ECT in Queensland, Australia

The journal Australasian Psychiatry recently published an article that looked at the use of electroconvulsive therapy (ECT) at Cairns Hospital, Queensland (Barry Stormont, Angelo A. Diedricks and Garry Kidd, A retrospective chart audit of electroconvulsive therapy at a regional Australian hospital).

Over a two-year period (2011-2013) 68 adult mental health patients were treated with ECT, and 66 (aged from 19 to 88) were included in the survey. The reason for excluding two people was given as “Two participants were excluded from analyses due to restrictions on their files intended to protect their anonymity”, which I don’t quite understand as I would have thought that all patients would have their anonymity protected.

In my last two posts I have commented on the fact that in Western countries ECT tends to be used predominantly for the treatment of depression and patients tend to include more women and older people than in countries elsewhere in the world where ECT is more often used as a treatment for schizophrenia. But at Cairns Hospital ECT was being given to equal numbers of men and women, and 27 of the 66 patients had a diagnosis of primary psychotic disorder, suggesting a practice that was veering away from the Western. The authors acknowledge that the practice at Cairns Hospital was not in keeping with practice elsewhere in Australia: “It is unclear why a greater proportion of younger males were treated for PPDs comparative to typical Australian ECT populations.” Over a quarter of the patients were receiving maintenance ECT, including 3 of the 16 men and 6 of the 11 women with a diagnosis of primary psychotic disorder. Again the authors acknowledged that the use of maintenance ECT at Cairns Hospital was unusual for Australia.

Also unusual was the practice at Cairns Hospital of administering ECT with bifrontal electrode placement (a sort of compromise between bilateral and unilateral). Only one patient received exclusively unilateral treatment, 40 received bifrontal and 25 bilateral. The authors were left wondering “whether the greater proportion of treated PPDs and the increased use of bifrontal and maintenance treatments reflect the unique characteristics of regional and rural practice or constitute evidence of changing patterns in the application of ECT in Australia.” My guess would be that they might have psychiatrists at Cairns Hospital who are out of step with the rest of the country.

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