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IntroductionElectroconvulsive therapy (ECT) is one of the most polarizing treatments in medicine. Although the treatment effect is well documented in clinical studies, there is a lack of data regarding patients treated in an ordinary clinical setting. In 2013, we established a regional register of neurostimulation treatment in Western Norway.ObjectivesTo describe the use of ECT at the Haukeland university hospital in Bergen.MethodsPatients treated with ECT between June 2013 and June 2015 were included in the register.ResultsOne hundred and forty-seven patients received ECT during the 2 years period. The mean age was 58.4 years (22–91 years), 67% were female. Half of the patients (49.7%) had been treated with ECT previously. Indication for treatment was depression in 137 patients (93.2%), of which 29 (19.7%) were moderately, and 69 patients (46.9%) severely depressed, and additional 37 patients (25.2%) presented with severe depression with psychotic features. All but two patients were treated with right unilateral electrode placement, with a mean of 9.7 (3–22) treatments.The mean MADRS before treatment was 34.2 (4–56) and after treatment 11.9 (0–39). One hundred and ten patients (74.8%) responded to treatment; of which 89 (60.5%) remitted (response defined as a 50% or greater decrease from MADRS baseline score, remission defined as MADRS ≤ 12). Twenty patients (13%) continued with continuation or maintenance ECT after the index series.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Electroconvulsive therapy (ECT) is a highly effective treatment option mainly in severe depression. ECTs longterm effects on cognitive function are currently unknown, limiting its use. Transcranial magnet stimulation (TMS), is considered less effective than ECT in treatment of severe depression, but is without cognitive side effects. TMS is studied to a less degree than ECT. Objectives There is a need of large scale studies of effect, side effects and patients’ subjective experience of ECT and TMS. Aims Generate data to better predict which patients will benefit from ECT and TMS by establishing a regional register including all patients referred to ECT and TMS as part of an ordinary clinical treatment practice in the western part of Norway. Methods All patients referred to ECT and TMS in Bergen and Stavanger will be asked to participate in the study. There are no exclusion criteria. Demographics and course of illness factors will be recorded before start of ECT. Severity of the depressive disorder and treatment effects will be evaluated with a mix of self evaluation and clinician administrated standardized rating instruments. There will be a follow up at 6 months. Date from the described register will be merged with other relevant central Norwegian health registers. Results We expect the described regional register to offer an opportunity to determine predictors for effect, side effects and subjective satisfaction of the treatments. Conclusion This register is investigator initiated, with the aim to investigate which patient will benefit from ECT and TMS without serious side effects.

Introduction Electroconvulsive therapy (ECT) is a treatment alternative in bipolar disorder (BD) depression. Cognitive side effects are the major concern limiting its use. Objectives We present data from the Norwegian randomized controlled trial of ECT in treatment resistant depression in bipolar disorder. Aims To compare effects on cognitive function of ECT or algorithm based pharmacological treatment at the end of a six-week acute, BD depression treatment trial. Methods Prospective, randomised controlled multi-centre, six-week acute treatment trial. Pre- and post-treatment assessments with the MATRICS Consensus Cognitive Battery (MCCB); a neuropsychological test battery designed to be sensitive to changes in cognitive function. Sample N = 51 patients ≥ 18 years fulfilling criteria for treatment resistant BD depression (MADRS score ≥ 25). Intervention ECT group: Three sessions per week for up to six weeks, total up to 18 sessions, and right unilateral electrode placement. Algorithm-based pharmacological treatment group: Based on Goodwin & Jamison, 2007. Results Both groups showed a net gain on MCCB scores without significant differences between the study groups. Mean change in MCCB composite T-score was 4.0 (5.7) in the ECT group and 2.7 (3.6) in the pharmacological group (F = 0.78, eta 2 = 0.021, p = 0.383). Conclusion In treatment resistant BD depression ECT and algorithm-based pharmacological treatment have comparable effects on cognitive function assessed with the MATRICS.

ObjectiveThere is a positive correlation between level of education and working function in the general population. Bipolar disorder (BD) is often associated with disability in social and working function. There is conflicting evidence considering educational achievements in BD patients.AimsOur aim was to investigate how education was related to social and occupational function in BD.MethodPatients with DSM-IV BD (N=257; 69.3% BD I, 25.7% BD II, 5.1% BD NOS, 51.4% females) were consecutively recruited from mental health clinics throughout Norway. The majority of patients were recruited when in-patients. About 1/2 had at least once experienced a psychotic episode. The BD sample was compared with a geographically matched reference sample from the general population (N=56.540) on levels of education, marital status, income, and disability benefits. Further analyses of association were carried out using logistic regression analyses.ResultsA significantly higher proportion of subjects in the BD group than in the reference group was single, had low income, or was disabled. No between-group difference was found in educational level. In the reference group education was inversely correlated with the risk of being disabled, but no such relationship was found in the BD group. In BD patients rapid cycling and recurring depressive episodes were the only clinical characteristics associated with low educational level.ConclusionDespite similar levels of education, BD patients had lower socio-economic status than the general population, and no association was found between education and disability for BD patients.