Electroconvulsive therapy practice in Thailand

Objectives: To obtain an overview of electroconvulsive therapy (ECT) practice in Thailand. Methods: Questionnaires were sent to all institutions providing psychiatric care; data were collected from September I 200 1, to August 31,2002. Results: Fifty-three responses were received from 67 institutions (79.1%). ECT is available in 26 hospitals. Approximately 6,914 patients received 51,565 ECT treatments, of which, 6,469 patients (93.56%) received 48,240 treatments (93.55%) in the psychiatric hospitals. The ECT utilization rate was 11.15 patients treated per 100,000. Twelve institutions used MECTA (Spectrum or SR1) or Thymatron DGx. Bilateral ECT was used exclusively in all institutions. In 2 medical schools, all patients received double ECT throughout their treatment courses. Unmodified ECT was always used in nine psychiatric hospitals and five general hospitals, and occasionally used in 2 university hospitals comprising 94.2% of all ECT usage. Patients with schizophrenia most frequently received ECT (74%), followed by mania (8%) and major depression (7%). The nurse alone administered ECT in four psychiatric hospitals. Although the death rate was estimated at 0.08%, there was no ECT-related death during the survey period. Continuation ECT was performed in 11 and maintenance ECT in 6 institutions. Five institutions had acceptable training programs for psychiatry residents but none had training syllabus, 2 institutions had teaching schedule for medical students. Conclusions: ECT use in Thailand is high. Nearly all ECTs (93.6%) were performed in the psychiatric hospital and 94.2% of all treatments were unmodified ECT. Lacking of proper training in ECT is evident.