In the tri-state New York City metropolitan region, 55% of institutions provided ECT (Prudic et al. 2001), 33% in Texas (Reid et al. 1998), and 44% of all psychiatric hospitals in North Carolina (Creed et al. 1995). A decrease from 1990 to 1994 in provision of ECT was reported in California and ECT provided by public institutions

to be very low, <6% (Kramer 1999). In Europe, ECT provision in the Netherlands was 23% (van Waarde et al. 2009), Belgium nationwide 22% (Sienaert et al. 2006), Flanders and Brussels capital region 26% (Sienaert et al. 2005a), Poland 34% (Gazdag et al. 2009a), Spain and Russia 46% (Nelson 2005; Bertolin-Guillen et al. 2006), France 51% (Benadhira and Teles 2001), Hungary 57% (Gazdag #BcrAbl inhibitor keyword# et al. 2004a), Germany 59% (Muller Inhibitors,research,lifescience,medical et al. 1998), Norway 72% (Schweder et al. 2011a), and in Denmark 100% (Andersson and Bolwig 2002). In Norway, patients had to wait up to eight weeks for treatment due to a low capacity in administrating ECT (Schweder et al. 2011b). ECT was mainly performed by junior doctors

in Denmark (Andersson and Bolwig 2002), England (Duffett and Lelliott 1998), and Norway (Schweder et al. 2011b). In Norway, 6% of ECTs were administered by nurses (Schweder et al. 2011b) and in the Netherlands sometimes by geriatricians or physicians (van Waarde et al. 2009). About one-third of clinics in England had developed clear policies Inhibitors,research,lifescience,medical to help guide junior doctors in administering ECT effectively (Duffett and Lelliott 1998). ECT teaching programs were found at 59% of institutions in India (Chanpattana et al. 2005b), and 78% in Japan, but rated Inhibitors,research,lifescience,medical in 10% as fair to poor (Chanpattana et al. 2005a). Acceptable ECT training in Thailand was only found for five hospitals (Chanpattana and Inhibitors,research,lifescience,medical Kramer 2004). In Saudi Arabia, a two-lecture course on ECT was given every year for junior doctors, as well as practical demonstration and training (Alhamad 1999). Diagnoses and diagnostic indication

Main diagnoses, diagnostic indication for ECT in Australia, New Zealand, USA, South America, and Africa, are illustrated in Figure 4. Figure 4 Diagnoses and ECT in Australia, New Zealand, USA, South America, Africa. Affective disorder (unipolar/bipolar depression) was the main diagnoses in the Australia and New Zealand (O’Dea et al. 1991; Wood and Burgess 2003; Teh et al. 2005; Chanpattana 2007; Lamont et al. 2011), but other main indications for administering ECT were also noted (Lamont et al. 2011), such as being too distressed to await drug response, patient preference, previous response, life saving, and medication resistance. Affective disorders (unipolar/bipolar depression) were also the main diagnoses in USA (72–92%), and schizophrenia and/or schizoaffective disorders were much less (8–29%) (McCall et al. 1992; Hermann et al. 1995; Rosenbach et al. 1997; Reid et al. 1998; Scarano et al. 2000; Sylvester et al. 2000; Prudic et al. 2001).