2000), it is not clear if the ECT-related deaths are due to lethal side effects (e.g., cardiac arrhythmia) or comorbid somatic illnesses or anesthetic complications. ECT is administered worldwide under involuntary and guardian consent conditions, ranging from a few percent in USA and Europe 1–3% (Reid et al. 1998; Kramer 1999; Scarano et al. 2000; Bertolin-Guillen et al. 2006; Sundhedsstyrelsen
2011a) to 20–29% (McCall et al. 1992; Muller et al. 1998; Huuhka et al. 2000; Fergusson et al. 2004). Involuntary conditions in the extracted data though cannot be taken Inhibitors,research,lifescience,medical as directly equivalent to or directly indicative of involuntary (against wish) treatment. In Asia, written informed consent is mainly obtained directly or counter signed
by selleck compound family members (Alhamad 1999; Chanpattana and Kramer 2004; Chanpattana et al. 2005a; Naqvi and Khan 2005). Consent given by legal bodies varies from 18% in Inhibitors,research,lifescience,medical Scotland (under the Scottish Mental Health Act) (Fergusson et al. 2004) to 60% in Sydney, Australia (by the Mental Health Review Tribunal) (Lamont et al. 2011). Mandatory ECT data reporting is almost nonexistent and found only in a few places (Texas, USA, and Australia) (Reid et al. 1998; Scarano et al. 2000; Wood and Burgess 2003). Likewise legislature regulating practice, such as obligatory anesthesia (Gazdag et al. 2004a), Inhibitors,research,lifescience,medical obligatory written informed patient consent (Schweder et al. 2011b), ECT licensed facilities (Wood and Burgess 2003), prohibited administered to persons under 16 years of age (Reid et al. 1998), involuntary by order of court or legal body (Fergusson et al. 2004; Lamont et
Inhibitors,research,lifescience,medical al. 2011), is also nonexistent. Implications of findings Worldwide improvement of ECT utilization and practice is needed, alongside Inhibitors,research,lifescience,medical development of an international minimal dataset standard applied in all countries. Continuous and mandatory monitoring and use of ECT health registrar reporting systems, taking into account patient confidentiality, would also ultimately reduce our knowledge gaps. This would again contribute to more uniform worldwide ECT Endonuclease practice, to the best for the patient. Strengths and limitations Strengths of this study are the extensive search strategy, high number of included studies, methodological transparency, and summary of findings table, providing an overview of contemporary worldwide use of ECT, which has not been undertaken in such detail previously. Limitations of this review are the inclusion of nonrandomized survey/questionnaire studies, based on practitioner accounts of ECT use, influencing the precision of the estimated rates, either to be overestimated or underestimated depending on the accuracy of the source. Seemingly, more accurate are direct reports from individual hospitals studies or national registers.