Electroconvulsive Therapy Training Research Articles

Interventional Psychiatry and Neurotechnologies: Education and Ethics Training.

The last two decades have seen dramatic growth in the application of procedurally based interventions for treating refractory psychiatric conditions, leading to interest in developing the foundations for the subspecialty of "Interventional Psychiatry." However, there is cause for concern that the rate of expansion of clinical advances in this field may be outpacing the ability of postgraduate curricula to provide sufficient exposure to and teaching and supervision of these treatments. The paucity of adequately trained practitioners in Interventional Psychiatry further exacerbates inequities in the ability of eligible patients to access and benefit from these approaches. This paper explores the rates of utilization of Interventional Psychiatry treatments, the current state of education in these treatments, and the role that training can play in translating scientific advances in this area to ensure equitable access and maximum impact at a population level. The majority of the discussion is centered on electroconvulsive therapy (ECT), the most established and available of these treatments, highlighting how enhancing education and training in ECT can reduce barriers to its utilization. It is argued that innovations in pedagogical approaches for disseminating the learning of these procedures are needed to increase the current low rates of competency in these treatments and can facilitate the more rapid dissemination of other Interventional Psychiatry approaches and neurotechnologies, such as repetitive transcranial magnetic stimulation, ketamine, deep brain stimulation, and focused ultrasound.

Stigmatization towards electro convulsive therapy: Impact of practical teaching on medical and nursing students

BackgroundThis study explored the impact of theoretical and practical teaching on electro convulsive therapy (ECT) on medical and nursing students’ stigmatizing attitudes towards ECT and representations of it. MethodFourth-year medical students and nursing students answered questions from the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) and from the Mental Illness: Clinicians’ Attitudes version 2 (MICA v2) scale. The questionnaires were completed before and after observing a 3-hour practical training session in the ECT unit. The endpoint was the impact of practical training as assessed by MICA and QuAKE scores. Multivariate analyses were used to explore the impact of practical training on MICA and QuAKE total scores. ResultsStigmatizing attitudes and representations of both medical and nursing students towards ECT were reduced after practical training (β=–4.43 [95% CI –6.15; –2.70] p=0.0001). The impact was greater in medical students (β=–8.03; 95% CI [–10.71; –5.43], P=0.0001) than in nursing students (β=–2.77; 95% CI [–4.98; to 0.44], P=0.02). Gender, psychiatric history in close persons, and having already followed a psychiatric/ECT course had no independent impact on stigmatizing attitudes towards ECT and representations of it. ConclusionPractical training in ECT should be given to all health professionals to improve access to it.

Examining the perceptions and practices of Romanian psychiatry residents regarding electroconvulsive therapy

Introduction. Electroconvulsive Therapy (ECT) stands as a controversial yet efficacious psychiatric intervention, attracting clinical interest and public debate. In Romania, where cultural, historical, and systemic factors influence medical practices, research on the perceptions of psychiatric residents regarding ECT is limited. Objective and methods. The primary objective of this study is to gain insights into the attitudes and practices of psychiatric residents regarding ECT in Romania. An online survey was conducted among Romanian trainees, collecting data on demographics, ECT exposure, safety and efficacy perceptions, training experiences, and the impact of stigma on clinical decisions. Results. The survey, encompassing responses from 49 Romanian psychiatric residents, revealed that nearly 70% of them were exposed to ECT procedures, with varying frequencies of attendance. While safety and efficacy perceptions were predominantly positive, with 75.5% considering ECT safe and 73.5% deeming it effective, significant training gaps were evident. Only 16.3% received specific ECT training, highlighting the need for more comprehensive education. Stigma had a mild to moderate impact on clinical decisions, emphasizing the importance of targeted educational efforts. Beliefs and preconceptions about ECT among patients and colleagues underscored the necessity for thorough patient education. Despite these challenges, an overwhelming majority (89.8%) expressed a favorable inclination towards expanding ECT use, signifying a potential shift towards greater acceptance within the young psychiatric community. Conclusion. This study provides valuable insights into the perspectives and practices of psychiatric residents regarding ECT in Romania. Enhancing ECT training and addressing stigma is essential to ensure its safe and effective use in psychiatric practice. Healthcare institutions and policymakers should prioritize these efforts to promote evidence-based psychiatric treatment decisions.

L’électroconvulsivothérapie en période périnatale : représentations des professionnels de santé mentale

IntroductionPsychiatric disorders are common in peripartum and are associated with adverse outcomes for mother and fetus. Electroconvulsive therapy (ECT) is one of the most effective and safe options to treat severe mental illness, including during the perinatal period. Nevertheless, it remains underutilized during this period, possibly due to negative representations. Research has been carried out on the representations and attitudes of caregivers towards ECT, but the specificities of these attitudes during peripartum have not been explored. ObjectivesWe aimed to assess the attitudes towards ECT during the peripartum among psychiatrists, nurses, social workers and psychologists. The primary objective was to compare the score of favorability for ECT during peripartum according to the profession. The secondary objective was to highlight other factors involved in the favorability for ECT in peripartum. MethodsWe investigated mental health professionals’ attitudes sending by e-mail an anonymous questionnaire in five hospitals in France. The questionnaire was composed of demographic details, one scale about the attitudes towards ECT (the Questionnaire on Attitudes and Knowledge of ECT (QuAKE)) used in several studies; in this questionnaire, a specific part for perinatal period has been added for our study, both using a Likert scale. The completion time for this online questionnaire was approximately 5 to 7minutes. A score of favorability for ECT in general and in peripartum was established for each participant. These scores represented the percentage of positive responses to favorable items and of negative responses to unfavorable items towards ECT. Comparison of the QuAKE answers with a sample of English caregivers in 2001 has been determined with χ2 tests. A Bonferroni correction was applied due to the large number of tests performed. Factors involved in the favorability for ECT have been studied with Pearson correlation, Kruskall-Wallis and Wilcoxon tests. ResultsTwo hundred and twenty one professionals (80 psychiatrists, 78 nurses, 19 social workers and 44 psychologists) were included in the study. Their answers to the QuAKE questionnaire were comparable or more favorable to ECT than the English sample answered in 2001. The perinatal part of questionnaire had a good internal consistency (Cronbach coefficient: 0,91). Participants were less favorable to ECT in perinatal period (favorability score: 44.2) than in general (63.6). They more often responded « uncertain » to the perinatal questionnaire (44,9 % against 18.4 % for the ECT in general; W=19931,5; P<0,001). The favorability for ECT in general and during peripartum were statistically associated with profession (psychiatrists were more favorable), specific training and experience in ECT. Gender, perinatal specialization, age, and the number of years in professional service were not associated with favorability for ECT in general and during peripartum in this study. ConclusionsIn this study, we have found that profession, training and experience in ECT are linked to the attitudes towards ECT, including in the perinatal period. It is necessary to inform professionals about the possibility of prescribing ECT in the perinatal period by training them in the specificities of pregnancy.

Research into psychiatry trainees views around the impact COVID-19 has had on the provision of electroconvulsive therapy training

AimsThe current COVID-19 outbreak has changed the way electroconvulsive therapy (ECT) is provided. In many areas it has been moved from the more traditional ECT suites to general surgical theatres for a number of reasons, most notably being the need to ensure adequate ventilation. The introduction of the need for PPE to be worn throughout ECT and for general hospital operating procedures to be adhered to has also been a big change. The change in the required infection control procedures has had an impact on treatment capacity and has led many areas to reduce, relocate or centralise their ECT provisions which has had a knock on effect on training.This study assesses the perceived impact COVID-19 has had on the provision of training and learning in ECT for core and higher psychiatry trainees in the North West as well as their perceived competence levels.MethodViews were sought through surveys and focus groups from September to December 2020, participants were core and higher psychiatry trainees in the North West. Participants were recruited via email, the total population size was 87, 21 Core trainees responded and 14 higher trainees. From the survey respondents, 5 participants agreed to attend a focus group.ResultResults show that the provision of ECT training has been poor during the COVID-19 outbreak. Almost 81% of core trainees surveyed and 92.86% of higher trainees had participated in no ECT sessions from the start of the COVID-19 outbreak to the time of data collection eight to ten months later.81% of core trainees and 85.71% of higher trainees had received no teaching in any form about ECT over the period studied.When considering the competencies required in ECT for a core trainee, one (4.76%) felt they were fully competent, 3 (14.29%) nearly competent, 7(33.33%) needs some improvement, 10 (47.62%) not yet competent. Only one higher trainee felt they met the RCPsych competencies, 5 (35.71%) were nearly competent, 6 (42.86%) need some improvement and 2 (14.29%) were not yet competent.ConclusionThis study indicates a clear lack of provision of training which is very concerning ,and possibly pre dates the COVID outbreak, particularly in the case of specialty trainees who may well be consultants in a number of months and will not have the time to make up for the lost training. In order for ECT provision to continue it is crucial that we are able to adequately train the future workforce.

Safety and Fidelity in Electroconvulsive Therapy (SAFE ECT): A Novel Virtual Reality-Based Training Program in Electroconvulsive Therapy (Phase 1).

Safety and Fidelity in Electroconvulsive Therapy (SAFE ECT): A Novel Virtual Reality-Based Training Program in Electroconvulsive Therapy (Phase 1).

Survey of Core Trainees' Confidence in Electroconvulsive Therapy.

The objective of the survey was to assess confidence in electroconvulsive therapy (ECT) in core psychiatry trainees across Scotland, looking at both theoretical and practical aspects of ECT. A link to a 14-item electronic questionnaire was distributed to core trainees via deanery administrators. Most questions were based on the Royal College of Psychiatry's ECT guidelines. A total of 85 responses were analyzed from trainees at all 3 levels of core training and from all health boards across Scotland. Almost 90% of trainees felt that their ECT training was sufficient, with more senior trainees rating their training better than those in the first year of training. Trainees who had theoretical teaching before their practical sessions rated their training better than those with purely observational training. Most trainees felt confident delivering ECT under supervision, and nearly 75% of trainees felt confident preparing a patient for ECT. The areas in which trainees felt least confident were in practical aspects such as dosing protocols and electroencephalogram interpretation. While ECT training and trainee confidence in delivering ECT were generally good, there are variations in trainees' experience that could be addressed by having a standardized ECT training, including theoretical teaching and practical competencies, in line with current guidelines. Ideally, evidence of meeting the Royal College recommendations for ECT competencies could be made a compulsory aspect of core training in the United Kingdom.

Pattern of electroconvulsive therapy use in Spain: Proposals for an optimal practice and equitable access

ObjectivesThe main aims of our study were to estimate the current rates and pattern of electroconvulsive therapy (ECT) use in Spain, as well as exploring the causes that may be limiting its use in our country. MethodsA cross-sectional survey was conducted covering every psychiatric unit in Spain as of 31 December 2012. ResultsMore than half (54.9%) of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. There are wide variations with regard to ECT application rates between the different autonomous communities (0.00–1.39) and provinces (0.00–3.90). ECT was prescribed to a mean of 25.5 patients per hospital that used the technique and 4.5 in referral centre (P=.000), but wide differences were reported in the number of patients who were prescribed ECT from hospital to hospital. ConclusionsAlthough the percentage of psychiatric units applying ECT in our country is among the highest in the world, the ECT application rate in Spain is among the lowest within western countries. Large differences in ECT use have been reported across the various autonomous communities, provinces and hospitals. Thus, health planning strategies need to be implemented, as well as promoting training in ECT among health professionals, if these differences in ECT use are to be reduced.

Electroconvulsive Therapy Practice in Spain: A National Survey.

The use of electroconvulsive therapy (ECT) in Spain has not been systematically evaluated since 2000 to 2001. The aim of this study is to assess the current use of ECT in Spain. A cross-sectional survey was conducted covering every psychiatric unit in Spain as of December 31, 2012. About 93.2% of the centers answered the questionnaire. About 54.9% of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. Wide variations existed among the different autonomous communities and provinces. Written informed consent was obtained in all the facilities. About 38.2% of ECT-treated patients were 65 years or older. About 55.7% were women. Depressive episodes were the main indication for ECT (80.2%). All the facilities applied modified ECT. No sine wave current devices are currently used in Spain. Bifrontotemporal ECT was elective in 85% of the hospitals, bifrontal in 13.3%, and unilateral in 1.8%. Stimulus titration methods were elective in 8.6% of the centers. The decision to end ECT relied on the psychiatrist's clinical impression in 89.4% of the centers and on rating scales in 10.6%. The ECT training was mandatory in 56.5% of the centers. The ECT practice has significantly improved in Spain in recent years. Overall, Spanish facilities seem to comply with established clinical guidelines; however, specific concerns were identified, meaning there is still further scope for improvement.

Pattern of electroconvulsive therapy use in Spain: Proposals for an optimal practice and equitable access.

The main aims of our study were to estimate the current rates and pattern of electroconvulsive therapy (ECT) use in Spain, as well as exploring the causes that may be limiting its use in our country. A cross-sectional survey was conducted covering every psychiatric unit in Spain as of 31 December 2012. More than half (54.9%) of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. There are wide variations with regard to ECT application rates between the different autonomous communities (0.00-1.39) and provinces (0.00-3.90). ECT was prescribed to a mean of 25.5 patients per hospital that used the technique and 4.5 in referral centre (P=.000), but wide differences were reported in the number of patients who were prescribed ECT from hospital to hospital. Although the percentage of psychiatric units applying ECT in our country is among the highest in the world, the ECT application rate in Spain is among the lowest within western countries. Large differences in ECT use have been reported across the various autonomous communities, provinces and hospitals. Thus, health planning strategies need to be implemented, as well as promoting training in ECT among health professionals, if these differences in ECT use are to be reduced.

Electroconvulsive Therapy Teaching in Canada

The objective of this study was to present survey data on the teaching of electroconvulsive therapy (ECT) in health care centers across Canada. Of 1273 centers identified, 175 were found to practice ECT. These centers were asked to complete a questionnaire, and 107 (61%) of them answered 5 questions dealing specifically with ECT teaching. These questions were as follows: (1) Does your facility have an ECT teaching program for residents in psychiatry? (2) How is ECT taught to residents in psychiatry? (3) If direct supervision of the administration of ECT is a requirement of the psychiatry training program, is there a minimum number of supervised treatments or minimum duration of training period? (4) Do residents provide unsupervised ECT at your center? (5) Which other groups of learners, if any, are provided with orientation, teaching, or training in ECT? Sixty percent of respondents had no ECT teaching program for psychiatry residents. Pedagogical methods varied, ranging from direct observation of ECT treatments to directed readings. Few centers required a minimum number of supervised treatments. No resident-administered ECT is performed without direct supervision. Interestingly, various groups of health care professionals were often invited to participate in ECT training. The situation regarding ECT teaching continues to be a cause for concern given the noted absence of organized, structured, and mandatory programs. No resident administering ECT, however, goes unsupervised, which is in keeping with good practice. Electroconvulsive therapy is taught in many different ways, and teaching is accessible to different groups of health care professionals. However, much remains to be done to standardize ECT teaching to render this therapy available to all those who need it and to overcome the stigma and bias associated with it.

Knowledge of and Attitudes Toward Electroconvulsive Therapy Among Medical Students, Psychology Students, and the General Public

Electroconvulsive therapy (ECT) is safe and effective for the treatment of various psychiatric disorders. Despite being a well-known treatment method among health care professionals, lay people generally have a negative opinion of ECT. The present study aimed to examine knowledge of and attitudes toward ECT among medical students, psychology students, and the general public. Psychology students were included because they are among the important groups in mental health care in Turkey. A Likert-type questionnaire was administered to fifth-year medical students (n = 28), master of science and doctor of philosophy clinical psychology students (n = 35), and a sample of the general public (n = 26). The questionnaire included questions about the general principles of and indications for ECT, and sources of knowledge of and attitudes toward ECT. The medical students were the most knowledgeable about ECT, as expected. The medical students also had a more positive attitude toward ECT than the other 2 groups. More psychology students had negative attitudes on some aspects than general public sample, despite being more knowledgeable. Medical school theoretical and practical training in ECT played an important role in increasing the level of knowledge of and decreasing the prevalence of negative attitudes toward ECT among the medical students; similar training for psychology students is required to achieve similar results.

Electroconvulsive therapy training: can it be a model of an entrustable professional activity in a competency program?

This paper gives an overview of the teaching and assessment process in electroconvulsive therapy (ECT) provided in the Hunter Region to see if it can be used as a successful example of competency assessment and training. We describe the process and practice of training and credentialing in ECT in the Hunter Region, and compare these with the requirements of an Entrustable Professional Activity (EPA) in particular and competency based training and assessment in general. The intensely supervised 'hands on' training and assessment in this program, and the entrusting of successful graduates to perform ECT and related activities with sufficient independence, demonstrate an 'Entrustable Professional Activity' as proposed for introduction in the Royal Australian and New Zealand College of Psychiatrists Competency Based Fellowship Program.

Electroconvulsive Therapy Training and Confidence in Administration

: As the lack of on-site electroconvulsive therapy (ECT) facilities in many psychiatric hospitals in Ireland may impact negatively on ECT training, we conducted a national survey of trainees with the aims of establishing the current standard of ECT training and to assess trainees' confidence in their abilities in ECT administration. : A national postal survey of 415 trainees was conducted in September 2008 using a self-designed 15-item questionnaire for the purpose of the study, containing no identification data and incorporating relevant questionnaire items from similar published trainee survey. Reminders were distributed to the entire study sample 4 weeks afterward within a sampling time frame of 3 months. Trainee responses were coded and converted to anonymized data, which the lead author held. : The overall response rate was 61%. Ninety-one percent of trainees had worked in ECT centers, of which 36% had given ECT on an occasion without direct consultant supervision. Overall, 12% of trainees had never administered or observed ECT, which includes 2 trainees on the national senior registrar scheme, and 19% of trainees had nil or minimal confidence in their ability to administer ECT. : Our findings indicate deficiencies in training and supervision, which is reflected in the proportion of trainees reporting nil or minimal confidence in their ability to administer ECT. Greater collaboration between training scheme coordinators, clinical tutors, and the College of Psychiatry of Ireland is essential to ensure ongoing monitoring and implementation of standards.

Resident Education in Electroconvulsive Therapy

In 2001, the American Psychiatric Association's Task Force on electroconvulsive therapy (ECT) recommended that psychiatry residents should receive at least 4 hours of didactic instruction on ECT, participate in at least 10 treatments, and assist in the care of at least 3 patients receiving ECT. Residency accreditation requirements as of 2007, however, require only that training programs ensure competency in "understanding the indications and uses" of ECT. Anecdotally, training in ECT is said to vary widely between residency programs. The purpose of the study was to obtain more systematic information about ECT training. A survey was e-mailed to directors of all accredited psychiatry residency programs in the United States and Puerto Rico in early to mid 2008, requesting information regarding their didactic and clinical instruction in ECT and estimates of number of treatments provided by their institutions. Responses were obtained from 91 training programs. Of these programs, 75% reported that some clinical exposure to ECT was required of their residents, but 37% estimated that the typical resident would participate in fewer than 10 treatments and 27% estimated that the typical resident would care for fewer than 5 patients receiving ECT. Most programs devoted less than 4 hours of lecture time to ECT. Most respondents believed that ECT was underused nationally; this perception did not differ based on the theoretical orientation of the training program. This study suggests that resident education in ECT varies considerably between programs but is often less than that suggested by the American Psychiatric Association's Task Force.

A Survey of the Practice of Electroconvulsive Therapy in Asia

To describe a comprehensive survey of the practice of electroconvulsive therapy (ECT) in Asia. Between 2001 and 2003, a 29-item questionnaire was sent to 977 psychiatric facilities in 45 Asian countries. 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. 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.

Third-Year Medical Students' Understanding, Knowledge, and Attitudes Toward the Use of Electroconvulsive Therapy

The purpose of this study was to examine the impact of the third-year psychiatric clerkship at the University of Texas on medical students' perception about and attitudes toward electroconvulsive therapy (ECT) and to determine whether direct observation of the procedure by students impacts their attitudes differently than attendance of lectures only. All third-year medical students were asked to complete a survey regarding their opinions about ECT before and after their third-year psychiatry rotation, and they were asked whether they received the required didactic ECT training alone or also received adjunctive observation training. The opinions of students in both groups (observed plus didactic vs didactic only) improved significantly from prerotation to postrotation. However, the opinions of those who observed ECT improved more than those who did not. The groups differed on only 1 item before the rotation. Students in the observed plus didactic group had a more positive response to the items after rotation than did their peers. Given the effectiveness of ECT, it would be beneficial for all students to have exposure to observed ECT during their psychiatric rotation. This study should be replicated in other medical school settings. Future directions will focus on replicating the study but ensuring that students do not self-select into the observation group.

P02-80 A survey of the practice of electroconvulsive therapy in Asia

Background: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. ECT was available in 257 institutions in 23 countries. During the year before the survey, 39,875 patients (62% male) received a mean of 7.1 ECT treatments. Most patients (73.1%) were 18-44 years old; few were &lt; 18 (6.0%) or &gt;64 (4.4%) years old. 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 103 (40.1%) institutions. Routine EEG 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 appear suboptimal: schizophrenia, not depression, is the commonest indication; most institutions offer sine-wave ECT; unmodified ECT is commonly administered; bilateral electrode placement is invariable in most institutions; EEG 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.

Survey of referrals to electroconvulsive therapy in Hungary

Background. The diagnostic distribution of patients treated with electroconvulsive therapy (ECT) in Hungary is significantly different from that in Western Europe or the USA. In Hungary most of the treated patients are diagnosed with schizophrenia. Aim. To analyze the practice of referring patients for ECT in Hungary. Methods. Questionnaires containing socio-demographic data were mailed to all Hungarian psychiatric units where ECT was used (n=34), and all of the psychiatrists working there were invited to participate. Respondents were asked to rate how often they considered ECT for various symptoms/syndromes on a five-point Likert Scale. Results. A total of 78 questionnaires were returned. Altogether, 89% of the respondents have referred patients to ECT, and 54.8% had done so in the last year. The respondents had most frequently recommended ECT for antipsychotic and antidepressant-resistant patients, catatonic symptoms, or patients with previous good treatment response to ECT. Conclusion. Considering the very high Hungarian suicide rate, the low referral rate in cases of severe suicidal intent and threat is surprising. The respondents also rarely considered ECT for NMS or severe depression. The discrepancy between current referral practices and standard recommendations could be decreased with more ECT training courses.

Practice of electroconvulsive therapy at the research and training hospital in Turkey

We sought to obtain an overview of electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, which is the biggest hospital for psychiatry in Turkey. From 1st January 2006 to 30th June 2007, a form enquiring about evaluation of ECT was filled retrospectively. The total number of patients, admitted for psychiatry during the survey period was 265,283. A total of 1,531 patients (12.4% among inpatients and 0.58% in all psychiatric admissions) received 13,618 sessions (including multiple hospitalizations) of ECT from 12,341 psychiatric inpatients during the survey period. Ninety-eight patients had multiple hospitalizations. The male-to-female ratio was 1.26-1. Patients with bipolar affective disorder, current episode manic with or without psychotic symptoms received ECT most frequently (30.3%), followed by patients with schizophrenia (29.5%), severe depressive episode with or without psychotic symptoms (include bipolar affective disorder current episode severe depression) (15.2%), other non-organic psychotic disorders (14.4%), schizoaffective disorders (6.3%), mental and behavioral disorders due to psychoactive substance abuse with psychotic disorders (3.5%) and catatonic schizophrenia (0.7%). Patients who received ECT were in age group of 25-44 years (64.7%), followed by 45-64 years (17.7%), 18-24 years (15.4%), 65 years and older (1.4%), and younger than 18 years (0.8%). All patients received modified ECT. There were no ECT-related deaths during the survey. The rate of ECT among all psychiatric inpatients during the survey period was 12.4%. The majority of patients who received ECT were diagnosed with bipolar affective disorder-current episode manic and schizophrenia. ECT training programs for psychiatry residents and specialists should be planned, and conducted systematically.