ECT in Finland Kaija Jrventausta MD Ph D

ECT in Finland Kaija Järventausta MD, Ph. D Psychiatrist Tampere University Hospital

ECT in Finland • • First remarks of ECT in Finland 1941 At present we have 29 ECT units in Finland We have no national guidelines Finnish Käypä Hoito -guideline recommends ECT for severe, psychotic and treatment resistant depression • We have an active ECT community in Finland via Google groups • We are starting regular ECT ”Hands-On” -courses in Finland this autumn • First course takes place in Tampere in August 30. -31. this year 2 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

ECT research in Scandinavia Pub. Med search: ”ECT” or ”Electroconvulsive therapy” and ”humans” search (12128) + country: • • • 3 6. 11. 2020 Denmark 76 publications Sweden 73 publications Finland 50 publications Norway 49 publications Iceland 4 publications Estonia 1 publication Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

Hospital districts and treated ECT patients n/100 000 inhabitants • ECT-treatment is available in every District in Finland • Regional differences are significant • The amount of ECT patients varies from 7, 5 to 52, 9 / 100 000 inhabitants • Finland mean 23 ECT patients / 100 000 inhabitants In Finland ECT is given less than in Denmark 31 / 100 000 Sweden 41 / 100 000 Estonia 28 / 100 000 Norway 24 / 100 000 inhabitants 4 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

ECT in Finland • An electronic survey was sent to the all ECT-units in Finland in 2014 • Patients receiving ECT n=1023, 58% women • Patients receiving maintenance ECT 301 (29. 4 %) • ECT sessions 10806 (10. 6 / patient) • Patients under age 18 years are rarely treated with ECT; only 8 patients (0. 90%), all women • Adult patients (18 to 64 years) get ECT in Finland 618 persons (68. 4%) 5 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

Patients – age and sex distribution Age <18 18 -64 >65 6 6. 11. 2020 Women 8 320 197 525 (58, 1%) Men 0 298 79 377 (41. 9 %) Pirkanmaan sairaanhoitopiiri – Esittäjän nimi 0. 9 % 68. 4 % 30. 6 %

Indications of ECT in Finland 7 • Psychotic depression • Unipolar depressive episode • Bipolar depressive episode 21. 6 % 30. 9 % 10. 2 % 62. 7% • Schizophrenia • Schizo-Affective dis. 5. 2 % 3. 0 % 7, 2% • Delirium 0. 3 % 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

Legal aspects and availability Legal aspects • Written information 86 % • Compulsory ECT treatment had been given in 25 % of the ECT units • Written informed consent is not required Availability • 75 % units report, that they can treat all patients who need ECT • Most ECT: s are given in recovery room of surgical unit, 1/3 has a separate ECT unit 8 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

Methods and facilities • ECT is given mostly by a doctors, nurses give ECT in three units (n=3) • Most common electrode placement • Bilateral 59 % • RUL 36 % • Bifrontal 5% • Treatment dose adjustment • Age based 75 % • Seizure treshold 21 % • Other 4% 9 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

Conclusion • ECT is available all over the country • There a big differences of ECT usage over the country • ECT is given in Finland half of that in Sweden compared to population • Bitemporal electrode placement remains still most common technique • After this survey the ECT community has been more active in Finland ECT is developing rapidly 10 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

The Research Group Petri Sumia, MSc (tech. ), Tampere University, Medical School 11 Niko Seppälä, MD, Ph. D Tampere University Hospital Juha Moring, MD, Ph. D, assoc. Prof. NIHW Jukka Ritschkoff, MD, Helsinki University Hospital Tarja Tammentie-Saren, Ph. D (nurse) Tampere University Hospital Esa Leinonen, Professor of Psychiatry, Tampere Univeristy Medical School and Tampere University Hospital Kaija Järventausta, MD, Ph. D, Tampere University Hospital 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi

References J. E. Andersson, T. G. Bolwig "Electroconvulsive therapy in Denmark 1999 - A nation-wide questionnaire study" Ugeskr Laeger, Vol. 164, pp. 3449 – 3452, 2002 "Årsrapport 2013 - Kvalitetsregister ECT" Rapport av Registercentrum Västra Götaland: Göteborg, p. 43, 2014, ISSN 2001 -6751 P. Nordanskog, M. Hultén, M. Landén, J. Lundberg, L. Knorring, and A. Nordenskjöld. "Electroconvulsive Therapy in Sweden 2013 Data From the National Quality Register for ECT". Journal of ECT, Decemper 31(4) p. 263 -7, 2015 L. J. Schweder, S. Lydersen, B. Wahlund, et al. "Electroconvulsive therapy in Norway. Rates of use, clinical characteristics, diagnoses, and attitude" Journal of ECT. Vol 27, pp. 292– 295, 2011 L. J. Schweder, B. Wahlund, P. Bergsholm, et al. "Questionnaire study about the practice of electroconvulsive therapy in Norway" Journal of ECT, Vol 27, pp. 296 – 299, 2011 Lõokene M, Kisuro A, Mačiulis V, Banaitis V, Ungvari GS, Gazdag G. Use of electroconvulsive therapy in the Baltic states. World J Biol Psychiatry. 2014 Jul; 15(5): 419 -24 12 6. 11. 2020 Pirkanmaan sairaanhoitopiiri – Esittäjän nimi