2011b), 16% Wales (Duffett et al. 1999), 18% Ireland (Enriquez et al. 2010), and 19% UK (Department of Health 2007). A-ECT was also practiced in Thailand (Lalitanatpong 2005) but A-ECT and C-ECT rarely were used in Hong Kong (Chung 2003). In India, C-ECT report varied from given to 1–10% to 60% of patients (Chanpattana et al. 2005b). Legislation and guidelines Inhibitors,research,lifescience,medical In Victoria, Australia legislation requires mandatory monthly reports (Teh et al. 2005). In Poland (Gazdag et al. 2009a) and the Chuvash Republic (Golenkov et al. 2010), the presence of an anesthetist under ECT was

mandatory. Locally developed guidelines were described in Norway (Moksnes et al. 2006; Schweder et al. 2011b) and Vienna (Tauscher et al. 1997), and in Belgium less than 44% of departments did not follow guidelines (Sienaert et al. 2005a). Inhibitors,research,lifescience,medical Guidelines were used only by 28% of Japanese institutions (Motohashi et al. 2004). In Hong Kong, a hospital policy of patient assessment every one to two treatments during an ECT course was practiced only sometimes

(Chung et al. 2003). Other—funding and attitudes Over half (57%) funding of ECT in the United States was financed by public third party payment ZSTK474 ic50 source (including Medicare) (Reid et al. 1998). Attitudes of psychiatrists toward Inhibitors,research,lifescience,medical ECT were generally favorable in Europe, for example, in Spain (Bertolin-Guillen et al. 2006), Germany (Muller et al. 1998), Russia (Nelson 2005), and Norway Inhibitors,research,lifescience,medical (Schweder et al. 2011a). Reasons for not prescribing ECT in Europe were attributed to lack of equipment, economy, and difficulties in recruiting anesthetist (Muller et al. 1998; Nelson 2005; Bertolin-Guillen et al. 2006; Schweder et al. 2011b). Main findings of this review are summarized as follows: There is a large variation in ECT utilization and practice worldwide today. Global crude estimates of TPR (age < 65 years) is 2.34, EAR 11.2, iP 6.1, and AvE eight. Only some (usually under half) of all institutions within Inhibitors,research,lifescience,medical the same country provide ECT. Mandatory report of ECT use and monitoring by governmental agents is overall

scant. Reporting of side effects, adverse events, and mortality is sparse. The results reflect that the guidelines by APA and Royal College of Psychiatrists are not internationally acknowledged, except in Western countries, and therefore the lack of implementation Histamine H2 receptor may be rational in these regions of the world. Overall, there is a considerable variation in ECT administration and parameters worldwide. Unmodified ECT is substantially used today, not only in Asia (over 90%), Africa, Latin America, but also occurs in Europe (Russia, Turkey, and Spain). The most common electrode placement is BL, but a few places in Europe and Australia/New Zealand adhere to UL as first choice. Brief-pulse wave current devices are used worldwide, but old sine-wave stimulus and apparatus still in use.