Electroconvulsive Therapy Practice in Thailand: A Nationwide Survey

Abstract

To determine the characteristics of electroconvulsive therapy (ECT) practice in Thailand. Methods: A cross-sectional survey of ECT practice in Thailand was conducted. A questionnaire was sent to all 34 hospitals providing ECT services nationwide. ECT staff of each hospital were asked to complete the questionnaire. Results: All 34 hospitals responded to the survey. The most common diagnosis was schizophrenia (5,958 patients/year), followed by bipolar disorder (982 patients/year) and major depressive disorder (869 patients/year). Brief pulse device was used in all hospitals. Bitemporal ECT was the most common type of electrode placement (88.2%), followed by bifrontal (44.1%) and right unilateral (38.2%) placement. The initial dose was determined by titration method in 24 hospitals (70.6%) and by age-based method in the remainder (29.4%). Modified ECT was always used in 25 hospitals (73.5%), including all university hospitals, 6 psychiatric hospitals (17.6%) and 10 general hospitals (29.4%). The primary anesthetics used were thiopentone (60.7%) and propofol (39.3%). Regarding acute ECT, ECT was performed three times per week in most hospitals (91.2%). The number of acute ECT treatment sessions in most hospitals was in the range of 4-6. In total, 22 hospitals (64.7%) performed continuation/maintenance ECT. Headache was the most common adverse event, followed by cognitive side effects and myalgia. Conclusion: ECT practice in Thailand has developed over the past two decades in many aspects. The most notable change is that the majority of patients are now treated with modified ECT. In addition, pre-treatment investigations, use of a device providing a brief pulse, unilateral electrode placement, and the monitoring of parameters during treatment are now used more widely in practice to maximize treatment efficacy while minimizing side effects. However, certain aspects of ECT can still be improved; promoting ECT education among psychiatrists and psychiatry residents could improve the quality of practice, for example.

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study

“…These patterns closely mirror the broader trends observed in Asian countries. 9 , 14 However, there are notable distinctions when compared to the United States, Australia, New Zealand, and several other Western nations, where mood disorders exhibit a higher prevalence. 15–19 …”

“… 8 In Thailand, the most common diagnoses among patients who received continuation-maintenance ECT were schizophrenia, followed by bipolar disorder, schizoaffective disorder, major depressive disorder, respectively. 9 …”

“…8 In Thailand, the most common diagnoses among patients who received continuation-maintenance ECT were schizophrenia, followed by bipolar disorder, schizoaffective disorder, major depressive disorder, respectively. 9 Neuropsychiatric Disease and Treatment 2023: 19 1427-1433 Previous studies demonstrated that continuation-maintenance ECT appears to be effective in reducing and shortening psychiatric admissions in people with severe affective illness. A recent study in the elderly with major depressive disorder revealed a 53% reduction in the number of admissions and a 79% reduction in admission duration in the two years after continuation-maintenance ECT treatment, compared to the previous two years.…”

Electroconvulsive Therapy Across Nations

“…3,4 Despite the recognized importance of practice decisions and the global prevalence of ECT, there has never been a published survey of worldwide ECT practice. Country-specific surveys on ECT practice have been published including from Australia, 5,6 Belgium, 7,8 Bulgaria, 9 Canada, [10][11][12] China, 13,14 Croatia, 15 Czech Republic, 16 Denmark, 17 Germany, 18 Greece, 19 Hungary, 20,21 India, 22,23 Iraq, 24 Italy, 25 Netherlands, 26 New Zealand, 27 Peru, 28 Poland, 29,30 Russia, 31 Serbia, 32 South Africa, 33 Slovakia, 34 Spain, 35,36 Thailand, 37 Ukraine, 38 the United Kingdom (UK), 39,40 and the United States (US). 41,42 Regional surveys encompassing multiple countries have been published for Asia, 43 Baltic States, 44 and Central-Eastern European countries.…”