A recently published article* has looked at the use of electroconvulsive therapy (ECT) in Lima, the capital city of Peru. Carla Cortez-Vergara and colleagues looked through the records of patients treated with ECT at a hospital in Lima (Instituto Nacional de Salud Mental “Honorio Delgado – Hideyo Noguchi”) over the period 2001 to 2011. The hospital is named after Honorio Delgado, who introduced ECT into Peru in 1943. It is one of fourteen hospitals in Peru which use ECT.
A total of 372 patients received 419 courses of ECT, consisting of 5439 individual treatments. These 372 patients represented 14 per cent of those admitted to the hospital. The most common diagnosis was paranoid schizophrenia (70.7 per cent). The authors said there was a good clinical response in 70.1 per cent of patients.
Patients ranged in age from 16 to 72 years, with fifty per cent of them less than 28 years old. Sixty per cent were men. Over the period studied the use of ECT had declined from a peak of 74 courses in 2002 to 16 courses in 2011. Nearly nine out of ten patients had a diagnosis of some form or other of schizophrenia and the most common reason (80 per cent of patients) for using ECT was given as resistance to treatment. The maximum number of treatments in a course was 44, with just over half of patients receiving between 6 and 12 treatments.
Anaesthesia was used in 44 per cent of courses and muscle paralysing drugs in 33 per cent, although by 2009 all patients were being given modified ECT. ECT was given with a MECTA spECTrum 5000Q (r) machine. Electrode placement was always bilateral, and electrical charge varied from 48 to 294 millicoulombs. Only four per cent of patients consented to treatment, in 75 per cent of cases family members gave consent.
The authors’ discussion compared ECT practice in Peru with that reported in other countries, for example contrasting the predominantly young male patients in Peru (and Uruguay and India) with predominantly older female ECT patients in Brazil, the USA and Australia. This they said was due to the high proportion of patients being treated for schizophrenia, a similar proportion to that found in African and Asian countries, while in the USA and Europe (with the exception of Hungary and Turkey) most ECT patients were being treated for depression.
Meanwhile in Wiltshire, England, the Avon and Wiltshire Mental Health Partnership NHS Trust has published a brief leaflet with the title: The truth about Electroconvulsive Therapy.
“It’s often considered a treatment from yesteryear and can be viewed as controversial, but what’s the truth about Electroconvulsive Therapy (ECT) and its role in modern mental health care? Who better to tell us than one of the busiest ECT teams in the country?”
The ECT team goes on to tell us that: “ECT was developed in Italy in the late 1930’s by two psychiatrists researching schizophrenia, although the treatment has no impact on this illness.” No impact? So why did psychiatrists in Peru think that 70 per cent of their patients, most of whom had a diagnosis of schizophrenia, responded well to ECT? And perhaps the Wiltshire ECT team could ponder why ECT, if it has no impact on schizophrenia, is still used in many parts of the world as a treatment for schizophrenia rather than depression. Closer to home why are small numbers of people in the United Kingdom still being given ECT as a treatment for schizophrenia ?
* Cortez-Vergara C, Cruzado L, Rojas-Rojas IG, Sánchez-Fernández M, Ladd-Huarachi G. Características clínicas de pacientes tratados con terapia electroconvulsiva en un hospital público de Perú. Rev Peru Med Exp Salud Publica. 2016;33(1):100-5. doi: 10.17843/rpmesp.2016.331.1940