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• W1488732394 abstract "Introduction Electroconvulsive therapy (ECT) is a controversial treatment. In 2003, a systematic review and meta-analysis of its efficacy and safety in depressive disorders was sponsored by the UK Department of Health and performed by the UK ECT Review Group. (1) A major finding of that review was that there was substantial evidence to support the short-term efficacy of ECT in depressive disorders, and that it was superior to antidepressant drug treatment. By contrast, other studies raised concerns about the cognitive side-effects of ECT. (2,3) Empirical stimulus dose titration was proposed as a means of reducing such side-effects. (4,5) In Hong Kong, the utilisation of ECT is low. One study reported the number of persons receiving ECT in Hong Kong in 1998 to be 0.34 per 10,000 of the population, (6) which was much lower than the rate in western countries. (7,8) Also, only in the recent few years has empirical titration been widely practised by Hong Kong psychiatrists. Because of limited ECT research on Chinese patients and the relative lack of local experience with empirical titration, western guidelines have been adopted for this purpose. In particular, recommendations in the ECT Handbook of the Royal College of Psychiatrists were most often referred to. (5) However, western guidelines are based on studies carried out on Caucasians and it is uncertain whether they can be generalised to Chinese patients. With a view to assessing the validity of such an assumption, we describe our early experience of ECT practice after starting empirical titration in 2006 in an acute psychiatric unit in Hong Kong. Methods This was a retrospective review of case notes of patients who had received ECT in the Pamela Youde Nethersole Eastern Hospital in Hong Kong from June 2006 to April 2009. This regional hospital undertakes a full range of specialty services. Its psychiatric unit serves a population of 0.8 million and admits both voluntary and sectioned patients. Empirical stimulus dose titration was first introduced in June 2006 and carried out using a standard protocol. A total of 34 patients received ECT during the 3-year study period. All relevant patient medical and ECT records were retrieved. Data collected included: demographic and clinical characteristics, consent for treatment, ECT parameters, documented side-effects, and clinical response. The ECT treatments were administered with MECTA spECTrum 5000Q (MECTA Corporation, Tualatin [OR], US). The device administered bidirectional, brief, square-wave pulses, using a constant-current stimulus (24-1152 millicoulombs [mC]). The empirical titration method was chosen, unless the patient had a life-threatening psychiatric illness (e.g. high suicidal risk or refusal to eat) necessitating a rapid clinical response, in which case preselected dosing was used. Preselected dosing was also used for patients who had previously responded well to such dosing, or were taking a beta-blocker or were at increased cardiac risk for other reasons. We adopted the protocol recommended by MECTA Corporation for both empirical titration and preselected dosing. (9) Empirical titration started with a stimulus of 48 mC. If this failed to produce a seizure of at least 15 seconds, re-stimulation was performed at the next level of 96 mC, followed by 192 mC; no more than 3 stimulations were undertaken per patient, per session. After the seizure threshold was determined, a stimulus of 50% above the seizure threshold was delivered at the next session. For preselected dosing, a stimulus of 144 mC was administered for females and 288 mC for males, in the belief it corresponded to 50% above the assumed seizure threshold. In patients taking anticonvulsants or benzodiazepines, the latter drugs might be withdrawn or reduced in dosage before starting ECT. Patients were given intravenous thiopentone for anaesthesia and intravenous suxamethonium as a muscle relaxant. All the patients were adequately ventilated with 100% oxygen before the administration of ECT stimulus. …" @default.
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• W1488732394 date "2009-12-01" @default.
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• W1488732394 title "Clinical and Treatment Characteristics of Chinese Patients Undergoing Electroconvulsive Therapy in an Acute Psychiatric Unit in Hong Kong" @default.
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