Open Access, Peer-reviewed

ISSN 2005-7571 (Online)
Volume 27, Number 2 (2/2020)
Review Article <page. 64-73 >
DOI : 10.22857/kjbp.2020.27.2.004

The Electroconvulsive Therapy in the Prevention of Suicide Risks and Attempts

Hee Cheol Kim, MD1;Seong Hoon Jeong, MD2;Yong Min Ahn, MD3;Seung Hyun Park, MD4;Yong Sik Kim, MD5; and In Won Chung, MD6;

1;Department of Psychiatry, Keimyung University School of Medicine, Daegu, 2;Department of Psychiatry, Eulji University Hospital, Daejeon, 3;Department of Psychiatry and Institute of Human Behavioral Medicine, National University Hospital, Seoul National University College of Medicine, Seoul, 4;Daedong Hospital, Daegu, 5;Department of Psychiatry, Nowon Eulji University Hospital, Seoul, 6;Department of Psychiatry and Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Korea

Suicidality is the most serious complication of mood disorders and psychosis; effective treatment should reduce suicide rates. The Organization for Economic Cooperation and Development age-standardized suicide rate in Korea was 22.6 in 2018, much higher compared to other countries worldwide. As mental and psychiatric problems are the main reasons for suicide attempts, accounting for 31.6% in 2018, targeting such problems should be the focus of efforts to reduce suicide rates. However, the ability of current pharmacotherapeutic and psychotherapeutic interventions to reduce suicide rates is limited due to their delayed effects. Therefore, electroconvulsive therapy (ECT) has been proposed as an alternative treatment. This approach is effective for treating most mental disorders associated with high suicide rates, including severe depression, bipolar disorder, and intractable psychotic disorders; ECT is also effective for Parkinson's disease, which has the highest suicide rate among all disorders in Korea. The acute, long-term, and prophylactic effects of ECT on suicidality have been reported in the literature, and treatment guidelines outside of Korea recommend that ECT be used at an early stage for rapid reduction of suicide rates, as opposed to being applied as a treatment of last resort. However, only ~0.092 of every 10000 members of the Korean general population received ECT in 2018; this is much lower than the average rate worldwide, of 2.2 per 10000. Elimination of obstacles to the use of ECT, early crisis intervention involving administration of ECT for rapid stabilization, and maintenance ECT to prevent recurrence should reduce suicide rates.


Key words : Mental health;Crisis intervention;Suicidality;Electroconvulsive therapy.

PSYCHIATRY INVESTIGATION

This Article