ECT in Iraq 2013

Psychiatrists in Iraq and Leicestershire, England, have recently carried out a survey of ECT use in public hospitals Iraq. The results were published in the British Journal of Psychiatry Bulletin in December 2015 (N. Alhemiary, Z. Ali and M.J. Abbas, ECT practices in Iraq: a national audit, pp. 308-311).

Generally speaking, in western countries, ECT is used predominantly in the treatment of depression, about two-thirds of patients are women, and older people are often over represented in ECT statistics. Further east, ECT tends to be used more in schizophrenia, ECT patients are younger, and the sexes more evenly balanced. This survey of ECT use in Iraq confirmed these findings.

Of 26 public psychiatric hospitals or units in Iraq, ten have facilities for administering ECT. One did not use the treatment during the time period of the survey (the first 6 months of 2013) and one did not provide any data. The remaining 8 units gave ECT to 251 patients. This represents a low use of ECT. However, the survey did not cover the use of ECT in private hospitals.

Men slightly outnumbered women among the ECT patients. All but two of the 251 patients were under the age of 65. One patient was under the age of 18. The mean age of patients was 36.2 years. Just over half the patients were being treated for schizophrenia. Three hospitals used unmodified ECT, that is, ECT without anaesthesia and muscle paralysing drugs. All but one hospital used brief-pulse waveform machines; the remaining hospital presumably using a sine wave machine. All ECT was given using bilateral electrode placement. At one point the article says that 28.3 per cent of patients were in-patients; at another it says that 28.3 per cent were out-patients. So the split was about 70 to 30 per cent between in-patient and out-patient treatment, which way round isn’t clear.

None of the hospitals used EEG monitoring during ECT, and the authors argued that the use of monitoring could mean lower doses being given. I did not follow the logic here, as it is possible to use establish a seizure threshold with dose titration without an EEG.

In Iraq it is common practice for relatives to consent to treatment; in this survey either the patient or a relative consented to treatment in all cases.

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