ECT in Nepal, 2012-13

In February the Journal of Clinical and Diagnostic Research published a survey of ECT use in Nepal’s largest psychiatric unit (S. Subedi, T.K. Aich and N. Sharma, Use of ECT in Nepal: a one year study from the country’s largest psychiatric facility).

The survey found that, out of 1095 people admitted to the psychiatric unit of the Universal College of Medical Sciences Teaching Hospital, Bhairahawa, from August 2012 to July 2013, 81 were treated with ECT. About half of them were being treated for schizophrenia or transient psychotic disorder. The patients were on the whole younger than ECT patients in western countries: their mean age was 29 and there was only one person over the age of 60 – a 61 year old. Although the patients were predominantly young, no-one under the age of 16 was treated with ECT. Women accounted for 56 per cent of the ECT patients, a smaller proportion than in most surveys in western countries. Although women outnumbered men the 56/44 per cent split doesn’t seem the justify the author’s conclusion that: “Our study suggested that use of ECT treatment was common among young adult patients and females.” However, the authors did find that women were referred more readily to ECT than men, having fewer drug trials before ECT was prescribed.

Treatment was given twice a week, with a brief-pulse waveform and bilateral electrode placment. The mean number of treatments per course was six. The mode was also six treatments, and 75 per cent of patients had 5, 6 or 7 treatments. One person had 10 treatments and no-one had more than ten, unlike in western countries where people can have large numbers of treatments either in long courses or as maintenance ECT.

ECT was always given “direct” or unmodified (without anaesthesia or muscle paralysing drugs) due to the higher cost of modified ECT. The authors, referring to surveys of ECT use in Asia, point out that “Direct ECT is very commonly used in many parts of the world accounting for the largest ECT population in the world” and defend its safety: “Studies have documented that unmodified ECT is safe compared to the much-advocated modified ECT.”

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