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The Practice of Electroconvulsive Therapy in Greece

Kaliora, Styliani C. MD; Braga, Raphael J. MD; Petrides, Georgios MD; Chatzimanolis, John MD; Papadimitriou, George N. MD; Zervas, Iannis M. MD

doi: 10.1097/YCT.0b013e31827e0d49
Original Studies

Objective To describe the practice of electroconvulsive therapy (ECT) in Greece.

Methods A survey was conducted during the academic year 2008–2009. Electroconvulsive therapy use was investigated for 2007. All civilian institutions providing inpatient care were included. Centers that provided ECT completed a 57-item questionnaire. Centers that did not offer ECT completed a 13-item questionnaire.

Results Fifty-five (82.1%) of 67 institutions responded. Electroconvulsive therapy was offered in 18 hospitals. Only 2 of 10 university hospitals offered ECT. Overall, 137 patients were treated with 1271 sessions in 2007. Only 1.47% discontinued treatment owing to adverse events. There were no deaths. Schizophrenia was the most common diagnosis (41.3%) among those receiving ECT, followed by major depression (28.9%), bipolar depression (9.1%), catatonia (4.1%), suicidal ideation (3.3%), and schizoaffective disorder (2.5%). Physicians considered major depression (93.8%), catatonia (86.5%), schizophrenia (56.3%), and mania (50%) the most appropriate indications. Written informed consent was required in 77.8% of the institutions, whereas the rest required verbal consent. Bilateral ECT was the preferred electrode placement (88.9%). Modified ECT was used exclusively. Propofol was the preferred anesthetic (44.4%), followed by thiopental (38.9%). Seven (38.9%) of 18 hospitals used a fixed stimulus dose at first treatment. Five (27.8%) of 18 hospitals used the half-age method. Continuation/maintenance ECT was used in 33.3% of the hospitals. Outpatient ECT was seldom used. Lack of training, difficult access to anesthesiology, billing issues, and stigma were cited as the main impediments to the practice of ECT.

Conclusions Electroconvulsive therapy is practiced in moderate numbers in Greece and almost exclusively on an inpatient basis. Lack of training and lack of availability of anesthesiologists were cited as the most common obstacles to providing ECT.

From the *First Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece and †The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, NY.

Received for publication May 18, 2012; accepted November 14, 2012.

Reprints: Styliani C Kaliora, MD, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, New York, NY 11004 (e-mail:

No external sources of support.

The authors have no conflicts of interest or financial disclosures to report.

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