode 6% psychoses 2% mania 0.9% other Gender and age: No information | Conditions: 44% written informed consent 65% patient information Training: 34% Other: 53% of the hospitals administered <10 ECT sessions per month Within-country significant difference in TPR utilization rates Attitudes psychiatrists: ECT is not used enough: 84.3% | TPR, Flanders: 2.6 TPR, Wallonia: 5.5 TPR, Brussels Capital Region: 10.6 TPR, Belgium total: 4.37 C-ECT: Rarely used (none (44%), 0–5 (47%)) A-ECT: Rarely used (none (44%), 0–5 (44%)) | Modified Anesthesia: 75% Propofol Current type: 34% sine wave Electrode placement & dose: BT: 66% UL: not used 37% combined BT and fixed high stimulus dose |
| England (L) | Department of Health (http://www.dh.gov.uk) (Department of Health 2007) | Study: National survey data (for governmental and private institutions) N= 12,800 ECT administrations N= 2,272 patients Date: January to March 2002 Time span: Three months | Diagnoses (ICD-10): 81% mood disorders 6.5% schizophrenia, schizotypal, delusional disorder 12.5% other Gender: 71% Women Age, year groups: 0%, <16 0.2%, 16–18 2%, 19–24 23%, 25–44 29%, 45–64 24%, 65–74 22%, >75 | Conditions: 16% Involuntary (Of the 600 patients formally detained while receiving ECT treatment, 60% did not consent to treatment) Other: No patients under 16 years, but 0.2% young patients age 16–18 years Decrease in use of ECT since 1999 | TPR: 1.84* (TPR, women: 2.56 TPR, men: 1.12) AvE: 5.6 (range 4.8–6.2) A-ECT: 19% | No parameters |
| *[Correction added after first online publication on 20 March 2012: The Rate Data for England (L) has been changed.] | ||||||
| Ethnicity: (patients per 100,000 ethnic origin) 4.2 White 1.8 Asian or Asian British 1.2 Black or Black British 1.0 Mixed 2.1 other | ||||||
| Hungary (L) | Gazdag G (Gazdag et al. 2004a) | Study: Semi structured (13 item) questionnaire survey to psychiatric departments. N= 76 departments, 43 answered (Response 57%, ECT not used in 43%) Date: 2002 Time span: One year | Diagnoses: 64% schizophrenia, schizoaffective 32% affective disorder (including mania, organic affective) 4% other Gender: 59% women Age: No information | Legal: Anesthesia obligatory Other: Within-country variability, ECT administered in little over one-half of all departments | TPR: 0.31 iP: 0.6% (up to 2.6%) AvE: 6. (range 3–17) | Modified ECT Anesthesia: 57% propofol 36% thiopental 7% etomidate Devices and type: 52% (sine wave) ICOMAT devices, 38% (brief pulse, square wave, constant currant) Siemans 10% (brief pulse) Thymatron Electrode placement: Mainly bitemporal (BL), also bifrontal (BF) in 2 units and UL in 1 unit |
| Poland (L) | Gazdag G (Gazdag et al. 2009a) | Study: Semistructured questionnaire (20 items) survey to all Polish psychiatric inpatient facilities N= 58 responded facilities (100% response rate) N= 25 confirmed use of ECT, but only N= 20 (34%) facilities administered ECT during study period N= 435 ECT-treated patients in period Date: 2005 Time span: One year | Diagnoses: Depression, mania, schizophrenia and schizoaffective, and other disorders Gender: 65% women Age: >18 years (but six units offered to patients <18 years) | Conditions: Written informed consent obligatory For involuntary approval from court necessary Legal: Requires specialist in anesthesiologist Other: Only one-third of facilities treated patients with ECT during study period. ECT administered under pregnancy in 10 settings | TPR: 0.11 iP: 0.79% (up to 6.46%) AvE: 9 C-ECT: 25% A-ECT: ECT not performed in Polish outpatient clinics | Modified Anesthesia: 58% thiopenthal 23% propofol 15% etomidate 4% midazolam Devices: Mecta JR-1, Mecta SR-1 & Spectrum 5000, Thymatron IV, Pabel ES and Siemens E2077 Type: 30% sine wave 70% brief pulse Placement: All BL Two facilities used UL or BF as second choice |
| Germany (L) | Muller U (Muller et al. 1998) | Study: Questionnaire survey to psychiatric hospitals and university clinics. N= 451 clinics (Response rate 64%) N= 1050 patients ECT treated Clinics (59%) providing ECT were: 82% university clinics 74% state hospitals 48% special hospitals 68% psychiatric wards Date: April to October 1995 Time span: Seven months | Diagnoses (diagnostic indication for ECT given by clinics): 79% catatonia 58% depression 24% malignant neuroleptic syndrome 2% neurological disorders Gender: No information Age: 18–64 years, seldom elderly patients | Side effects reported (common to rare): amnesia, headache, cognitive problems, organic psychoses, dental injuries, neurologic disease Conditions: 20% involuntary (nonconsent) Patient information: 43% oral 42% oral and written 15% written Other: Reasons for not providing ECT: No equipment and not enough knowledge or for political reasons Attitudes: 96% positive | TPR, East Germany: 0.15 TPR, West Germany: 0.36 (between 1992 &1994) TPR total: 0.26 C-ECT:14% | Modified Anesthesia: 64% barbiturate 38% etomidate 20% propofol Devices: 21%Thymatron DG 39% Siemens konvulsator 2077S 2% other machines Type: 21% brief pulse 39% sine wave Dose: 39% titration 18% fixed Placement: 21% UL 19% BL 18% both BL & UL 39% no data |
| Spain (L) | Bertolin-Guillen JM (Bertolin-Guillen et al. 2006) | Study: Questionnaire survey to all hospitals with psychiatric unit in Spain. N= 233 hospitals (response rate 100%) N= 108 (46%) provided ECT (28% prescribed and 25% neither prescribed nor applied ECT) Date: January to June 2001 Time span: Six months | Diagnoses: 34% depression 26% schizophrenia 12% mania 11% psychoses 8% other not diagnostic (including pregnancy, suicide risk) 3% OCD 3% organic 3% other (anxiety, neurotic, personality disorder) No age, gender, or diagnostic information | Conditions: 98.7% informed consent (1.3% involuntary) Training: 92% ECT given of psychiatrist or resident Other: Variety of diagnostic indication. 59 (25%) hospitals neither applied nor prescribed ECT Reasons for not providing ECT: 49% lack of technical means 27% no ECT type of patients | TPR: 0.61 (range 0.03–1.7) AvE: 9 C-ECT:16% of patients C-ECT practice: 35% of institutions using monthly or decreasing frequency regimes | Modified mainly 0.6% unmodified 2.3% without muscle relaxants Type: 65% brief pulse 14% sine wave 3% both 18% unknown Placement: 90% BL |
| Other reasons: therapeutic inefficacy; inexperience; ethical or moral concerns; side effects; bureaucratic problems; lack of protocols; attitudes. | ||||||
| Russia (L) | Nelson AI (Nelson 2005) | Study: Questionnaire survey to 1468 hospitals representing 54 of the 89 Russian states, which represents 80% of the population N= 114 responded hospitals (out of 1468, 8% response rate) N= 52 (out of 114, 46%) provided ECT Date: November 2003 to June 2004 Time span: eight months | Diagnoses: No information No age, gender, or diagnostic information Indication: 71% equivalent to drug therapy 29% last resort 27% medication resistance 25% as first-line treatment 12% as lifesaving | Other: No specific license, credentials or privileging required for provision of ECT Reasons for not prescribing ECT: Lack of equipment or space Unfamiliarity with ECT Absence of consideration Attitudes: 57% positive physician attitudes toward ECT | TPR: 0.54 iP: 1.4% AvE: 8 A-ECT: 2% of institutions C-ECT: 26% of institutions (Although no mention of m-ECT in official Russian ECT guidelines) | Modified and unmodified Unmodified ECT>80% Device: Modern elikon-01 (from Ukraine) EKT-01 FILAT Siemens-400 Siemens konvulsator 2077 Type: 39% brief pulse 26% sine wave Placement: 94% BL 13% UL 4% BF |
| Netherlands (L) | van Waarde JA (van Waarde et al. 2009) | Study: Questionnaire survey sent to 35 University, psychiatric and general hospitals providing ECT. Total N= 142 university, general, psychiatric hospitals 35/142 (25% providing ECT) N= 35 (Response rate 94%, 33 responded) Date: February 2008 Time span: Questionnaire period to psychiatrists, six weeks | Diagnoses: sparse information, ECT administered to patients with comorbid physical diseases, patients with malignant neuroleptic syndrome or other catatonic disorders | Training: 20 of 33 (61%) of institutions trained psychiatrists to administer ECT 50% of psychiatrists had attended certified course in ECT treatment ECT sometimes administered by other profession (geriatrician and physician) Used international guidelines (APA, RCP, DAP) Other: Most institutions had long experience, used ECT five to 25 years (median 18 years) | AvE: 8.5 (per 10,000) C-ECT: Many could manage C-ECT on an outpatient (ambulatory) basis. | Modified Type: Brief pulse and constant current device used according to guidelines 88%. (91% had local protocols) Placement (more than one answer allowed): 55% BL (25% BL only) 2% BF 40% RUL 2% RFT 2% not described Mainly UL first, then change to BL |
| France (L) | Benadhira R (Benadhira and Teles 2001) | Study: Questionnaire survey to all 815 French Psychiatric Public Hospital services N= 391 (response rate 48%) 51% of, responded hospitals administered ECT Period: 1996–1997 Time span: One year | Diagnoses: 63% medication resistant depression 18% schizophrenia 10% mania Gender and age: not reported | Other: Only half of all hospitals in France administer ECT | No rate/prevalence data | Modified Anesthesia: 65% Propofol 24% Thiopenthal Device: 55% Thymatron DG/Mecta SRI 44%Lapipe et Rondepierre Type: brief pulse and sine wave Placement: 18% UL |
| Denmark (L) | Andersson JE (Andersson and Bolwig 2002) | Study: Questionnaire survey to hospitals in Denmark, Greenland, and Faroe Islands N= 35 clinics, (100% response) All provided ECT N= 1556 patients received ECT Period: 1999 Time span: One year | Diagnostic indication from 35 units (%): 35 (100%) depression 28 (80%) delirium 22 (63%) mania 12 (34%) schizophrenia 5 (14%) other | Training: Provided by 49% (17 of 35) institutions. Psychiatrist administering ECT. In most institutions, junior doctors performed ECT. | TPR: 3.0 iP: 5% (1.8–10.0%) AvE: 9 (range 6–18) | Anesthesia, 33 units (%): 28 (85%) Barbiturate 3 (9%) propofol 2 (6%) unknown Devices and Type: Thymatron or Mecta (brief-pulse wave) one Siemens konvulsator device (sine wave) |
| Denmark (L) | Sundhedsstyrelsen (Sundhedsstyrelsen 2011a) | Study: National register data, 2000–2007 N= 17 psychiatric units, hospitals No. of ECT-treated patients/ECT administrations per year: 260/2336 (2000) 313/3237 (2001) 460/4686 (2002) 1399/15,174 (2003) 1563/16,606 (2004) 1786/19,173 (2005) 1774/19,389 (2006) 1772/19,127 (2007) | Main indication: Elderly depressed patients | Side effects: No. of deaths 24 h after ECT in study period = 6 and evaluated as not ECT-related Conditions: Prevalence of involuntary ECT treated patients (supplementary ECT data from same online source (http://www.sst.dk) in Use of coercion in Mental Health Care, 2009 (Sundhedsstyrelsen 2011b): 2.8%[722/25,199] (2002) | AvE per year: 11.1 (2000) 9.2 (2001) 9.8 (2002) 9.2 (2003) 9.5 (2004) 9.3 (2005) 9.1 (2006) 9.2 (2007) | No information |
| Period: 2000–2007 Time span: Seven years | 2.6%[667/25,291] (2003) 2.8%[714/24,872] (2004) 2.9%[734/24,501] (2005) 3.1%[765/24,308] (2006) 3.1%[736/24,129] (2007) 3.3%[821/24,311] (2008) 3.2%[848/26,014] (2009) Guidelines: Not all institutions followed all instructions, developed by Sunhedsstyrelsen guidelines no. 9001, 20 November 2000. Other: High increase in no. of ECT-treated patients from 2000 to 2007. | |||||
| Norway (L) | Schweder, LJ (Schweder et al. 2011a) | Study: Questionnaire survey to psychiatric hospitals, mental health care community centers, including child and adolescent psychiatry about ECT practice. N= 125 (Response rate 54%, but 69% from hospitals) ECT was performed in 72% of the hospitals Date: 2004 Time span: One year | Diagnoses: 70% unipolar depression 19% bipolar depression 1% mania 4% schizoaffective disorders 1% schizophrenia, polymorphic psychoses 3% mixed episodes 1% Parkinson disease 1% other Indication (main): 60% lack of psychopharmacological effect Gender: 65% Women Age, year groups: 0%, <18 8%, 18–24 13%, 25–44 30%, 45–64 55%, >65 | Other: 63% wished to offer more ECT, but unable to due to low capacity Approximately eight weeks waiting list for ECT treatment Reasons for not providing were mostly lack of equipment or anesthesiologist and not large enough institution Attitudes: 96% psychiatrists positive attitudes toward ECT | TPR: 2.4 (significant TPR Regional variation 1.83 to 3.44) iP: 5.3% (range 4.2–6.9%) | |
| Norway (L) | Schweder LJ (Schweder et al. 2011b) | Study: Questionnaire survey about ECT practice to psychiatric hospitals, mental health care community centers, including child and adolescent psychiatry. N= 125 (total response rate 54% and 69% from hospitals) Date: 2004 Time span: One year | No information | Side effects according to much/very much impaired: 26% memory impairment: 5% headache Outcome: 78% very much/much improved 21% minimal/no change 1% worse Conditions: 100% provided information about ECT 50% written informed consent Training/administration: Administration of ECT by 96% junior doctors, with or without psychiatrist present and 6% by nurses Other: Local guidelines, pretreatment examination, equipment, facilities, drugs during ECT also reported | No. of ECTs: 1-3 (7%), 4-6 (23%), 7-9 (30%), 10-12 (24%), >12 (15%) C-ECT practice: 88% of the units C-ECT: 14% of patients A-ECT practice: 63% of the units A-ECT: 15% of patients | Modified Anesthetics: 94% thiopental 6% propofol Device and Type: Thymaton or Mecta device (brief pulse) Placement: 94% UL 63% BL 2% BF |
| Sweden (R) | Socialstyrelsen (http://www.socialstyrelse.se) (Socialstyrelsen 2010) | Study: Pilot study of ECT use in hospitals, in middle region of Sweden Middle Sweden: N= 7 hospitals N= 441 ECT-treated patients, in total population 1.2 mill Skellefteå: One psychiatric unit N= 1029 ECTs N= 109 patients, population 57,530 Date: 2009 Time span: One year | Diagnoses: 55% depression 5% mania or schizophrenia 9% unknown diagnoses Gender: 59% women, Mean age in years: 54.5 (range 15–92) | Other: No national data | TPR Middle Sweden: 3.67 TPR Skellefteå: 1.89 AvE Middle Sweden: 8 (range 1–22) AvE, Skellefteå: 10 | No information |
| Belgium (R) | Sienaert P (Sienaert et al. 2005a) | Study: Questionnaire survey (30 item) sent to all psychiatric hospitals and psychiatric wards, in Flanders and Brussels Capital Region N= 88 (hospitals and wards) N= 23 (100% response rate) 26% providing ECT Date: 2003–2004 Time span: One year | Diagnoses (main indication): 88% major depression 8% schizophrenia 3% mania 1% other Gender and age: Not reported | Training/administration: Administration performed by: 57% psychiatrist 43% trainee psychiatrist without supervision 9% trainee psychiatrist with supervision Guidelines: 44% followed guidelines Other: 75% of psychiatrist had attended a specific ECT course Psycotropic drug use also reported Attitude: 96% expressed a concern of ECT under use | TPR: 4.7 | Modified ECT Anesthesia: 74% propofol 17% thiopental 13% etomidate 4% methohexital 4% ketamine 4% sevoflurane 13% others Device and type: 52% Mecta or Ectron (brief pulse) 30% Siemens konvulsator (sine wave) Dosage: 48% fixed high dose 48% dose titration strategy Placement (more than 1 answer allowed): 65% bitemporal 22% bifrontal 8.6% unilateral 13% used more than one electrode placement |
| Wales, UK (R) | Duffett R (Duffett et al. 1999) | Study: Survey questionnaire and visits to all clinics in Wales. N= 17 hospitals by phone N= 321 patients received ECT Period: first six months in 1996 Time span: Six months | Diagnoses: 82% depression 7% schizoaffective 5% schizophrenia 5% mixed affective disorder 1% mania 1% puerperal psychosis Indication: 80% Failure to respond 13% Life-saving procedure 5% patient choice Gender: 71% women Mean age: 56.9 years women 55.5 years men | Outcome: 59% much or very much impaired 31% improved 1.5% worse Conditions: 9% were given ECT against their consent 20% detained under Mental Health Act Information about pharmacotherapy | TPR: 2.2 AvE: 6.7 (range 1–8) A-ECT: 16% of patients | No information about ECT parameters |
| England (R) | Duffett R (Duffett and Lelliott 1998) | Study: Survey, questionnaire, visits, and telephoning ECT clinics (ECT practice audit) N= 215 clinics (Response rate 84%) N= 130 observed ECT-treated patients Period:1995–1996 Time span: One year | Diagnoses, age: No information Gender: 64% women | Training: 42% had attended an ECT course Usually junior doctors give ECT Guidelines: 36% followed guidelines Other: 7% used old not more recommended device 15% difficulties in obtaining anesthesiologist | No rate data | Modified Anesthesia: 17% propofol Devices: 18% Thymatron 11% Mecta 5% Neurotronics 24% Ectron 5a/b 34% Ectron 5 Type: Brief pulse and sine wave Placement: Mainly BL 7% UL |
| England (R) | Pippard J (Pippard 1992) | Study: Survey, visits by first author to hospitals in North–East Thames (NET) and East Anglian (EA). NET covered 16 health authority districts where ECT was provided in 22 NHS hospitals and three private hospitals (N= 25) EA covered eight health authority districts, where ECT was provided in 13 NHS hospitals and two private nursing homes (N= 15) Date of audit: 1991 Data from:1988–1989 Time span: One year | Other: A practical description of ECT use in the units visited Replacement of old sine-wave devices began in 1982. Guidelines: By Royal college of psychiatrist, 1989 used. Training/administration: Training programs for ECT inadequate and in one-third of hospitals there was almost none. ECT performed by: 25% patients own doctor 74% by duty doctor in training on call | [TPR (NET): 1.47] [TPR (EA): 3.7] [TPRs <1990] | Modified ECT Type: sine wave [Devices in use before 1990: Ecton Mark 4 Series 2+ and 3+ (updated models) Series 5 (1987)] | |
| Ireland (R) | Enriquez S (Enriquez et al. 2010) | Study: Survey of annual reports from Limeric mental health services Data-gathering process N= 126 ECT-treated patients with N= 153 series/courses Period: 2003 to 2008 Time span: Five years | Diagnoses: 95% depression 4% nonaffective psychosis 1% mania Gender: 66% women Age, mean (SD) years: 50.6 (16.7) (range 18–87) | Adverse events: 0.7% cardiac arrests 3% cardiac arrhythmias 0% prolonged seizure 21% cognitive impairment 1.3% respiratory difficulties 0.7% oro-pharyngeal bleeding 1.3% hypotension Conditions: 7% involuntary 14% not able to written consent Other: Annual reports from 2005 to 2007,but with limited information | TPR: 1.7 (variation in use) AvE: 6.5 (range 1–13) A-ECT: 18% | Device: Mecta spectrum 5000M Placement: 85% BL |
| Chuvash republic, Russia (R) | Golenkov A (Golenkov et al. 2010) | Study: Annual statistical hospital reports Date: 1998–2007 | Diagnoses: 88% schizophrenia Gender: 56% women Age, mean (SD) years: 34.4 (10.6) (range 15–64) | Outcome: 10.6% significant improvement 48.9% moderate improvement Consideration: Qualified anesthetist is mandatory Other: 61% of inpatients diagnosed with schizophrenia. Also about attitudes: Authors say answers revealed a high level of false beliefs and markedly negative attitudes | TPR (for 2006 & 2007): 0.8 AvE: 10.3 (SD 2.0) (range 2–20) A-ECT: are lacking | Modified, but only 40% used muscle relaxants Device: Elicon-01 machine Type: Square wave (brief pulse) Placement: BL only |
| Vienna, Austria (C) | Tauscher J (Tauscher et al. 1997) | Study: Prospective study in a hospital. N= 21 ECT-treated patients Date: September 1994 to August 1995. Time span: One year | Diagnoses: 72% Depression 14% schizoaffective psychoses 14% catatonic schizophrenia Gender: 81% women Age, mean years: 49 (range 23–69) | Side effects: 33% headache 14% reversible disorientation or amnesia Outcome: mean CGI: –3.7 Guidelines: Local guidelines as well as by American Psychiatric Association | iP: 3% AvE: 8.9 (range 5–15) | Modified Anesthesia: Propofol or methohexital Device: Thymatron Placement: mainly UL, switch to BL if no effect after 6 ECTs |
| Barcelona (C) | Bernardo M (Bernardo et al. 1996) | Study: Descriptive, interview of hospitals. N= 20 hospitals Date: August 1993 | Diagnoses: 83% depression 17% schizophrenia | No rate data | Type: Mainly sine wave | |
| London, United Kingdom and Bengaluru, India (C) | Eranti SV (Eranti et al. 2011) | Study: Retrospective case note study of all patients referred for ECT and comparison between centers (teaching hospitals) in UK and India N= 46 hospitals, London (Lo) N= 345 hospitals Bengaluru (Be) Date: 2001, London and 2002, Bengaluru Time span: One year | Diagnoses: Depression 89% Lo, 40% Be Manic episodes 4% Lo, 7% Be Schizophrenia & other psychosis 2% Lo, 41% Be Schizoaffective disorder 4% Lo, 4% Be Organic psychosis 0 Lo, 1% Be Catatonia: 0 Lo, 7% Be Indications: Not eating and drinking: 21% Lo, 6% Be Stupor 6% 1 Lo, 10% Be Suicide: 14% Lo, 33% Be Previous good response 18% Lo, 12% Be Treatment resistance 38% Lo, 12% Be Gender (women): 69.6% Lo, 51.2% B Age, mean (SD) years: 62.8 (16.0) Lo 30.3 (10.4) Be | Treatment response Complete recovery: 10% Lo, 26% Be Major improvement: 50% Lo, 55% Be Minor improvement or no change 40% Lo, 19% Be Side effects: Confusion/amnesia: 29% Lo, 12% Be Anesthetic complication 6% Lo, 13% Be Headache 1% Lo, 37% Be Injuries 0 Lo, 2% Be Other: ECT-treated patients were much younger and, more often men in Bengaluru compared to London | IP%: 0.9% Lo 8.2% Be AvE: 8.75 (6.02) Lo 6.67 (2.83) Be | Modified (Lo and Be) Anesthesia: Methohexitone, Propofol, etomidate (Lo) Thiopentone (Be) Type: Brief-pulse wave (Lo and Be) Device: Thymatron DGx (Lo) NIVIQURE (Technonivilac, Bangalore, India) Be Dosage: Half-age method (Lo) Determined by motor seizure threshold (Be) |
| Ethnicity (among depressed patients): Caucasian: 88% Lo, 0 Be Afro Caribbean. 8% Lo, 0 Be South Asian: 4% Lo, 100% Be | ||||||
| Edinburgh, Scotland (C) | Glen T (Glen and Scott 1999) | Study: Register database survey of ECT records at Royal Edinburgh Hospital Total no. of ECT treated patients, by year: N= 145, 1992–1993 N= 138, 1993–1994 N= 93, 1994–1995 N= 94, 1995–1996 N= 78, 1996–1997 Total no. of ECTs, by year: N= 1189, 1992–1993 N= 1013, 1993–1994 N= 774, 1994–1995 N= 557, 1995–1996 N= 696, 1996–1997 Date: 1992 to1997 Time span: Five years | Gender: 71% women Gender age group 18–64: 67% women Gender age group >65: 83% women | The rate of ECT use was on average three times higher for population of age >65 years than in the general adult population “rate of ECT use fell progressively and significantly (p,0.01) from 2.9 to 1.4 treatments” ECT-treated patients in 1997 were 58% less than the number treated in 1992. As measured by the number of treatments per thousand population—there was an overall 53% reduction in rate of ECT use | TPR in age groups 18–64 and >65, by year: 3.4 and 10.3, 1992–93 3.2 and 8.6, 1993–1994 2.3 and 6.1, 1994–1995 2.5 and 4.5, 1995–1996 1.7 and 6.1, 1996–1997 EAR for age groups 18–64 and >65, by year: 2.9 and 7.9, 1992–1993 2.3 and 8.0, 1993–1994 1.9 and 5.1, 1994–1995 1.6 and 2.3, 1995–1996 1.4 and 6.6, 1996–1997 AvE in age group 18–64: Range 6–8 AvE in age group >65: Range 5–10 | Placement: all BL |
| Edinburgh (C) | Okagbue N (Okagbue et al. 2008) | Study: Survey data from computerized ECT treatment records at Royal Edinburgh Hospital No. of patients ECT treated by year: N= 146 (1993) | No information | Other: Four patients younger than 18 years treated before 1998, none after Usage diminished significantly (P < 0.01) over time, for both adult 18–64 and >64 years age groups | TPR by year: 3.3 (1993) 2.9 (1994) 2.1 (1995) 2.1 (1996) 1.8 (1997) 1.6 (1998) 1.4 (1999) | No information |
| N= 130 (1994) N= 94 (1995) N= 95 (1996) N= 78 (1997) N= 73 (1998) N= 62 (1999) N= 71 (2000) N= 76 (2001) N= 64 (2002) N= 60 (2003) N= 61 (2004) N= 61 (2005) Total N= 1071 Periode: 1993 to 2005 Time span:13 years | Some overlapping rate data (1992–1997) to previous reference, Glen T (Glen and Scott 1999) | 1.6 (2000) 1.7 (2001) 1.4 (2002) 1.3 (2003) 1.3 (2004) 1.3 (2005) | ||||
| Munich (C) | Baghai TC (Baghai et al. 2005) | Study: Survey of ECT treated patients at university hospital N= 445 ECT-treated patients N= 4803 ECT administrations Date: 1995 to 2002 Time span: Eight years | Diagnoses: 63% depression 17% schizophrenia 9% bipolar 6% schizoaffective 0.2% mania 2% other Gender: 66% women Mean age: 51.2 ± 15.4 years Side effects: 61% no amnesia 32% mild amnesia 6% severe amnesia 0.3% severe cardiac | iP: 4% | Modified Device and Type: Thymatron (brief pulse) Placement from 2000: 60% UL 35% BL | |
| Dikemark Hospital, Norway (H) | Moksnes KM (Moksnes and Ilner 2010) | Study: Retrospective survey of medical records from three units at Dikemark psychiatric hospital N= 141 ECT-treated patients N= 1960 ECT administrations Period: 1960–1995 Time span: 35 years | Diagnoses: 88% affective disorder 6% organic 6% schizophrenia, schizoaffective Gender: 74% women Age, mean (SD) years: 64 (10.9) (range 29–87) (16%, 29–59 years) | Other: ECT mainly given to elderly population only 16% under 59 years, none under 18 | Prevalence among inpatients: 1990–1995: 1.7% [1980–1989: 1.0%] [1960–1979: 0.3%] AvE: 8 (Average no. of courses 1.7) | Modified Devices: 80% Siemens konvulsator After 1992, the new Thymatron apparatus with brief-pulse wave stimulation |
| Ullevaal University Hospital, Oslo (H) | Moksnes KM (Moksnes et al. 2006) | Study: Retrospective survey of medical records at Dikemark and Ullevaal hospital. N= 383 ECT-treated patients (1988–2002) Date: 1988–2002 Time span: 15 years | Diagnoses: No information Gender: 69% women Age in years: mean women: 67 mean men: 65 (range 23–91) (58% > 65) | Guidelines: Local developed by author, Dikemark Hospital in accordance with International by APA and Royal College of Physician Data for [1988: 0.5–1.7%] [1989: 0.7–2.8%] | TPR 2002: 2.8 iP and EAR, by year: 0.8% and 2.8, 1990 1.5% and 4.8, 1991 2.1% and 9.2, 1992 2.1% and 10.7, 1993 1.9% and 7.4, 1994 2.4% and 11.1, 1995 3.8% and 16.5, 1996 3.2% and 15.0, 1997 5.2% and 19.3, 1998 5.7% and 24.9, 1999 3.3% and 15.1, 2000 4.0% and 20.3, 2001 2.9% and 14.5, 2002 AvE: 8.8 | Modified Devices: Until 1995 Siemens konvulasor After 1995 Thymatron Type: sine wave until 1995 and brief pulse >1995 Placement: UL |
| Hospital Innland, Norway (H) | Eiring O (Eiring 2010) | Study: Health region “Innlandet” psychiatric hospital ward survey, three local hospitals N= 162 ECT-treated patients Date: 2008 Time span: One year | Diagnoses: No information | No information about diagnoses | TPR: 4.3 (Calculated by authors according to national resident population data from http://www.ssb.no. Population “Innlandet” 2006: 371714 (162/371714) AvE: Range 6–8 | Modified Dosage: Age-dose or stimulus-titration method Placement: RUL or BL |
| Pitkaniemi Hospital, Finland (H) | Huuhka MJ (Huuhka et al. 2000) | Study: Clinical record survey of all ECT-treated patients at hospital in 1944, 1964, and 1997. N= 46 patients (1997) N= 2289 ECT treatments (1997) Dates: [1994, 1964] 1997 Time span: One year | Diagnoses (1997): 78% Affective disorders 22% Schizophrenia Gender (1997): 76% women Age, mean years (1997): 58.9 (range 18–83) | Side effects (1997): 24% some problems during the treatment, none serious 13% amnesia 9% headache 2% minor cardiac complication Conditions (1997): 26% Involuntary | iP (1997): 2.0% AvE (1997): 8 (range 3–12). | (1997) Modified Anesthesia: Propofol or methohexital, and succinylcholine muscle relaxant 100% oxygenation Device: Siemens konvulsator 2077 Placement: BL only |
| Other: Drop in iP over time from 14.4%, 1944 to 2.2% in 1964 and 2.0% in 1997. In 1944 and 1964, main indication schizophrenia, whereas in 1997 >75% had affective disorders. ECT was administered unmodified in 1944 and 1965. ECT administered more often to young men with schizophrenia in 1944 and 1964. Use of psychotropic drug treatment during ECT | Monitoring: Oxymetry and EEG monitored Cuff method used Other: Treatment frequency, 3 times weekly | |||||
| Hospital, Istanbul, Turkey (H) | Saatcioglu O (Saatcioglu and Tomruk 2008) | Study: Retrospective case review study of ECT-treated patients admitted to Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istabul N= 1531 patients and N= 13,618 ECT administrations Date: 1 January 2006 to 30 June 2007 Time span: One and half year | Diagnoses: 37% schizophrenia, schizoaffective 30% bipolar 15% depressive disorder 14% nonorganic Psychotic disorder 4% Other (OCD, substance abuse) Gender: 44% women Age, mean (SD) years: 35.1 (10.9) Age, year groups: 1%, <18 15%, 18–24 65%, 25–44 17%, 45–64 1%, >64 Side effects: 79.7% Memory problems 34.5% Headache 27.8% Muscle pain | Outcome: Improvement: 79% completely 19% partially 2% minimum | iP: 12% AvE: 9 (range 1–18) | Modified Anesthesia Propofol & succinylcholine (muscle relaxant) & oxygenation Device: Thymatron IV Type: Brief pulse Placement: Bifrontotemporal (BL) standard |
| Scotland (H) | Fergusson GM (Fergusson et al. 2004) | Study: Audit of clinics from 1997 to 1999 N= 36 sites providing ECT ECT-treated patients: N= 794 (1997) N= 717 (1999) Date: February 1997 to July 1999 Time span: Two years and five months | Diagnoses: 87% depressive episode 6% schizophrenia/ schizoaffective 3% manic episode Indications for ECT: 55% resistant to antidepressants 39% previous good response Gender: 70% women Age (ECT among depressed inpatients), year groups: 3.4%, 15–24 4.8%, 25–44 11.6%, 45–64 13.6%, 65–74 12.7%, >75 Ethnicity: Mainly (99%) to white adult patients suffering from a depressive disorder | Conditions: 18% receiving treatment under the safeguards of the Mental Health (Scotland) Act 1984 Gender comment: Ratio of women to men, approximately: 2:1. Age comment: ECT not given disproportionately to the elderly Legal status: 76% voluntary (involuntary 24%) 82% consent given 18% under Mental Health (Scotland) Act of 1984 Training and supervision: Initial training of junior doctors evaluated good, but difficulties in providing continued supervision. Clinical global index scale (CGI): 61% of the 29 patients with schizophrenia and 68% of the 13 patients with manic-episode were rated as at least “much improved” and none as worse | EAR (1997): 15.5 EAR (1999): 13.0 AvE (1997): 6.8 AvE (1999): 6.6 AvE (total): 7 (range 1–19) | 95% BL (in accordance with advice in the Royal college of psychiatrists handbook, 1995) Equipment evaluated as: All, up to date |
| Cukurova University Psychiatry Service, Turkey (H) | Zeren T (Zeren et al. 2003) | Study: Retrospective chart review of hospital ECT-treated patients at Cukurova University, Department of psychiatry. University, Dept. of psychiatry. N= 384 ECT-treated patients Date: 1990–2001 Time span: 12 years | Diagnoses: 45% psychotic 49% affective 6% other (including postpartum psychoses, dissociative, personality disorders, obsessive compulsive) Gender: 52% women Age, year groups: 5%, <18 92%, 18–64 3%, >64 Mean age 33.1 years Education: Average no. of education years: 8.7. 54% of patients undergoing ECT had high school and higher education | iP: 14% AvE: 8 Side effects: 53% for unmodified 41% for modified (memory impairment, muscle pain, headache, confusion, prolonged seizure, cardiovascular, ECT induced mania/hypomania, bone fracture) Outcome: 82% moderate to marked improvement | Unmodified N= 179 (47%) Modified N= 205 (53%) Since 1996 all ECT performed under anesthesia. Until 1996 use of anesthesia judged according to age (<40 years) or medical condition. Device constant current brief pulse Siemens Placement: all BL (bitemporal) Frequency: 3 times week | |
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TPR: treated person rate = persons ECT treated per 10,000 resident population per year.
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EAR: ECT administration rate = no. of ECTs administered per 10,000 resident population.
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iP: inpatient prevalence = proportion (percent,%) ECT treated among inpatient population.
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AvE: average number of ECTs administered per patient (in a session or course).
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C-ECT: continuation-ECT.
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A-ECT: ambulatory-ECT.