Changes in the Practice of Electroconvulsive Therapy in Poland: A Nationwide Survey Comparing Data Between 2005 and 2020

Abstract

Background The use and the characteristics of the practice of electroconvulsive therapy (ECT) in Poland have not been evaluated since 2005, when a nationwide survey revealed its rare utilization (0.11 patients/10,000 inhabitants/year). The aims of this study were to determine the current use of ECT and to compare the findings with those of the previous survey. Methods Two questionnaires were sent to all 48 inpatient psychiatric centers in Poland. The first one - to units providing ECT to explore its practice, and the second - to units not performing ECT to explore the reasons for not using this treatment. Results Nineteen (39.6%) of all psychiatric inpatient centers confirmed the use of ECT. The utilization rate was 0.13 patients/10,000 inhabitants. Similar to the findings from 2005, the main indications were affective disorders, and bitemporal electrode placement was the dominant method used for the delivery of ECT. Age-based and titration-based methods were applied exclusively in 50% and 25% of the centers, respectively (compared with 15% and 35% in 2005, respectively), while both methods were used in the remaining 25%. Improvements in safety were reflected by the use of comprehensive pre-ECT evaluation and treatment monitoring. None of the centers used sine-wave devices; this contrasts with their use by 29% of the centers in 2005. The main reasons for not using ECT were insufficient funding and a lack of experienced staff. Conclusion The frequency of ECT use in Poland remains very low. In view of the improvement in the quality of health services in the past decade, such a markedly rare use of an effective treatment was unexpected. There is an urgent need of education to create more positive attitude towards ECT among health professionals and among public, and to increase the training of mental health professionals in ECT.

Knowledge, attitudes and beliefs about electroconvulsive therapy among Polish students

“…This may be due to both insufficient education in this area and an unjustified reluctance to this method of treatment. This thesis is supported by the low utilization rate of use of electroconvulsive therapy [10]. Changing the approach to ECT in the public may prove to be an impossible task if it does not have the strong support of mental health professionals that medical students may soon become.…”

“…W świetle obecnych dowodów naukowych terapia elektrowstrząsowa nie powoduje trwałego organicznego uszkodzenia mózgu, a niektóre badania wskazują, że jest bardziej bezpieczna i skuteczna niż farmakoterapia [8,9,3]. Mimo to, wykorzystanie EW pozostaje na niskim poziomie, a wskazania do jej stosowania są stale ograniczane [10,11]. Towarzyszy temu negatywne postrzeganie oraz niski poziom wiedzy na temat tej terapii w społeczeństwie [12,13].…”

“…Przyczyniać się może do tego zarówno niewystarczającą edukacja w tym zakresie, jak i nieuzasadniona niechęć do tej metody leczenia. Potwierdzeniem tej tezy jest niski wskaźnik wykorzystania terapii elektrowstrząsowej [10]. Zmiana podejścia do EW w opinii publicznej może okazać się zadaniem niewykonalnym, jeśli nie będzie miała mocnego poparcia w profesjonalistach zdrowia psychicznego, którymi już za niedługo mogą zostać studenci medycyny.…”

“…In the light of current scientific evidence, electroconvulsive therapy does not cause permanent organic brain damage, and some studies indicate that it is safer and more effective than pharmacotherapy [8,9,3]. Nevertheless, the use of ECT remains low, and the indications for its use are constantly limited [10,11]. It is accompanied by negative perceptions and a low level of knowledge about this therapy in the society [12,13].…”

Can electrical interventions be helpful in treating mood disorders in patients diagnosed with personality disorders? Case report and literature review.

“…Despite this, as indicated by the 2021 studies, their use in Poland is quite rare and significantly lower compared to Western European countries. This highlights the significant impact of financial constraints in healthcare in Poland and the perception of ECT as an invasive treatment method [1].…”