Involuntary and voluntary electroconvulsive therapy: A case-control study

Finnegan, Martha; O’Connor, Stephanie; McLoughlin, Declan M.

doi:10.1016/j.brs.2018.04.002

Cited by 21 publications

(22 citation statements)

References 12 publications

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“…“Electroconvulsive therapy (ECT) against the natural will” is a topic that has gained some attention recently. Several publications have reported mostly positive outcomes [1–4], which is in line with earlier findings [5, 6]. Accordingly, the author’s attitudes and conclusions concerning involuntary ECT treatment are predominantly positive.…”

supporting

confidence: 85%

Electroconvulsive therapy against the natural will: Some concerns

Lenzen

Grözinger

2019

Eur. psychiatr.

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In recent years, the scientific interest in “Electroconvulsive therapy (ECT) against the patient’s natural” will has grown. Several publications have reported mostly positive outcomes in cases, where ECT has been implemented against the patient’s natural will. The author’s findings primarily indicate the effectiveness of ECT in non-consenting patients, which confirms earlier findings. All author’s overall presumption turned out to be mainly positive. Within the discussion on involuntary ECT treatment, we missed disadvantageous arguments, which also need to be considered for a balanced judgement. By bringing up the following viewpoint, would like to contribute to a balanced decision making process in cases where involuntary ECT is a legal treatment option.

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supporting

confidence: 85%

Electroconvulsive therapy against the natural will: Some concerns

Lenzen

Grözinger

2019

Eur. psychiatr.

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“…These guidelines also state that valid informed consent should be obtained without pressure or coercion, in the context of significant stigma, discrimination and controversy associated with the treatment. 2 A substitute decision maker should be available to patients lacking capacity to give consent, as there is increasing evidence that patients lacking capacity have equivalent 4 to superior responses 5 to ECT compared with capacitous patients. Despite its impressive effectiveness and broad spectrum of effect, ECT has experienced at least 20 years of decreasing in-patient use in the USA.…”

mentioning

confidence: 99%

Model for ethical triaging of electroconvulsive therapy patients during the COVID-19 pandemic

2020

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Summary Electroconvulsive therapy (ECT) is an essential treatment for severe mental illnesses such as depression with suicidality and catatonia. However, its availability is being threatened by resource limitations and infection concerns due to the COVID-19 pandemic. This may necessitate the triage of patients for ECT but there is no established ethical framework to prioritise patients. We offer an application of an ethical framework for use of scare medical resources in the ECT setting.

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“…Previous studies 29,30,33,48 found that between 0% 48 and 88% 33 of incapable patients regained capacity while being treated with ECT. In our study, most patients in both groups experienced treatment response, with some cognitive impairments.…”

Section: Discussionmentioning

confidence: 97%

“…Two studies suggested that there were no differences in clinical outcomes between consenting/voluntary and involuntary/non-consenting patients. 30,31 In one study, incapable patients had longer hospital stays and illness recurrence. 32 A case series 33 only described patients who were treated involuntarily.…”

Section: Introductionmentioning

confidence: 99%

“…27,28 Several studies have described the outcomes for patients with mental illness who were treated with ECT as incapable or involuntary patients. [29][30][31][32][33][34] In Ontario, Canada, involuntary admission does not require a lack of capacity but patients lacking capacity are more likely to be admitted to hospital involuntarily. [35][36][37] The usual criteria for involuntary admission include a diagnosis of a psychiatric illness and risk of harming herself/himself or others or a risk of serious physical impairment.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Capacity and Clinical Outcomes for Patients With Schizophrenia Who Were Treated With Electroconvulsive Therapy: A Retrospective Cohort Study

Plahouras

Konstantinou

Kaster

et al. 2020

Schizophrenia Bulletin

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Background Patients with schizophrenia are often found incapable to consent to psychiatric treatment. We evaluated clinical outcomes for incapable and capable patients with schizophrenia treated with electroconvulsive therapy (ECT). Methods We conducted a chart review of all inpatients treated with an acute course of ECT between 2010 and 2018 at the Centre for Addiction and Mental Health, Toronto, Canada. Short-term outcomes included treatment response and cognitive impairment. We assessed whether incapable patients regained the capacity to consent to treatment. Long-term outcomes included readmissions and subsequent courses of acute or maintenance ECT. Results A total of 159 (67%) incapable and 79 (33%) capable patients were included. Patients experienced treatment response (incapable, n = 108, 67.9%; capable, n = 52, 65.8%; P = .771) and few experienced cognitive impairment (incapable, n = 21, 13.2%; capable, n = 19, 24.1%; P = .043). A minority of patients were treated with a subsequent course of acute ECT (incapable, n = 46, 28.9%; capable, n = 16, 20.3%; P = .162). Incapable patients were more likely to be treated with maintenance ECT for at least 6 months (incapable, n = 46, 28.9%; capable, n = 13, 16.5%; P = .039). Both groups had similar readmission rates (incapable, n = 70, 44.0%; capable, n = 35, 44.3%; P = 1.000). Eight (5.0%) incapable patients regained capacity and 7 consented to further treatment. Conclusions Irrespective of treatment capacity, the majority of patients demonstrated clinical improvement. Incapable patients experienced less cognitive side effects when compared with capable patients, though they had fewer treatments overall. This study informs clinicians, patients, and substitute decision-makers about the outcomes and challenges of ECT in patients with schizophrenia.

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Involuntary and voluntary electroconvulsive therapy: A case-control study

Cited by 21 publications

References 12 publications

Electroconvulsive therapy against the natural will: Some concerns

Electroconvulsive therapy against the natural will: Some concerns

Model for ethical triaging of electroconvulsive therapy patients during the COVID-19 pandemic

Treatment Capacity and Clinical Outcomes for Patients With Schizophrenia Who Were Treated With Electroconvulsive Therapy: A Retrospective Cohort Study

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