Australian and US Responses to Electroconvulsive Therapy Dosage Selection

Abstract

Objective: The practice of electroconvulsive therapy (ECT) varies considerably across sites with a lack of certainty as to what constitutes seizure adequacy. The aim of this study was to trial a method to explore decision making and to describe any differences between Australian and US practitioners. Method: Two hundred and thirty-six consultant psychiatrists from Australia and US were asked what dosage of electrical energy they would prescribe after reading a standardized clinical vignette in which an unremarked upon change in seizure tracings followed the first two treatments. Results: Considerable variability in the dosage was found with 17.3% decreasing, 46.8% maintaining and 30% increasing charge. Involvement in administration of ECT was unrelated to this decision. Conclusion: Standardized vignettes may be a useful method to assess clinicians’ responses in dosage selection.