A retrospective record review of electroconvulsive therapy (ECT) at a specialist psychiatric hospital in Johannesburg
Date
2018
Authors
Ramiah, Carmel
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Abstract
ECT remains an effective and safe procedure. However, the fear of serious medical and psychiatric consequences as well as the stigma attached to ECT seem counterintuitive to its use. Furthermore, there are no well-defined treatment guidelines in South Africa. This makes provision of this treatment modality challenging.
The motivation for this study was to demonstrate the prevalence, efficacy and safety of ECT in a South African context, and possibly motivate for improving ECT guidelines.
Aims and Objectives
To determine the prevalence of ECT use at Tara Hospital over the last ten years, the pattern of anesthetic use, technical aspects of ECT application, indications for ECT, as well as patient outcomes.
Methods
The sample included all patients (n 19) that received ECT at Tara Hospital from January 2006 to December 2015. The small sample size was a significant limitation and thus only a descriptive analysis was done. The study was a retrospective review of patient files.
Results
The mean age was 50 years (range 36-63 years). The most common indication for ECT was Major Depressive Disorder (47.4%), followed by treatment resistant Bipolar Disorder type 1 (21.1%) and treatment resistant schizophrenia (15.8%). The inhaled anesthetic Sevoflurane, were used in 52.8% of cases. Bilateral ECT was conducted in all cases, with stimulus dose titration being the most common dosing strategy. The first response to ECT was observed after an average of 3 sessions, and the mean total number of sessions was 14. The mean minimum and maximum stimulus intensities were 32.6% and 78.5% respectively. Importantly, the majority of patients (79%) improved. There were 31.6% of patients who experienced short-term cognitive effects, which was recorded to have lasted a few hours to a maximum of two days.
Conclusion
Future research is pivotal to discovering more about the benefits of ECT, as well as methods for improvement, particularly the mandatory monitoring of adverse effects. It would be useful to conduct this study prospectively throughout all hospitals that offer ECT in Gauteng
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry
Johannesburg, 2018