Use of electroconvulsive therapy in a state hospital: A 10-year review

Background: The use of electroconvulsive therapy (ECT) in the state hospita l setting currently represents a very small percentage of the total overall use of this modality in the treatment of the mentally ill. Method: Using records kept by a state hospital, we retrospectively identifi ed all patients who had received ECT between the years 1986 and 1995. A rev iew of the records at the state hospital from where patients were referred and the university hospital where ECT was administered was undertaken. Demo graphic and clinical characteristics, reasons for referral, symptom profile , ECT parameters, clinical outcomes, and restraint/seclusion data were asse ssed. Results: Over 10 years, 21 patients were treated with ECT, representing 0.4 % of all admissions to the state hospital. Of these subjects, 17 records co uld be retrieved. The majority were women (N = 12; 71%) and were diagnosed with a mood disorder. Ten subjects (59%) were over the age of 60 years, 4 o f whom were 70 years or older. Most patients had a state hospital length of stay of 1 year or less. The mean number of ECT treatments was 12.2. There were no medical complications that led to premature termination of ECT. Ele ven patients (65%) were discharged either directly from the university hosp ital or within 10 days of readmission to the state hospital. Six of 7 patie nts who had restraint and seclusion episodes prior to ECT were found to hav e no further episodes afterwards. The seventh experienced a dramatic decrea se in number and total hours of episodes. Conclusion: For a substantial minority of patients in this state hospital s etting, ECT appears to have been an effective and safe form of treatment, a nd its use should be considered early rather than late in the course of hos pitalization.