Abstract:
Background: Electroconvulsive therapy (ECT) is a non-invasive somatic treatment
that is highly effective for severe mood, catatonic and psychotic disorders but remains
underutilized, with a lot of variations in its use despite the international guidelines
available. There is sparse ECT data across Africa, Kenya included, hence the need for
local studies to add to literature, inform practice and contribute to local or national
guidelines which are currently lacking.
Objective: To determine the indications and clinical outcomes of ECT at Moi
Teaching and Referral Hospital (MTRH).
Methods: A prospective study that was conducted at MTRH Mental Health Unit on
patients undergoing ECT. A minimum sample size of 31 was required, hence a census
was conducted between September 2019 to April 2021, obtaining a sample size of 32.
Participants were assessed twice, within 3 days before and after completion of the
treatment course. Sociodemographic and clinical data were recorded onto a data
collection form. Illness severity was assessed using: Brief Psychiatric Rating Scale
(BPRS) for psychotic disorders, Patient Health Questionnaire-9 (PHQ-9) for
depression, Bush-Francis Catatonia Rating Scale (BFCRS) for catatonia and Mini-
Mental Status Exam (MMSE) for cognitive functioning. Response to ECT and change
in cognitive functioning were determined by the difference between pre-ECT and
post-ECT scores. A checklist was used for non-cognitive adverse effects. Categorical
variables were summarized using frequencies and percentages while mean and
standard deviation were used for continuous variables. Fisher‟s Exact test was used to
test for associations between participants‟ clinical and sociodemographic
characteristics and ECT outcomes.
Results: The mean age of the participants was 29.7 years, 59.4% were male. The
major diagnostic indications were schizophrenia (34.4%) and catatonia (34.4%),
depression was minor (6.3%). The clinical indications were treatment resistance
(75%) and need for a rapid response (25%). Overall, 90.9% of participants had partial
to complete improvement. The only characteristic significantly associated with a good
response was the diagnosis of catatonia (p=0.005). Headache (41.2%) and muscle
aches (29.4%) were common side effects, dental injuries were also relatively common
(17.6%). One patient had cognitive impairment and one mortality occurred secondary
to pulmonary thromboembolism after COVID-19 infection.
Conclusion: ECT in MTRH is used where pharmacotherapy has failed and when a
rapid response is needed to save life. It is more commonly used for psychotic
disorders and catatonia than for mood disorders. It is an effective intervention with
mostly non-severe side effects, however there was a high proportion of dental injuries
and one mortality during the study period.
Recommendations: The continued use of ECT at MTRH but with standard
guidelines to ensure patient safety while maximizing its benefit. The guidelines
should outline all the indications, cover screening procedures for thrombosis,
techniques to limit oral injuries, monitoring of cognitive functioning and other side
effects.