Indications and clinical outcomes of electroconvulsive therapy at Moi Teaching and Referral Hospital, Eldoret, Kenya

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.