ECT practices in Iraq: a national audit

Abstract

Aims and methodThis national audit examined practice of electroconvulsive therapy (ECT) in Iraq against local standards. Data were collected by a questionnaire sent to heads of departments or medical directors in the 10 Iraqi hospitals which provide ECT and by examining case notes of all patients who had ECT in the first 6 months of 2013.ResultsOf the 26 psychiatric hospitals in Iraq, 10 provide ECT. There were some resource shortcomings in the ECT clinics (e.g. only 2 had a minimum of 2 rooms and all had no EEG monitoring). During the audit period, 251 patients had ECT. The mean age was 36.2 years and 51.8% were males. Bilateral ECT was used in all cases, general anaesthesia in 77.15%. The main indication for ECT was schizophrenia, followed by severe depression, resistant mania, catatonia and others.Clinical implicationsMore work is needed to ensure all patients receive modified ECT. ECT is still used widely for schizophrenia. This needs further exploration and training.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy

“…Our data showed almost equal gender distribution in patients treated with ECT; this differs from ndings in other European countries, where more female patients receive ECT [13,14]. The majority of our patients were middle aged (mean age 56), slightly younger than mean of 60 years old found in similar studies in other Western countries [15] and older than patients who received ECT in Asia and in the Middle East [16,17]. Chanpattana et al [16] proposed that this age difference in Asian ECT practice could be due to a demographic factor, and that the main indication for ECT in Asian studies is schizophrenia with more prevalence in young people.…”

Demographic and Clinical Profile of Patients Receiving Electroconvulsive Therapy at a Tertiary Care Hospital in Oman: A Cluster Analysis

“…Our finding is opposite to what was found in other studies done in the region, like Iraq and Iran, with similar studies tended to be younger men with schizophrenia. 16 , 22 In this study, most of the patients in cluster two who had ECT had a primary diagnosis of schizophrenia and schizophrenia affective disorder (91.8%). In addition, > 75% who underwent ECT were treatment-resistant to medications.…”

“…This finding is similar to a study conducted in Iran and Iraq, where the main indication for ECT was the resistant treatment of schizophrenia. 16 The average number of ECT sessions received for patients in cluster two was 10.3±3.5, significantly higher than patients in cluster one. However, our finding is similar to studies by Gonzalez-Pinto et al, 23 and Krossler et al, 24 who found that the number of ECTs given per patient was 9.7±3.7 and 11.0±3.1, respectively.…”

“…18 Another study on the ECT practices in Iraq reported that the main indication for ECT was schizophrenia (51%), followed by severe depression (31.5%), resistant mania (10.4%), catatonia (2.4%), and others (4.4%). 16 According to a study done in Thailand, patients with schizophrenia most frequently received ECT (74%), followed by mania (8%) and major depression (7%). 15 The authors suggested that this difference in age group trends could be caused by the demographics of the Asian population and the fact that schizophrenia (with higher prevalence in younger patients) is the main indication for ECT in Asian patients.…”

“… 14 It also noted that in western countries, the main indication for ECT was depression (78% in Sweden, 70% in Denmark, and 80.2% in Spain). 4 , 15 , 16 A retrospective study in South Africa showed that the most common indication for ECT was depression, with most patients aged between 18 and 59 years old. 17 In contrast, in Asian countries, the patients tended to be younger men with schizophrenia.…”