Outcomes in patients with and without capacity in electroconvulsive therapy

Tor, Phern‐Chern; Tan, Fams. June Su; Martin, Donel; Loo, Colleen

doi:10.1016/j.jad.2020.01.150

Cited by 22 publications

(24 citation statements)

References 50 publications

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“…To our knowledge, though studies have examined the role of capacity in treatment outcomes for depressed patients, there are no studies examining capacity on the likelihood of ECT. 29 In Ontario, Canada, there is a well-developed legal framework designed to protect the right of individuals to make autonomous treatment decisions. When an individual is declared incapable to consent to a specific psychiatric treatment (ECT or otherwise), they are notified with a legislatively defined form and have the opportunity to challenge this finding at an independent tribunal in which they will receive legal representation at no cost.…”

Section: Discussionmentioning

confidence: 99%

Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés

et al. 2020

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Objective: A variety of patient characteristics drive the use of electroconvulsive therapy (ECT) in depression. However, the extent to which each characteristic influences the receipt of ECT, and whether they are appropriate, is unknown. The aim of this study is to identify patient-level characteristics associated with receiving inpatient ECT for depression. Method: We identified all psychiatric inpatients with a major depressive episode admitted to hospital ≥3 days in Ontario, Canada (2009 to 2017). The association between patient-level characteristics at admission and receipt of inpatient ECT was determined using logistic regression, where a generalized estimating equations approach accounted for repeat admissions. Results: The cohort included 53,174 inpatients experiencing 75,429 admissions, with 6,899 admissions involving ECT (9.2%). Among demographic factors, age was most associated with ECT—younger adults had reduced (OR = 0.30, 95%CI, 0.24 to 0.37; 18 to 25 years) while older adults had increased (OR = 3.08, 95%CI, 2.41 to 3.93; 85+ years) odds compared to middle-aged adults (46 to 55 years). The likelihood of ECT was greater for individuals who were married/partnered, had postsecondary education, and resided in the highest neighborhood income quintile. Among clinical factors, illness polarity was most associated with receiving ECT—bipolar depression had reduced odds of receiving ECT (OR = 0.62, 95%CI, 0.57 to 0.69) The likelihood of receiving ECT was greater in psychotic depression, more depressive symptoms, and incapable to consent to treatment and was reduced with comorbid substance use disorders and several medical comorbidities. Conclusions: Nearly 1 in 10 admissions for depression in Ontario, Canada, involve ECT. Many clinical factors associated with receiving inpatient ECT were concordant with clinical guidelines; however, nonclinical factors associated with its use warrant investigation of their impact on equitable access to ECT.

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Section: Discussionmentioning

confidence: 99%

Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés

et al. 2020

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“…Prescribing ECT with a substitute decision-making process or in patient's best interests is increasingly supported by recent evidence of equivalent to superior outcomes in patients lacking capacity to consent to ECT. 5…”

Section: General Medical Ethics Applied To Ectmentioning

confidence: 99%

“…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.…”

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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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“…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%

“…There was a greater improvement in mood and function for the patients who lacked the capacity to consent to psychiatric treatment. 34 However, these studies were limited by their small sample sizes. Furthermore, the studies were not exclusive to patients with a diagnosis of schizophrenia or schizoaffective disorder.…”

Section: Introductionmentioning

confidence: 99%

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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Outcomes in patients with and without capacity in electroconvulsive therapy

Cited by 22 publications

References 50 publications

Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés

Patient-level Characteristics and Inequitable Access to Inpatient Electroconvulsive Therapy for Depression: A Population-based Cross-sectional Study: Caractéristiques au niveau du patient et accès inéquitable à la thérapie électroconvulsive pour patients hospitalisés

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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