PURPOSE:This study aims to examine attitudes toward LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and more) physicians among Thai psychiatric patients and to identify associated factors across three regions of Thailand. PATIENTS AND METHODS:A cross-sectional survey was conducted from June to August 2023 in Central, Northern, and Southern Thailand. The Attitudes Toward LGBTQ+ Physician Questionnaire and a patient-doctor relationship questionnaire were utilized. Data analysis involved descriptive statistics and linear regression. RESULTS:The study included 543 participants with a median age of 37 years (IQR 26-52), predominantly female (68.9%) and Buddhist (78.1%). The median score for perceived attitudes toward LGBTQ+ physicians was 86 (IQR 73.0-95.5), with significant regional variations. Most participants perceived LGBTQ+ physicians as normal (85.5%) and integral to society (94.5%). A significant portion disagreed with the idea that being an LGBTQ+ physician was sinful (85.3%) or immoral (84.0%). However, 20.3% expressed discomfort with the possibility of LGBTQ+ physicians conducting private physical examinations. Lower perceived attitudes were associated with older age and being Muslim. Conversely, higher education, female gender, having LGBTQ+ connections, and a reported gender non-conformity showed a correlation with more positive attitudes. CONCLUSION:Thai psychiatric patients generally hold positive attitudes toward LGBTQ+ physicians, though demographic factors influence these attitudes. There needs to be a particular focus on improving attitudes regarding conducting private physical examinations to maximize patient comfort and trust.

Background The prevalence of depression in medical students was greater than in the general population. Knowing of predictive factors for depression among medical students is useful. The objectives of this study included the assessment of personality traits as well as the association between the personality traits and the presence of symptoms of depression, and suicidal ideation among medical students covering several regions of Thailand.Methods From April to July 2023, a cross-section study was conducted. The participants included first to sixth-year medical students studying at three Faculties of Medicine in Thailand; Prince of Songkla University; Ramathibodi Hospital, Mahidol University; and Chiang Mai University. Using the online process, the questionnaires were composed of three sections; demographic data; the International Personality Item Pool-NEO (IPIP-NEO), Thai version; and the Patient Health Questionnaire-9 (PHQ-9), Thai version. Demographics, personality traits, depression, and suicidal ideation were analyzed using descriptive statistics. The results were presented as frequency, mean, and standard deviation (SD) or median and interquartile range (IQR). The association between independent variables and the presence of depression was identified using binary logistic regression analysis, and the association with suicidal ideation was identified using ordinal logistic regression analysis.Results The 868 medical students participated in this study. Most of them were female (63.5%), Buddhist (82.0%), and first-year medical students (31.8%). The mean age (SD) was 20.8 (2.2) years, and the mean cumulative Grade Point Average (SD) was 3.5 (0.4). They reported the median (IQR) score of PHQ-9 as 6.0 (3.0-9.0), 238 participants (27.4%) presented with depression, and 138 (15.9%) participants reported suicidal ideation. According to the IPIP-NEO, participants with depression or suicidal ideation had higher Neuroticism scores and lower Extraversion, Agreeableness, and Conscientiousness scores compared to those without such issues. An increase in the Neuroticism score was linked to higher odds of depression, while an increase in the Conscientiousness score was associated with lower odds of depression. Suicidal ideation significantly increased with higher Neuroticism scores and the presence of a psychiatric illness.Conclusions More than a quarter of Thai medical students reported depression. A higher Neuroticism and lower Extraversion, Agreeableness, and Conscientiousness scores related to depression. Therefore, medical schools may benefit from knowing medical students' personality traits, to identify coping mechanisms and predict those at a higher risk of developing depression in the future.

BACKGROUND:Nursing school is a stressful environment that demands high performance both professionally and academically. Interpersonal mindfulness training has shown promise for its stress-reducing capacity in other contexts; however, few descriptions or tests of this method in nursing training settings exist in the literature. PURPOSE:This pilot study examined effects of a brief interpersonal mindfulness program embedded in a 4-week psychiatric nursing practicum in Thailand. METHODS:Mixed methods were used with 31 fourth-year nursing students to measure changes in mindfulness and assess their experiences of the program's impact. The control and experimental groups received the same clinical training, but the experimental group was also trained to practice interpersonal mindfulness throughout the course. FINDINGS:The experimental group reported statistically significantly greater increases in Observing, Describing, and Non-reacting subscale scores, and in scores for the overall Five-Facet Mindfulness questionnaire, Thai version, than the control group (p < .05, Cohen's d = 0.83-0.95, large effect sizes). Group interviews revealed themes: initial challenges to mindfulness practice, experiences of becoming more mindful, intrapersonal benefits, and consequences of mindfulness on interpersonal skills. CONCLUSION:Overall, an interpersonal mindfulness program embedded in a psychiatric nursing practicum was effective. Further studies are required to address limitations of the present study.

Objective To examine the effect of continuation-maintenance electroconvulsive therapy (ECT) on psychiatric hospitalization in Thai patients. Methods This retrospective mirror-image study reviewed medical records of Thai patients who received continuation-maintenance ECT at Ramathibodi Hospital, Bangkok, between September 2013 and December 2022. The initiation of continuation-maintenance ECT served as the index event, establishing pre-initiation and post-initiation periods. The primary outcome measured the differences in admissions and admission days before and after continuation-maintenance ECT. Results Forty-seven patients were included in the study, with diagnoses of schizophrenia (38.3%), schizoaffective disorder (21.3%), and bipolar disorder (19.1%) being the most common. The mean (standard deviation; SD) age was 44.6 (12.2) years. The total duration that patients received continuation-maintenance ECT was 53 ± 38.2 months. Following the initiation of ECT, there was a significant reduction in the median (interquartile range) number of hospitalizations for all patients (2 [2] versus 1 [2], p < 0.001), as well as for the psychotic disorder group (2 [2] versus 1 [2.75], p = 0.006) and the mood disorder group (2 [2] versus 1 [2], p = 0.02). Moreover, there was a significant reduction in the median (interquartile range) length of admission days for all patients after the initiation of continuation-maintenance ECT (66 [69] versus 20 [53], p < 0.001). Specifically, the psychotic disorder group (64.5 [74] versus 15.5 [62], p = 0.02) and mood disorder group (74 [57] versus 20 [54], p = 0.008) demonstrated statistically significant decreases in admission days. Conclusion Continuation-maintenance ECT may be an effective treatment option for reducing hospitalizations and admission days in patients with various psychiatric diagnoses. However, the study also highlights the need to carefully consider the potential adverse effects of ECT in clinical decision-making.

BackgroundSchizophrenia is a severe mental illness and a common indication for electroconvulsive therapy (ECT). Research is lacking on the factors that influence response to acute ECT treatment in schizophrenia patients. AimsThis study examined the response rate and associated factors in patients with schizophrenia undergoing bilateral ECT. MethodDemographic data, clinical characteristics, ECT data and treatment response were respectively reviewed in patients with schizophrenia undergoing bilateral ECT from January 2013 to June 2022. ResultsForty-six patients were included. Nine responded after the first three sessions, 17 after six sessions, 20 after nine sessions, 25 after 12 sessions and 28 after the last ECT session, cumulatively. The mean of the baseline Brief Psychiatric Rating Scale psychotic symptom subscale score was significantly higher in responders (17.0) than non-responders (10.9) (P < 0.05). The mean of duration of electroencephalogram seizure was significantly longer in responders (53.9) than in non-responders (42.7). There was no association between demographic and ECT data and treatment response. Among 28 responders, 20 responded to ECT after nine sessions (faster responders) and eight responded later (slower responders). The number of failed antipsychotics prior to ECT was 2.8 for faster responders and 4.4 for slower responders (P = 0.02). Nominal logistic regression showed that the number of failed antipsychotics prior to ECT was associated with speed of response to ECT (P = 0.037, odds ratio = 1.77). ConclusionsECT is an effective treatment for schizophrenia and may be influenced by the number of failed antipsychotics prior to ECT.

Objective: To determine the level of and factors associated with empathy among medical students.Materials and Methods: This cross-sectional study surveyed all first- to sixth-year medical students at the Facultyof Medicines, Prince of Songkla University, at the end of the 2020 academic year. The questionnaires consisted of:1) The personal and demographic information questionnaire, 2) The Toronto Empathy Questionnaire, and 3) ThaiMental Health Indicator-15. Data were analyzed using descriptive statistics, and factors associated with empathylevel were assessed via chi-square and logistic regression analyses.Results: There were 1010 participants with response rate of 94%. Most of them were female (59%). More than half(54.9%) reported a high level of empathy. There was a statistically significant difference in empathy levels betweenpre-clinical and clinical medical students; in regards to empathy subgroups (P-value < 0.001). The assessment ofemotional states in others by demonstrating appropriate sensitivity behavior, altruism, and empathic respondingscores among the pre-clinical group were higher than those of the clinical group. Multivariate analysis indicatedthat female gender, pre-clinical training level, and minor specialty preference were factors associated with empathylevel. The protective factor that significantly improved the level of empathy was having fair to good mental health.Conclusion: More than half of the surveyed medical students reported a high level of empathy. The protective factorthat improved the level of empathy was good mental health. However, future qualitative methods, longitudinalsurveillance, or long-term follow-up designs are required to ensure the trustworthiness of these findings.

Objective To determine the characteristics of electroconvulsive therapy (ECT) practice in Thailand. Methods A cross-sectional survey of ECT practice in Thailand was conducted. A questionnaire was sent to all 34 hospitals providing ECT services nationwide. ECT staff of each hospital were asked to complete the questionnaire. Results All 34 hospitals responded to the survey. The most common diagnosis was schizophrenia (5,958 patients/year), followed by bipolar disorder (982 patients/year) and major depressive disorder (869 patients/year). Brief pulse device was used in all hospitals. Bitemporal ECT was the most common type of electrode placement (88.2%), followed by bifrontal (44.1%) and right unilateral (38.2%) placement. The initial dose was determined by titration method in 24 hospitals (70.6%) and by age-based method in the remainder (29.4%). Modified ECT was always used in 25 hospitals (73.5%), including all university hospitals, 6 psychiatric hospitals (17.6%) and 10 general hospitals (29.4%). The primary anesthetics used were thiopentone (60.7%) and propofol (39.3%). Regarding acute ECT, ECT was performed three times per week in most hospitals (91.2%). The number of acute ECT treatment sessions in most hospitals was in the range of 4–6. In total, 22 hospitals (64.7%) performed continuation/maintenance ECT. Headache was the most common adverse event, followed by cognitive side effects and myalgia. Conclusion ECT practice in Thailand has developed over the past two decades in many aspects. The most notable change is that the majority of patients are now treated with modified ECT. In addition, pre-treatment investigations, use of a device providing a brief pulse, unilateral electrode placement, and the monitoring of parameters during treatment are now used more widely in practice to maximize treatment efficacy while minimizing side effects. However, certain aspects of ECT can still be improved; promoting ECT education among psychiatrists and psychiatry residents could improve the quality of practice, for example.

Introduction:Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and treatment principles to optimize the management TRD in SEA.Methods:Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.Results:The expert panel agreed that "pharmacotherapy-resistant depression" (PRD) is a more suitable term for TRD and defined it as "failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode". A stepwise treatment approach should be employed for the management of PRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD.Conclusion:These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD.

Background: Coronavirus disease 2019 (COVID-19) vaccinations have been proven to prevent hospitalization and mortality. However, some caregivers may be hesitant to authorize COVID-19 vaccination of people under their care. Our study aimed to evaluate factors associated with caregiver hesitancy to authorize vaccination of dependent older adults. Method: We conducted a cross-sectional telephone survey of vaccine hesitancy among caregivers of dependent older patients in the geriatric clinic of Ramathibodi Hospital. Caregivers were contacted and interviewed by trained interviewers from 20 June to 25 July 2021. Results: The study enrolled 318 participants with a mean age of 55.9 years. The majority of the participants were the patients’ children (86.5%). In total, 39.9% of participants were hesitant to authorize COVID-19 vaccination of the older adults under their care. Factors associated with caregiver vaccine hesitation were uneasiness, anxiety, agitation, sadness, and worry in association with social distancing, refusal to receive a COVID-19 vaccine, and concern about vaccine manufacturers. Conclusion: The prevalence of caregiver hesitancy to allow older adults to undergo COVID-19 vaccination was relatively high, and several factors associated with this vaccine hesitancy were identified. These findings may aid efforts toward COVID-19 vaccination of dependent older adults.

Abstract Background The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. Methods A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. Results Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification – incorporating both severity and temporality, or using a prevention-focused risk formulation – should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. Conclusions There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.

Objective: Older people are the most vulnerable group for developing SARS-CoV-2 infection. Although vaccination against coronavirus disease 2019 (COVID-19) reduces infection, hospitalization, and mortality rates, some older people have refused to get vaccinated. Our study aimed to evaluate factors associated with COVID-19 vaccine hesitancy among Thai seniors. Methods: We conducted a cross-sectional telephone survey on vaccine hesitancy in a geriatric clinic at Ramathibodi Hospital in Bangkok, Thailand. Patients aged >= 60 years were contacted and interviewed by trained interviewers between June 20 and July 25, 2021. Results: In total, we interviewed 282 participants aged 60-93 years (mean age 73.0 +/- 7.5 years). We found that 44.3% of participants were hesitant to get a COVID-19 vaccination. Factors associated with high vaccine hesitancy were low education, lack of confidence in the healthcare system's ability to treat patients with COVID-19, vaccine manufacturers, being offered a vaccine from an unexpected manufacturer, and a low number of new COVID-19 cases per day. Conclusion: The prevalence of COVID-19 vaccine hesitancy among Thai seniors is relatively high, and is associated with specific factors. These findings will help in promoting COVID-19 vaccination among Thailand's senior citizens.

Data and information of all participants in research "Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: A randomized double-blind controlled trial"

The study aimed to compare the effectiveness and safety of other atypical antipsychotics (non-clozapine) plus electroconvulsive therapy (ECT) (NC+ECT) versus clozapine plus ECT (C+ECT) for treating treatment-resistant schizophrenia (TRS). Data of 32 patients with TRS who was receiving ECT were analysed. We compared clinical characteristics, response to treatment [defined as an improvement of 40% in the Brief Psychotic Rating Scale (BPRS) psychotic symptom subscale from pretreatment scores], change of Mini-mental Status Exam (MMSE) scores, and other adverse effects between the NC+ECT group (N= 16) and C+ECT group (N =16). We found that the overall response rate was 65.6% (75.8% for the NC+ECT group and 56.3% for the C+ECT group, p=0.26). The overall BPRS score in both groups decreased significantly. The mean difference in total BPRS psychotic subscale score between pre-ECT and after last ECT was 10.4 + 5.8 (p<0.001) for the NC+ECT group and 6.6 + 7.3 (p = 0.002) for the C+ECT group. When comparing the NC+ECT group to the C+ECT group, the mean difference in total BPRS psychotic subscale score was not significant. (p = 0.104). The mean difference in MMSE score between pre-ECT and after the last ECT was -1.1 + 5.1 (p =0.45) for the NC+ECT group and 0.2 + 4.3 (p=0.855) for the C+ECT group. The change of MMSE score in the NC+ECT group was not significant different compare to the C+ECT group (p = 0.461). We concluded the combination of antipsychotics and ECT is an effective and safe treatment option for patients with TRS. Other NC+ECT groups’ efficacy may be comparable to that of clozapine plus ECT.

Abstract Background Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders, but is associated with acute hyperdynamic responses including transient hypertension and tachycardia. This study aimed to assess the effectiveness of premedication with dexmedetomidine for hemodynamic attenuation after ECT and to evaluate its effects on seizure duration, postictal asystole duration, post ECT agitation and recovery time. Methods Twenty-four psychiatric patients who underwent a total of 72 ECT sessions (three sessions per patient) were randomly allocated to receive either dexmedetomidine 0.5 mcg/kg intravenous, dexmedetomidine 1 mcg/kg intravenous, or saline (control group) 15 min before the first ECT session. The patients subsequently received the other two premedication options for their next two ECT sessions. Blood pressure and heart rate were recorded at 5, 10, and 15 min after drug infusion and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after ECT. Asystole duration, seizure duration, post ECT agitation and recovery times were also recorded. Results The baseline characteristics were similar between the groups. Systolic blood pressure in both dexmedetomidine groups was significantly lower than that in the control group after ECT (p = 0.002). Diastolic blood pressure and heart rate were significantly lower in the dexmedetomidine 1 mcg/kg group (p = 0.002 and p = 0.013, respectively) compared with the control group. Asystole duration, seizure durations, post ECT agitation and recovery times were similar between the groups. Conclusions Dexmedetomidine 1 mcg/kg administered 15 min before ECT attenuated the hemodynamic response, including suppressing the systolic, diastolic and heart rate increases, during ECT without affecting recovery time. It also did not prolong the post-stimulus asystole duration. Trial registration TCTR20170715003 , registered at Thai Clinical Trials Registry (TCTR), principal investigator: Pattika Subsoontorn, date of registration: 15/07/2017.

Objective: To evaluate the effects of low-dose fentanyl combined with a reduced dose of propofol on seizure duration and hemodynamic response during electroconvulsive therapy (ECT). Materials and Methods: Twenty-two patients with the American Society of Anesthesiologist Physical Status II to III undergoing ECT were enrolled in the present study. One hundred and five bilateral ECT sessions randomized to receive thiopental 2 mg/kg, propofol 1 mg/kg, and fentanyl 0.3 mcg/kg, followed by propofol 0.5 mg/kg. Succinylcholine 0.5 mg/kg was used for muscle paralysis. Seizure duration, awakening time and hemodynamic changes were compared between groups. Results: One hundred and five bilateral ECT treatments were randomized into thiopental group (n=35), propofol group (n=35), and fentanyl plus propofol group (n=35). The thiopental and fentanyl plus propofol groups had longer EEG and motor seizure durations than the propofol group, but the differences were not statistically significant. There was no difference in stimulus intensity across groups. However, fentanyl plus propofol group had statistically significant prolonged awakening time compare with thiopental group [mean difference 2.71, (95% CI 0.37 to 5.06, p=0.019)] and propofol group (mean difference 2.77, 95% CI 0.42 to 5.12, p=0.016). Only systolic blood pressure in propofol group was significantly lower than thiopental group [mean difference –10.4, (95% CI –19.4 to –1.38, p=0.018)]. There were no significant differences in diastolic blood pressure (df=2, F=2.546, p=0.083), heart rate (df=2, F=0.596, p=0.553), or oxygen saturation across group (df=2, F=2.914, p=0.059). Conclusion: Using a combination of low-dose fentanyl and low-dose propofol during ECT could be beneficial. Further investigation is needed to establish the optimal dose of propofol and fentanyl. Keywords: Electroconvulsive therapy; Fentanyl, Hemodynamic response; Propofol; Thiopental; Seizure duration

1Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Objective: Older people are the most vulnerable group for developing SARS-CoV-2 infection. Although vaccination against coronavirus disease 2019 (COVID-19) reduces infection, hospitalization, and mortality rates, some older people have refused to get vaccinated. Our study aimed to evaluate factors associated with COVID-19 vaccine hesitancy among Thai seniors. Methods: We conducted a cross-sectional telephone survey on vaccine hesitancy in a geriatric clinic at Ramathibodi Hospital in Bangkok, Thailand. Patients aged ≥60 years were contacted and interviewed by trained interviewers between June 20 and July 25, 2021. Results: In total, we interviewed 282 participants aged 60–93 years (mean age 73.0±7.5 years). We found that 44.3% of participants were hesitant to get a COVID-19 vaccination. Factors associated with high vaccine hesitancy were low education, lack of confidence in the healthcare system’s ability to treat patients with COVID-19, vaccine manufacturers, being offered a vaccine from an unexpected manufacturer, and a low number of new COVID-19 cases per day. Conclusion: The prevalence of COVID-19 vaccine hesitancy among Thai seniors is relatively high, and is associated with specific factors. These findings will help in promoting COVID-19 vaccination among Thailand’s senior citizens.

Objective: To study predictors of the number of electroconvulsive therapy (ECT) sessions required for symptom remission in psychiatric patients. Patients and Methods: We conducted chart reviews for 95 patients whose condition remitted following inpatient ECT. We analyzed the clinical characteristics of the patients and compared the number of ECT sessions between adult (age 18-59 years) and elderly (age >= 60 years) patients. Results: The overall mean +/- SD of the number of ECT sessions was 11.8 +/- 4.7 (range: 6-24). By diagnosis, it was 13.3 +/- 5.5 for individuals with schizophrenia, 10.1 +/- 2.7 for schizoaffective disorder, 14.4 +/- 5.6 for bipolar depression, 9.4 +/- 1.9 for bipolar mania, 10.9 +/- 4.3 for major depressive disorder (MDD), and 11.8 +/- 4.3 for those with other diagnoses. For MDD, the number of ECT sessions in elderly patients (13.4 +/- 4.6) was statistically greater than that in adult patients (9 +/- 2.9) (p = 0.008). Conclusion: The number of ECT sessions varied by age and diagnosis. The number of ECT sessions in elderly MDD patients was higher than that in adult MDD patients.

Pichai Ittasakul Siraprapha Vora-arporn 1 Punjaporn Waleeprakhon Phern-Chern Tor 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Mood and Anxiety, Institute of Mental Health, Singapore Objective: To study predictors of the number of electroconvulsive therapy (ECT) sessions required for symptom remission in psychiatric patients. Patients and Methods: We conducted chart reviews for 95 patients whose condition remitted following inpatient ECT. We analyzed the clinical characteristics of the patients and compared the number of ECT sessions between adult (age 18–59 years) and elderly (age ≥ 60 years) patients. Results: The overall mean ± SD of the number of ECT sessions was 11.8 ± 4.7 (range: 6–24). By diagnosis, it was 13.3 ± 5.5 for individuals with schizophrenia, 10.1 ± 2.7 for schizoaffective disorder, 14.4 ± 5.6 for bipolar depression, 9.4 ± 1.9 for bipolar mania, 10.9 ± 4.3 for major depressive disorder (MDD), and 11.8 ± 4.3 for those with other diagnoses. For MDD, the number of ECT sessions in elderly patients (13.4 ± 4.6) was statistically greater than that in adult patients (9 ± 2.9) (p = 0.008). Conclusion: The number of ECT sessions varied by age and diagnosis. The number of ECT sessions in elderly MDD patients was higher than that in adult MDD patients.

Objectives This study aimed to compare the accuracy of the stimulus intensity (SI) calculated by age-based methods with that using the dose-titration method. Methods The initial seizure threshold (IST) was determined using a standardized dose titration in hospitalized Thai patients treated with right unilateral (RUL, n=32) and bilateral (BL, n=57) electrode placement. The correlation between the IST and clinical variables was analyzed. The estimated SI based on the patient’s age was compared with the SI determined by dose titration. Results Age was highly predictive of the IST for both groups (RUL, P=0.012; BL, P=0.045). Gender (P=0.006) and anticholinergic drug use (P=0.025) predicted the IST for the BL group. For the RUL group, the mean±SD (median) SI estimated using the half-age and age methods was 158±46 (169) mC and 315±92 (338) mC, respectively. The SI determined using the dose-titration method was higher compared with the half-age method and lower compared with the age method. For the RUL group, 31% of subjects using the half-age method and 22% of subjects using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 19% of subjects using the half-age method and 19% using the age method would have received unacceptably low (<50%) or high (>200%) intensities. For the BL group, 18% of subjects using the half-age method and 32% using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 39% with the half-age method and 18% with the age method would have received an unacceptably low or high SI, respectively. Conclusion Age strongly predicts the IST, but it does not robustly predict the SI compared with dose titration because the SI calculated using age-based methods results in an unacceptably low or high SI that is associated with a marked risk of adverse effects or inadequate response. We recommend the dose-titration method to determine the SI.

Objective : To assess the efficacy of ketamine plus electroconvulsive therapy (ECT) compare with ECT alone for treatment of major depressive episode in major depressive disorder and bipolar disorder Method : A double-blind randomized control trial was conducted between July 2015 to July 2016. Subjects included patients with major depressive episode who received inpatient ECT at department of psychiatry, Ramathibodi Hospital, Bangkok.Twelve patients were randomized into 2 groups, the experimental group received ketamine 0.5 mg/kg plus ECT (n =7) and control group received ECT alone(n =5). Montgomery-Asberg depression scale (MADRS) was used to assess depressive symptoms at baseline, after first ECT, after third, then after three consecutive ECTs until the end of treatment. Hemodynamic changes and adverse events were recorded. Results : MADRS score of experimental group had greater decrease than control group after third ECT evaluation (p=0.047). Remission rate after sixth ECT evaluation in experimental group was higher than control group (p=0.048). No statistical significance between control and experimental group was detected in hemodynamic changes and adverse events. Conclusion : Intravenous injection of ketamine 0.5 mg/kg plus ECT could accelerate the effect of ECT in depressive patients during the initial phase. But ketamine injection does not increase the effect of ECT at the end of treatment.