Epidemiological analysis of electroconvulsive therapy in Victoria, Australia

Objective: To determine the population-based utilization rate of electroconvulsive therapy (ECT) in Victoria between 1998-1999, to examine the characteristics of the ECT treated group, and to identify patient factors independently associated with differential rates of ECT treatment. Method: Electroconvulsive therapy is reported under statute in Victoria, Australia. Crude, age-adjusted and age-sex specific utilization rates were calculated using this statutory data for the 1998-1999 financial year and estimated mid-year populations from the Australian Bureau of Statistics. Descriptive characteristics of those treated with ECT were derived from the statutory data. Patient factors associated with an increased likelihood of ECT in the public sector were explored with logistic regression analysis, using non-ECT treated mental health patients from the Victorian Psychiatric Case Register as the reference population. Results: The crude treated-person and age-adjusted rates for the State (both public and private sectors) were 39.9 and 44.0 persons per 100 000 resident population per annum, respectively. The crude and age-adjusted administration rates were 330.3 and 362.6 ECT administrations per 100 000 resident population per annum, respectively. Age-sex specific rates varied by age and sex, with rates generally increasing with age and female sex. Overall, 62.8% of the treated group were women, 32.9% aged over 64, and 75.2% had depression. Diagnosis, age and sex each independently predicted ECT in the public sector, with diagnosis the most important factor, followed by age then sex. Conclusions: Despite decades of use, the appropriate rate of ECT utilization is still unclear. Further research should be directed at exploring the factors, including provider variables, determining ECT treatment.

A naturalistic comparison of two right unilateral electroconvulsive therapy dosing protocols: 2-3X seizure threshold versus fixed high-dose

The aim of this study was to compare the outcomes associated with two differing right unilateral (RUL) electroconvulsive therapy (ECT) dosing protocols: 2-3X seizure threshold (2-3X ST) and fixed high dose (FHD) at 353 mC. A retrospective chart review was performed to compare patient outcomes during the implementation of two different dosing protocols: 2-3X ST from October 2000 to May 2001 and FHD from June 2001 to February 2002. A total of 56 patients received ECT under the 2-3X ST protocol, and 46 received ECT under the FHD protocol. In total, 13.6% of patients receiving ECT according to the 2-3X ST protocol received more than 12 ECT, whereas none of the FHD group received more than 12 ECT. The mean number of ECT per treatment course reduced significantly from 7.6 to 5.7 following the switch from the 2-3X ST protocol to the FHD protocol. There were no significant differences between the two groups in the incidence of adverse cognitive effects. ECT practitioners adhered to the 2-3X ST protocol for only 51.8% of ECT courses, with protocol adherence improving to 87% following introduction of the FHD protocol. Although this naturalistic retrospective chart survey had significant methodological limitations, it found that practitioners are more likely to correctly adhere to a fixed dose protocol, therefore, increasing its 'real world' effectiveness in comparison to titrated suprathreshold dosing techniques. The FHD protocol was associated with shorter courses of ECT than the 2-3X ST protocol, with no significant difference between the two protocols in clinically discernable adverse cognitive effects.