China accounts for over one sixth of the world’s population, but it generally does not receive much attention in discussions on the use of electroconvulsive therapy (ECT). Such discussions generally centre on its use in Western countries, especially English-speaking ones, with only the occasional survey of its use in other places. These surveys generally show that in Asian countries ECT patients are more male, younger, and more likely to have a diagnosis of schizophrenia than ECT patients in Western countries.
An article published recently in the Journal of ECT (Qing-E Zhang et al. Common use of electroconvulsive therapy for Chinese adolescent psychiatric patients, Journal of ECT 2016 December; 32(4): 251-255) looked at the use of ECT on young patients (aged 13-17 years) at a Beijing hospital with 800 beds and a catchment area of 20 million. It can be read here
The retrospective study found that 406 young people under the age of 18 had been given ECT between 2007 and 2013. In 2013, 46 per cent of adolescents admitted to the hospital were treated with ECT. During the same period, a total of 12,608 patients at the hospital (54 per cent) were given ECT, suggesting that psychiatrists were slightly more cautious in their use of ECT on adolescents than on adults.
The most common diagnosis of the young people undergoing ECT was schizophrenia-spectrum disorders (over one third), followed by major depression, bipolar disorder and “others”. Almost all the ECT patients were prescribed anti-psychotic drugs, 70 per cent were prescribed benzodiazipines, 60 per cent mood stabilizers and 35 per cent antidepressants. Over 70 per cent were considered to be at “high risk” for aggression.
The hospital uses an American ECT machine and treatment is given in modified form, that is, with an anaesthetic (propofol) and a muscle-paralysing drug (succinylcholine). Unlike in Western countries, where ECT is usually given two or three times a week, the hospital give patients ECT five times in the first week and then three times a week. The authors say that adolescents are “usually receive fewer sessions than adult patients” but don’t give details.
The authors included, as well as Chinese psychiatrists, a psychiatrist working in Australia and two American psychiatrists, and the language of ECT is familiar – “safe”, “effective”, “treatment-resistant”, “therapeutic armamentarium”, etc. But, unusually, the use of ECT on adolescents at this particular hospital is described as “alarmingly” and “exceedingly” high. Reasons for this high use, the authors say, “should warrant urgent investigations”. The authors mentioned a survey in Australia which found that only 0.2 per cent of ECT patients were under the age of 18, whereas at the Beijing hospital under 18 year olds accounted for 3.2 per cent of ECT patients. Which is right and which is wrong? Can the differences be accounted for by the concept of “socioculturally distinct regions” mentioned by the authors?