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A Survey of the Practice of Electroconvulsive Therapy in Asia

Chanpattana, Worrawat MD*; Kramer, Barry Alan MD; Kunigiri, Girish MD; Gangadhar, B.N. MD§; Kitphati, Rungrueng MD; Andrade, Chittaranjan MD

doi: 10.1097/YCT.0b013e3181a74368
Original Study

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

Method: 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.

From the *Department of Psychiatry, Samitivej Srinakarin Hospital, Bangkok, Thailand; †Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles, CA; ‡Bradgate Mental Health Unit, Glenfield Hospital, Leicester, UK; §Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; ∥Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand; and ¶Department of Pharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.

Received for publication December 10, 2008; accepted January 17, 2009.

Reprints: Worrawat Chanpattana, MD, Department of Psychiatry, Samitivej Srinakarin Hospital, 488 Srinakarin Rd, Suanluang, Bangkok 10250, Thailand (e-mail:

Dr W. Chanpattana conducted this survey while he was working at the Department of Psychiatry, Srinakharinwirot University, Bangkok, Thailand.

Presented at the 2007 Annual Meeting of the Association for Convulsive Therapy, May 20, 2007, San Diego, Calif.

Partially supported by grant SWU 1112544 from the Srinakharinwirot University and grant BRG 3980009 from the Thailand Research Fund, Office of the Prime Minister, Bangkok, Thailand.

© 2010 Lippincott Williams & Wilkins, Inc.