Read John, Harrop Christopher, Geekie Jim, Renton Julia, Cunliffe Sue
School of Psychology, University of East London, UK.
West London NHS Trust, UK.
Psychol Psychother. 2021 Sep;94(3):603-619. doi: 10.1111/papt.12335. Epub 2021 Mar 16.
To assess progress towards improving the administering of electroconvulsive therapy (ECT) in England since an audit covering 2011, 2013, and 2015. The same information was gathered, for 2019, on usage, demographics, consent, and adherence to national guidelines and the Mental Health Act.
Freedom of Information Act requests were sent to 56 National Health Service Trusts.
Thirty-seven trusts (66%) provided data. The gradual decline in the use of ECT in England has levelled off at about 2,500 people per year. There was a 47-fold difference between the Trusts with the highest and lowest rates per capita. Most recipients are still women (67%) and over 60 (58%). Only one Trust could report how many people received psychological therapy prior to ECT, as required by government (NICE) guidelines. More than a third of ECT (37%) is still given without consent, with 18% of Trusts non-compliant with legislation concerning second opinions. There were slight declines, compared to a previous audit, in the use of standardized depression scales, down to 30%, and standardized measures of cognitive dysfunction, down to 24%. Only six Trusts provided any data for positive outcomes and seven for adverse effects. None provided data on efficacy or adverse effects beyond the end of treatment. Twelve Trusts used identical sentences to each other, verbatim, in response to one or more questions.
Given the apparent failure of current monitoring and accrediting of ECT clinics in England, by the Royal College of Psychiatrists' ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed.
Psychologists and other mental health staff should ensure that people are offered evidence-based psychological treatments before being offered E.C.T. All staff should ensure that patients are fully informed of the high risk of memory loss and the smaller risk of cardiovascular failure and mortality. Individuals receiving ECT should be closely monitored for adverse cognitive effects, and treatment immediately terminated if these become apparent. Because of increased risk of memory loss for women and older people, the use of ECT should be kept to a minimum and avoided where possible, with these two groups.
评估自2011年、2013年和2015年的一项审计以来，英格兰在改善电休克治疗（ECT）管理方面取得的进展。2019年收集了关于使用情况、人口统计学、同意情况以及对国家指南和《精神健康法》的遵守情况的相同信息。
根据《信息自由法》向56家国民保健服务信托机构发出请求。
37家信托机构（66%）提供了数据。英格兰ECT使用量的逐渐下降已趋于平稳，每年约2500人。人均使用率最高和最低的信托机构之间相差47倍。大多数接受者仍然是女性（67%）且年龄在60岁以上（58%）。只有一家信托机构能够按照政府（国家卫生与临床优化研究所）指南的要求报告有多少人在接受ECT之前接受了心理治疗。超过三分之一的ECT治疗（37%）仍然是在未经同意的情况下进行的，18%的信托机构不符合关于提供第二种意见的立法规定。与之前的审计相比，标准化抑郁量表的使用略有下降，降至30%，认知功能障碍的标准化测量指标降至24%。只有6家信托机构提供了任何关于积极结果的数据，7家提供了关于不良反应的数据。没有一家机构提供治疗结束后疗效或不良反应的数据。12家信托机构在回答一个或多个问题时，逐字使用了彼此相同的句子。
鉴于英国皇家精神科医学院的ECT认证服务（ECTAS）目前对英格兰ECT诊所的监测和认证显然失败，迫切需要进行一次由政府发起的独立审查。
心理学家和其他心理健康工作人员应确保在为人们提供ECT之前，先为其提供循证心理治疗。所有工作人员应确保患者充分了解记忆丧失的高风险以及心血管衰竭和死亡的较小风险。接受ECT的个体应密切监测是否有不良认知影响，如果这些影响明显，应立即终止治疗。由于女性和老年人记忆丧失的风险增加，应尽量减少对这两组人群使用ECT，并尽可能避免使用。
