Kari Ann Leiknes

Contemporary use and practice of electroconvulsive therapy worldwide

To explore contemporary (from 1990) utilization and practice of electroconvulsive therapy (ECT) worldwide. Systematic search (limited to studies published 1990 and after) was undertaken in the databases Medline, Embase, PsycINFO, SveMed, and EBSCO/Cinahl. Primary data‐based studies/surveys with reported ECT utilization and practice in psychiatric institutions internationally, nationally, and regionally; city were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria, and extracted ECT utilization and practice data from those retrieved in full text. Seventy studies were included, seven from Australia and New Zealand, three Africa, 12 North and Latin America, 33 Europe, and 15 Asia. Worldwide ECT differences and trends were evident, average number ECTs administered per patient were eight; unmodified (without anesthesia) was used in Asia (over 90%), Africa, Latin America, Russia, Turkey, Spain. Worldwide preferred electrode placement was bilateral, except unilateral at some places (Europe and Australia/New Zealand). Although mainstream was brief‐pulse wave, sine‐wave devices were still used. Majority ECT treated were older women with depression in Western countries, versus younger men with schizophrenia in Asian countries. ECT under involuntary conditions (admissions), use of ambulatory‐ECT, acute first line of treatment, as well as administered by other professions (geriatricians, nurses) were noted by some sites. General trends were only some institutions within the same country providing ECT, training inadequate, and guidelines not followed. Mandatory reporting and overall country ECT register data were sparse. Many patients are still treated with unmodified ECT today. Large global variation in ECT utilization, administration, and practice advocates a need for worldwide sharing of knowledge about ECT, reflection, and learning from each others experiences.

Current somatoform disorders in Norway: prevalence, risk factors and comorbidity with anxiety, depression and musculoskeletal disorders

BackgroundThe future existence of somatoform disorders (SDs) has recently been debated. The objectives of this study were to investigate the prevalence of current SDs (defined as the presence of multisomatoform disorder [MSD] or somatoform disorders not otherwise specified [SDnos], without psychosocial impairment) and severe current SDs (MSD or SDnos with psychosocial impairment) in Norway. Differences in markers of severe current SDs, anxiety/depression and self-reported musculoskeletal disorders were explored. In addition, psychological distress and utilization of healthcare in subclasses (defined according to comorbidity with anxiety, depression and musculoskeletal disorders) of severe current SDs were examined.MethodsWe interviewed 1,247 respondents using the Composite International Diagnostic Interview (CIDI) in the Oslo–Lofoten general population survey in 2000–2001. Six-month prevalence rates (%) and 95% confidence intervals (CIs) for current SDs were investigated by gender and age. Risk factors of disorders, psychological distress, healthcare utilization and use of medication were explored using logistic regression analyses.ResultsThe overall prevalence rate for severe current SDs was 10.2%. When psychosocial impairment was excluded as a criterion, the rate increased to 24.6%. Anxiety was strongly correlated with severe current SDs. Comorbidity of severe current SDs with anxiety/depression was 45%, and with musculoskeletal disorders, 43%. Analysis of healthcare utilization and use of medication showed that the presence of a comorbid psychiatric condition was more important than the presence of somatoform disorders alone. Conclusion Somatoform symptoms alone (with no psychiatric comorbidity) should not be considered a psychiatric disorder.

Commonalities and differences between the diagnostic groups: Current somatoform disorders, anxiety and/or depression, and musculoskeletal disorders ☆

OBJECTIVE To identify the similarities and differences of risk factors and correlates of different groups of people fulfilling criteria for specified diagnostic groups according to current somatoform disorder (SDs) criteria, presence of anxiety and/or depression, and self-reported musculoskeletal disorders. METHODS Participants of the Oslo-Lofoten general population cross-sectional study in 2000-2001 interviewed with the Composite International Diagnostic Interview (CIDI) somatoform section were examined by comparing similarities and differences in 8 groups identified by cross-tabulation of current SDs, anxiety and/or depression, and musculoskeletal disorders. The current SDs group was computed from the CIDI somatoform section raw data, anxiety and/or depression from the CIDI diagnostic algorithms and musculoskeletal disorders by questionnaire and self evaluation. RESULTS In the 2001 sample of 1668 (875 women and 793 men) participants, the following eight disorder groups were identified: (i) current SDs, n=49 (75.5% women) (ii) musculoskeletal (functional somatic disorders), n=327; (53.5% women) (iii) anxiety and/or depression, n=148 (73.6% women); (iv) current SDs with anxiety and/or depression, n=38 (73.7% women); (v) current SDs with musculoskeletal, n=44 (72.7% women); (vi) current SDs with anxiety and/or depression and musculoskeletal, n=34 (76.5% women); (vii) musculoskeletal with anxiety and/or depression, n=101 (66.3% women); and (viii) no disorders, n=927 (43.3% women). Commonalities and differences between current SDs, anxiety and/or depression, and musculoskeletal disorders are apparent. Impairment of outcomes and risk factor load is high in current SDs with anxiety and/or depression and musculoskeletal. CONCLUSION The data in this article could help toward the needed DSM-V and ICD-11 diagnostic revision of the SDs category.

Re: Electroconvulsive therapy during pregnancy revisited

Our extended thanks to Donna Stewart for her comments (Stewart 2015) on our case report review about the use of electroconvulsive therapy during pregnancy (Leiknes et al. 2013). We understand the Blimits of knowledge^ based on earlier reviews influencing the 2001 text book (Stewart and Erlick Robinson 2001). We are sorry to hear that this important book on the interface between psychiatry and gynecology will not be updated into a later revised version. Stewart’s article on ECT treatment during pregnancy, with case vignette (Stewart 2011), express a reservation for ECT during pregnancy, alongside an awareness for careful ECT monitoring. This case vignette was not included in our review due to insufficient primary data. We are glad to hear Donna Stewart’s position on not to recommend ECT during pregnancy as a first-line treatment and without appropriate safeguards. We totally agree that existing guidelines need to be revised and systematic reviews revised, when appropriate, on this topic. Future growth in published reports, register data, and studies on the administration of ECT during pregnancy will no doubt add more body to our knowledge on both benefits and harms of the intervention. This again will be an aid to inform clinicians and women in complicated treatment decision making. Until then, bearing in mind potential harms as mentioned in our review, ECT during pregnancy will require a close monitoring of the fetus/baby and mother in a joint specialist treatment collaboration, between obstetrician and psychiatrist.