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Modified and Unmodified Electroconvulsive Therapy: A Comparison of Attitudes Between Psychiatrists in Beijing and Hong Kong

Leung, Chi-Ming MD, MRCPsych*; Xiang, Yu-Tao MD, PhD*†; He, Jia-Li MD; Xu, Hui-Li MD, MSc; Ma, Liang MD; Fok, Marcella LY MBChB§; Ungvari, Gabor S. MD, PhD, FRCPsych*

doi: 10.1097/YCT.0b013e31817b8135
Original Studies

Objective: Unmodified electroconvulsive therapy (ECT) is still widely practiced in many psychiatric institutions in China. The study reported herein aimed to explore the attitudes of psychiatrists in Beijing toward unmodified and modified ECT and compare them with those of psychiatrists in Hong Kong, where only modified ECT has been used during the past 40 years.

Method: One hundred five psychiatrists of a university-affiliated psychiatric hospital in Beijing and all psychiatrists (n = 238) currently practicing in Hong Kong were invited to complete a questionnaire exploring their attitudes toward unmodified and modified ECT.

Results: The Beijing respondents had significantly more experience with unmodified ECT than their Hong Kong counterparts. Although 56% of the Beijing respondents preferred modified to unmodified treatment, 81% of them regarded unmodified ECT as safe and associated with minimal morbidity and mortality. Patient choice, financial status, and safety considerations were the main factors that dictated the choice of mode of ECT in Beijing.

Conclusions: It seems that unmodified ECT still has a role as an effective psychiatric treatment in developing countries such as China. Any initiative to replace unmodified with modified treatment should take into account economic conditions, the sociocultural context, and the psychiatric traditions of the particular regions of the country.

From the *Department of Psychiatry, Chinese University of Hong Kong, Shatin, N.T., Hong Kong; †Beijing Anding Hospital, Capital Medical University; ‡Chaoyang Mental Health Care Institute, Beijing, China; and §Institute of Psychiatry, London, United Kingdom.

Received for publication January 2, 2008; accepted April 1, 2008.

Reprints: Yu-Tao Xiang, MD, PhD, Department of Psychiatry, Shatin Hospital, Shatin, Hong Kong, China (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.