A Survey of the Practice of Electroconvulsive Therapy in Asia
A Survey of the Practice of Electroconvulsive Therapy in Asia
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DOI：
10.1097/yct.0b013e3181a74368
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发表时间：
2010-03-01
期刊：
影响因子：
2.5
通讯作者：
Andrade, Chittaranjan
中科院分区：
文献类型：
--
作者：
Chanpattana, Worrawat;Kramer, Barry Alan;Andrade, Chittaranjan
目的：对亚洲地区电休克治疗（ECT）的实践进行全面调查。方法：在2001年至2003年间，向45个亚洲国家的977家精神病院发送了一份29项问卷。结果：29个国家（64.4%）的334个机构（34.2%）完成了问卷调查。23个国家的257个机构提供电休克治疗。在调查前一年，39,875名患者（62%为男性）平均接受7.1次ECT治疗。大多数患者（73.1%）年龄在18 ~ 44岁；年龄小于18岁（6.0%）或大于64岁（4.4%）者极少。ECT的适应症为精神分裂症（41.8%）、重度抑郁症（32.4%）、躁狂症（14.0%）、紧张症（6.9%）、药物滥用（1.8%）、心境恶劣（1.6%）等。197个机构中只有115个（58.4%）使用了短脉冲电痉挛装置。仅有59家（23.0%）机构进行常规脑电图监测。202所（78.6%）机构双侧电极放置不变。14个国家141家机构（54.9%）的22194例（55.7%）患者接受了未经修改的ECT治疗。17个国家的115家机构（44.7%）提供继续ECT。没有任何机构有正式的电痉挛疗法培训项目。结论：ECT在亚洲的应用似乎不太理想：最常见的适应症是精神分裂症，而不是抑郁症；大多数机构提供正弦波ECT；通常采用未经修改的电痉挛疗法；在大多数机构中，双侧电极放置是不变的；脑电图监测不常见；继续电痉挛治疗少见；也没有正规的电痉挛治疗培训。我们推测，次优实践反映了发展中国家医疗保健标准的感觉需求和基本现实，而不是滥用电痉挛疗法。
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.