The Clinical Alliance and Research in Electroconvulsive Therapy Network: An Australian Initiative for Improving Service Delivery of Electroconvulsive Therapy.

OBJECTIVE: There is currently substantial heterogeneity in electroconvulsive therapy (ECT) treatment methods between clinical settings. Understanding how this variation in clinical practice is related to treatment outcomes is essential for optimizing service delivery. The Clinical Alliance and Research in ECT Network is a clinical and research framework with the aims of improving clinical practice, enabling auditing and benchmarking, and facilitating the collection of naturalistic clinical data. METHODS: The network framework and clinical and treatment variables collected and rationale for the use of particular outcome measures are described. Survey results detailing the use of ECT across initial participating clinical centers were examined. RESULTS: The data are reported from 18 of 22 participating centers, the majority based in Australia. Melancholic unipolar depression was the most common clinical indication (78%). Right unilateral (44%) and bifrontal (39%) were the most commonly used electrode placements. Eighty one percent of the centers used individual seizure titration for initial dosing. CONCLUSIONS: There was substantial heterogeneity in the use of ECT between participating centers, indicating that the Network is representative of modern ECT practice. The Clinical Alliance and Research in ECT Network may therefore offer the opportunity to improve service delivery and facilitate the investigation of unresolved research questions pertaining to modern ECT practice.

Relationship between anxiety and quality of life in older mental health patients.

AIM: This study aims to investigate the impact of anxiety on quality of life (QOL) in older people with mental disorders. METHOD: Forty patients from a district Older Persons Mental Health Service were assessed using the Mini-International Neuropsychiatric Interview (MINI-5).They then completed the brief version of the World Health Organization Quality of Life Scale (WHOQOL-BREF),Geriatric Anxiety Inventory and Geriatric Depression Scale. RESULTS: Self-reported anxiety was significantly associated with reduced overall QOL on the WHOQOL-BREF.Anxiety was also associated with the psychological, social and environmental domains of the WHOQOL-BREF, but not with the physical health domain. Anxiety was correlated with more individual domains of QOL than depression. CONCLUSIONS: Anxiety makes a significant contribution to self-rated QOL in older people with serious mental disorders.