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Electroconvulsive practice in Singapore consistent with other developed nations

Stephen Padilla
09 Jul 2019
Electroconvulsive therapy (ECT) machine used in 1945 through 1960. Photo credit: Science Museum, London

A recent study reports a highly uniform practice of electroconvulsive therapy (ECT) in Singapore, with rates and indications consistent with those applied by other developed nations. Moreover, ECT is more commonly used for schizophrenia in the country.

Researchers collected data from all ECT centres (n=6), representing ECT available in 23.1 percent of all hospitals and 50.0 percent of all psychiatric specialist centres. ECT rate stood at 5.89 treatments/10,000 residents per year, with each patient receiving 5.4 ECT per course on average. Of the ECT administered, 7.0 percent were for continuation/maintenance. [Singapore J Med 2019;doi:10.11622/smedj.2019064]

Depression was the most common indication for ECT (83.3 percent), followed by schizophrenia. Majority of the sessions were brief (0.5 ms) bitemporal ECT with age-based dosing, and most (93.0 percent) were administered in an inpatient setting. All sessions were conducted under general anaesthesia, and the most common type of anaesthetic used was propofol (66.8 percent).

“Future advances for ECT in Singapore include the use of individualized dosing based on empirical seizure threshold titration, expanded electrode placements and increased utilization of continuation/maintenance ECT,” researchers said.

Of the ECT sessions in Singapore, 63.5 percent were conducted in just one centre (with 1,900 beds), which is the largest psychiatric hospital in the country. The second largest centre, despite having only 12 beds, provided 17.9 percent of ECT sessions.

A tertiary psychiatric institute houses the largest ECT centre, which served as a referral site for the most severe cases of psychiatric disorders; the next busiest site was a private inpatient psychiatric ward, attended by a third of psychiatrists in Singapore in private practice, said researchers.

“The tertiary referral nature of the private psychiatric ward may account for the relatively high rates of ECT in that centre,” they noted.

Recent evidence supports this observation that ECT is preferentially available in private settings for nonminority patients with insurance coverage in developed countries, according to researchers. [Ann Acad Med Singapore 2007;36:795-796]

Moreover, nearly half of ECT sessions at the busiest centre was conducted for schizophrenia, whereas other centres used it to treat depression. This observation seems to reflect the development of mental health services in Singapore, in which the National Mental Health blueprint focused care for psychotic disorders in the largest centre for effective use of limited resources.

“There is no specific legislation distinguishing ECT from other psychiatric treatment, and its involuntary application is governed by the Mental Health (Care and Treatment) Act,” researchers said. [https://sso.agc.gov.sg/Acts-Supp/21-2008/Published/20081030?DocDate=20081030]

The current study utilized a cross-sectional structured questionnaire sent in 2015 to all ECT centres in Singapore to obtain qualitative and quantitative data regarding the procedure. The questionnaire evaluated the types of ECT (eg, electrode placement, stimulus parameters), indications, anaesthetic technique, dosing methods, outcomes monitoring and credentialing.

ECT use in Singapore started way back in 1947, according to researchers.

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