2004). In Thailand, almost all (94%) ECT administration was unmodified (Chanpattana and Kramer 2004). In India, both modified and unmodified ECT was administered (Chanpattana et al. 2005b), 52% of patients received unmodified at 50% of all institutions, and 30% of institutions administered only unmodified. Overall in Asia, only 45% of facilities used modified ECT exclusively (Chanpattana et al. 2010), in Hong Kong 87% modified (Chung et al. 2003), and the Asian Pacific Region (Little Inhibitors,research,lifescience,medical 2003) and Katmandu, Nepal, used only modified (Ahikari et al. 2008). Eight facilities in Asia reported succinylcholine muscle relaxant used routinely without anesthesia (Chanpattana et al.

2010). Anesthesia was also used without muscle relaxants in Japan, and extreme motion from the convulsions held down with aid of assistants restraining Inhibitors,research,lifescience,medical patient’s shoulders, arms, and thighs (Ishimoto

et al. 2000). Overall, 26% Latin American countries used unmodified ECT (Levav and Gonzalez 1996), except for all modified in Rio de Janeiro, Brazil and one country in the Caribbean (Levav and Gonzalez 1996; Pastore et al. 2008). Placement and devices On a worldwide scale, Inhibitors,research,lifescience,medical BL placement was the preferred electrode placement. However, UL placement was the first main choice in Australia and New Zealand (O’Dea et al. 1991; Ministry of Health 2005; Chanpattana 2007; Lamont et al. 2011), likewise to several European countries such as Vienna (Tauscher et al. 1997), Munich Inhibitors,research,lifescience,medical (Baghai et al. 2005), Netherlands (van Waarde et al. 2009), and Norway (Schweder et al. 2011b). In the United States, there was some sine wave (2%) (Prudic et al. 2001) and some UL (16–21%) (Reid et al. 1998; Scarano et al. 2000; Prudic et al. 2001) report, but BL placement (73–79%) and brief-pulse wave current (Reid et al. 1998; Scarano et al. 2000; Prudic et al. 2001) was mainstream. Similarly, brief-pulse wave current devices were dominant Inhibitors,research,lifescience,medical in Europe, except sine-wave current still used in Spain 14% (Bertolin-Guillen et al. 2006), Russia 26% (Nelson 2005),

Belgium 34% (Sienaert et al. 2006), Poland 30% (Gazdag et al. 2009a), Germany 39% (Muller et al. 1998), and Hungary 52% (Gazdag et al. 2004a). Overall electrode placement in Asia was BL (77%) (Chanpattana et al. PDK4 2010). Thailand (Chanpattana and Kramer 2004) and Japan (Motohashi et al. 2004) reported only the use of BL and India 5-Fluoracil research buy always reported the use of BL in 82% (Chanpattana et al. 2005b). In Asia, 58% of institutions used brief-pulse devices and 42% sine wave (Chanpattana et al. 2010). In Japan, the device type was often Japanese-produced Sakai C1, but also some had Thymatron® DGx devices (Somatics, Inc., http://www.thymatron.com) (Chanpattana et al. 2005a). In India, a diversity of devices was in use, including locally made (Chanpattana et al. 2005b). In Katmandu, Nepal, device type was only brief pulse (Ahikari et al. 2008).