van der Wurff F B, Stek M L, Hoogendijk W J G, Beekman A T F
Department of Psychiatry, Vrije Universiteit-VUmc and GGZ-Buitenamstel, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands.
J ECT. 2004 Mar;20(1):37-41. doi: 10.1097/00124509-200403000-00008.
Current guidelines consider electroconvulsive therapy (ECT) in the Netherlands a treatment of choice for a depressive disorder with psychotic features, severe suicidal behavior, severe physical exhaustion, or resistance to treatment with antidepressants (consecutively SSRIs, TCAs, lithium, MAO inhibitors). It is advised to use ECT early on in the treatment of depressed elderly patients. In practice, ECT is applied to only a minority of depressed elderly patients in the Netherlands. This situation dates back to the 1970s, in which strong aversive opinions toward ECT grew in the Netherlands, largely as a reaction to the malpractice of ECT in that time and influenced by social-cultural opinions toward psychiatry. Negative attitudes among professionals and lack of knowledge may contribute to the under use in depressed elderly patients.
A postal questionnaire was sent to 152 psychiatrists who specialize in old age to assess their opinions and attitudes toward ECT.
Only a small minority thought ECT was a treatment of choice in a depressive disorder with psychotic features (4%), severe suicidal risk (2%), or physical exhaustion (5%). The majority of the psychiatrists had strongly reserved opinions in considering ECT as a treatment of first, second or third choice in depressed elderly patients, even in treatment-resistant depressive disorders.
Many psychiatrists who specialize in old age in the Netherlands divert from the current guidelines and are reluctant toward using ECT as a treatment of choice in a number of specific, clinical situations. This might be a major contributing factor to the present and past underuse of ECT in depressed elderly patients in the Netherlands.
目前荷兰的指南认为，电休克疗法（ECT）是伴有精神病性症状的抑郁症、严重自杀行为、严重身体疲惫或对抗抑郁药（依次为选择性5-羟色胺再摄取抑制剂、三环类抗抑郁药、锂盐、单胺氧化酶抑制剂）治疗耐药患者的首选治疗方法。建议在老年抑郁症患者治疗早期使用ECT。实际上，在荷兰只有少数老年抑郁症患者接受ECT治疗。这种情况可追溯到20世纪70年代，当时荷兰对ECT的厌恶情绪强烈，这在很大程度上是对当时ECT不当医疗行为的反应，并受社会文化对精神病学看法的影响。专业人员的消极态度和知识缺乏可能导致老年抑郁症患者ECT治疗使用不足。
向152名老年精神科医生邮寄问卷调查，以评估他们对ECT的看法和态度。
只有极少数人认为ECT是伴有精神病性症状的抑郁症（4%）、严重自杀风险（2%）或身体疲惫（5%）的首选治疗方法。大多数精神科医生对将ECT作为老年抑郁症患者的第一、第二或第三选择治疗方法持强烈保留意见，即使是在难治性抑郁症中。
荷兰许多老年精神科医生背离了当前指南，不愿在一些特定临床情况下将ECT作为首选治疗方法。这可能是荷兰目前及过去老年抑郁症患者ECT治疗使用不足的一个主要因素。
