Yu-Tao Xiang1,2, Gabor S Ungvari3,4, Christoph U Correll5, Helen F K Chiu2, Kelly Y C Lai2, Chuan-Yue Wang6, Tian-Mei Si7, Edwin H M Lee8, Yan-Ling He9, Shu-Yu Yang10, Mian-Yoon Chong11, Ee-Heok Kua12, Senta Fujii13, Kang Sim14, Michael K H Yong14, Jitendra K Trivedi15, Eun-Kee Chung16, Pichet Udomratn17, Kok-Yoon Chee18, Norman Sartorius19, Chay-Hoon Tan20, Naotaka Shinfuku21. 1. Faculty of Health Sciences, University of Macau, Macao, China. 2. Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China. 3. School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia. 4. University of Notre Dame Australia, Perth, Australia. 5. Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, USA. 6. Beijing Anding Hospital, Capital Medical University, Beijing, China. 7. Key Laboratory of Mental Health, Ministry of Mental Health & Peking University Institute of Mental Health, Beijing, China. 8. Department of Psychiatry, University of Hong Kong, Hong Kong, China. 9. Shanghai Mental Health Center, Shanghai, China. 10. Taipei City Hospital, Taipei, Taiwan. 11. Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Chang Gung, Taiwan. 12. Department of Psychological Medicine, National University of Singapore, Singapore, Japan. 13. Fukushima Medical University, Fukushima, Japan. 14. Institute of Mental Health, Buangkok View, Singapore, Japan. 15. Department of Psychiatry, C. S. M. Medical University UP, Lucknow, India. 16. Department of Psychiatry, National Seoul Hospital, Seoul, Korea. 17. Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. 18. Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. 19. Association for the Improvement of Mental Health Programs, Geneva, Switzerland. 20. Department of Pharmacology, National University of Singapore, Singapore, Japan. 21. School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan.
Abstract
AIMS: Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophrenia patients in Asia between 2001 and 2009 and its independent demographic and clinical correlates. METHODS: Data on 6761 hospitalized schizophrenia patients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data-collection procedure. RESULTS: The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter-country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35-64-year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second-generation antipsychotic medications compared to those who were not treated with ECT (R(2) = 0.264, P < 0.001). CONCLUSIONS: ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study.
AIMS: Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophreniapatients in Asia between 2001 and 2009 and its independent demographic and clinical correlates. METHODS: Data on 6761 hospitalized schizophreniapatients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data-collection procedure. RESULTS: The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter-country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35-64-year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second-generation antipsychotic medications compared to those who were not treated with ECT (R(2) = 0.264, P < 0.001). CONCLUSIONS: ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study.