O46. A National Study for Regional Variation of Inpatient ECT Utilization From 4,411 Hospitals Across the United States

Patel, Rikinkumar S; Sreeram, Venkatesh; Thakur, Tanu; Bachu, Ramya; Youssef, Nagy A.

doi:10.1016/j.biopsych.2019.03.311

Cited by 8 publications

(18 citation statements)

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“…About three-fourths of our study inpatients were covered by public insurances. Our results are supported by past studies that found ECT was used for mood disorders predominantly in females (65.2%) than in males, and one-third of ECT recipients were aged 65 years and older and more than half of the population is covered by Medicare [12][13][14][15]. Several factors may be relevant to higher utilization of ECT in the geriatric population, like patients have a lower tolerance to medication owing to age-associated pharmacokinetic changes and increased sensitivity to psychotropic medications [13].…”

Section: Discussionsupporting

confidence: 90%

“…Although a higher proportion of females received ECT, which was also seen in past studies, we found that males with BD, manic episodes and managed with ECT have higher odds for longer hospitalization stay [12,15]. About 86% of psychiatric inpatients managed with ECT in the US are whites [15]. We found that race is not a significant predictor for ECT utilization in BD, manic episode patients, and was also supported by another inpatient study [12].…”

Section: Discussionsupporting

confidence: 86%

“…This could be one of the possible reasons for older adults >50 years in our study had 2.4 times higher odds for longer hospitalization stay. Although a higher proportion of females received ECT, which was also seen in past studies, we found that males with BD, manic episodes and managed with ECT have higher odds for longer hospitalization stay [12,15]. About 86% of psychiatric inpatients managed with ECT in the US are whites [15].…”

Section: Discussionsupporting

confidence: 80%

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Predictors for Extending Hospitalization Stay in Electroconvulsive Therapy Recipients With Bipolar Disorder, Manic Episodes

Bodicherla

Mathialagan

Caraballo-Rivera

et al. 2020

Cureus

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We aim to discern the demographic predictors that may extend the hospitalization length of stay (LOS) for patients with bipolar disorder (BD), manic episodes managed with electroconvulsive therapy (ECT), and to study the impact of insurance and hospital characteristics on LOS. Methods We used the Nationwide Inpatient Sample (NIS, 2012-2014) from the United States hospitals and included 2,785 adult inpatients (mean age 51.3 ± 16.2 years) with a primary diagnosis of BD, manic episode, and managed with ECT. The median LOS of the sample population is 16 days, and the study inpatients were divided into subgroups: ≤16 days versus >16 days. The logistic regression model was used to find the odds ratio (OR) for the associations of demographic and hospital variables with inpatient stay >16 days versus ≤16 days. Results BD inpatients managed with ECT during their hospitalization had a mean LOS of 21.6 ± 22.1 days. About 48.65% (N = 1355) had LOS >16 days. Older adults (age >50 years) have 2.4 times higher odds (95% CI 2.06-2.87) for hospital LOS >16 days compared to younger adults. Although a higher proportion of females received ECT (71.8%), males had two times higher odds (95% CI 1.59-2.27) for hospital LOS >16 days. BD inpatients covered by private insurance/self-pay were at 1.5 times higher odds (95% CI 1.27-1.77) for hospital LOS >16 days. In terms of hospital setting, ownership type and teaching status are significant predictors with inpatients managed in public and teaching hospitals at higher odds for LOS >16 days. Conclusions Older men and inpatients covered by private insurance/self-pay have a higher likelihood of extended hospitalization stay during ECT management of BD, manic episodes. The LOS is also influenced by hospital setting with patients managed in public teaching hospitals at higher odds of longer LOS compared to their counterparts.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 80%

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Predictors for Extending Hospitalization Stay in Electroconvulsive Therapy Recipients With Bipolar Disorder, Manic Episodes

Bodicherla

Mathialagan

Caraballo-Rivera

et al. 2020

Cureus

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“…A recent editorial by a prominent US ECT researcher, entitled 'Modern Electroconvulsive Therapy: Vastly Improved yet Greatly Underused', accurately captures the current state of affairs (15). In terms of absolute rates of usage, it is estimated that between 80 000 and 100 000 patients receive ECT annually in the United States, and that approximately 500 000 ECT procedures are performed, although recent, high quality data remain unavailable (16,17).…”

Section: Current Use Of Ectmentioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

121

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When to consider electroconvulsive therapy (ECT) Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT).Objective: To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. Method: We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. Results: ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. Conclusion: ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia. Clinical recommendations for ECT• ECT should be prescribed earlier in the course of a severe depressive episode, not necessarily withheld until after numerous medication trials • ECT may be considered a first-line (primary) treatment for certain urgently ill patients, including those who are very suicidal, psychotic, or physically debilitated from depression Diagnostic indications for ECT • In many Western countries, severe and treatment-resistant depression is the main indication for ECT • Schizophrenia is the number one indication for ECT worldwide, but is little used for this indication in Western countries • ECT is an effective treatment for treatment-resistant mania • Delirious mania is an urgent indication for ECT • ECT is effective for treatment-resistant schizophrenia, including clozapine-resistant illness • Catatonia is very responsive to ECT • Both the motor and behavioural symptoms of Parkinson's disease respond to ECT Predictors of ECT response • Older age, psychotic symptoms, and shorter episode duration are predictors of better ECT response • Melancholic features and greater baseline depressive symptom severity are likely associated with better ECT response 304 ECT technique • Bilateral, bifrontal, and right unilateral electrode placement are all effective ECT techniques • Less urgently ill patients are often treated initially with right unilateral electrode placement • Brief and ultrabrief pulse width stimuli, now commonly used, are associated with a more benign cognitive effect profile • There is no a priori fixed number of ECT in an acute course: patients should continue treatment with ECT until they remit or a plateau has been reached, or tolerability issues require interruption of the course • Tapering of acute courses of ECT should be considered for most patients (e.g., approximately weekly treatments for several weeks past remission) • Continuation/Maintenance (C/M) ECT should be considered for patients with a history of severe, recurrent episodes who have failed to remain well on medications Additional comments • ECT is underutilized because of stigma, lack of knowledge about it, and bureaucratic restrictions • ECT is among the safest procedures performed under general anesthesia • Cognitive adverse effects are markedly decreased with modern ECT techniques, largely transient, and should not deter seriously ill patients from considering ECT.

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“…Our study included adult inpatients (age 18 years or above) with discharges in January 2010 to December 2014 from the Nationwide Inpatient Sample (NIS) data and previously described in reference [20]. The NIS is the largest inpatient data in the US and includes about 20% of discharges from nonfederal, acute care hospitals [21].…”

Section: Study Samplementioning

confidence: 99%

Combination of lithium and electroconvulsive therapy (ECT) is associated with higher odds of delirium and cognitive problems in a large national sample across the United States

2020

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Background: Lithium is a helpful adjunct to patients undergoing ECT. However, only case reports and limited data suggest increase risk of delirium. Thus, this continues to be a controversial issue. Objective: In this study, we examine 1) The association and odds of delirium and cognitive problems with ECT and lithium (ECT þ Li) combination compared to ECT alone, 2) If positively associated, would this association vary by both type of mood episode and type of disorder? Methods: A national sample of 64,728 adult psychiatric inpatients across the US (identified from a total data of about 70 million total discharges annually) was analyzed using linear-by-linear association and logistic regression to assess the odds ratio (OR) for delirium and cognitive impairment for those treated with lithium (N ¼ 158), ECT (N ¼ 64148), or ECT þ Li (N ¼ 422) after adjusting for demographics and psychiatric diagnoses. Results: The prevalence of delirium was higher in the ECT þ Lithium group (5.7%) vs. ECT only (0.6%) or lithium only groups (0%). Patients managed with ECT þ Lithium have 11.7-fold higher odds (95% CI 7.55 e17.99, P < 0.001) of delirium compared to ECT alone. In the ECT þ Li group, delirium prevalence was 7.8% in unipolar depression, 3.4% in bipolar depressed, 0% in bipolar mania. Conclusion: These results are surprising given the fading concern about delirium association with ECT þ lithium combination. The high odds in the combination group warrant clinical caution, use of lower lithium doses (if combinations cannot be avoided), and vigilance regarding early signs of delirium. These results warrant replication in future studies.

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O46. A National Study for Regional Variation of Inpatient ECT Utilization From 4,411 Hospitals Across the United States

Cited by 8 publications

References 0 publications

Predictors for Extending Hospitalization Stay in Electroconvulsive Therapy Recipients With Bipolar Disorder, Manic Episodes

Predictors for Extending Hospitalization Stay in Electroconvulsive Therapy Recipients With Bipolar Disorder, Manic Episodes

When to consider electroconvulsive therapy (ECT)

Combination of lithium and electroconvulsive therapy (ECT) is associated with higher odds of delirium and cognitive problems in a large national sample across the United States

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