The changing utilization of electroconvulsive therapy: A longitudinal study in a Norwegian catchment area, 1970–1986

This is a year-to-year study of electroconvulsive therapy (ECT) utilization from 1970 to 1986 at the Central Hospital, Rogaland county (SIR), Norway. In the whole period a mean of 2.8% of inpatients were treated with ECT; in the last 3 years, 3–4%. In the catchment area of SIR a mean of 10.1 per 100,000 inhabitants received ECT yearly from 1980 to 1986. There was a marked yearly variation in the utilization. Two outstanding peaks occurred; one in 1971, when 4.4% of inpatients received ECT, and the other in 1981, when 8.2% received ECT. In contrast, only 0.9% undervent ECT at the lowest level in 1974. The variation could not be explained by changes in patient turnover or diagnostic distribution. The variation seemed rather to be due to the psychiatrists' changing attitude towards ECT. influenced by ideology and wealth of information. ECT was given twice as frequently to patients from the catchment area of SIR as to those from the neighbouring area. The latter patients had to be transported from another hospital to SIR for ECT. The most frequent ICD-8 diagnoses among the ECT-treated patients were depressive neurosis (34%). most of whom actually had endogenous clinical features, affective psychosis (32%). and reactive depressive psychosis (18%). ECT was given most frequently to the elderly. A Siemens Konvulsator 622, giving quarter-sine-wave pulses of 5-msec duration, was used. A mean of eight treatments per series was given, and 80% of the patients received one series only. In the last 2 years bilateral electrode placement was used in 71% of the treatments. No serious complications were reported.