Survival Rate Following Involuntary Electroconvulsive Therapy: A Population-Based Study

Abstract

Objective: Involuntary electroconvulsive therapy (ECT) can be a lifesaving intervention for patients suffering from potentially lethal conditions who are unable to give informed consent. However, its use is not widespread, probably partly because of the scarce data on hard outcomes following involuntary ECT. In Denmark, involuntary ECT is only used when patients are at imminent/potential risk of dying if not receiving ECT. Here, we aimed to estimate the 1-year survival rate after the administration of involuntary ECT as a proxy for the effectiveness of this treatment. Methods:We conducted a register-based cohort study involving (i) all patients receiving involuntary ECT in Denmark between 2008 and 2019, (ii) age-and sex-matched patients receiving voluntary ECT, and (iii) ageand sex-matched individuals from the general population. One-year survival rates were compared via mortality rate ratios. Results:We identified 618 patients receiving involuntary ECT, 547 patients receiving voluntary ECT, and 3080 population-based controls. The survival rate in the year after involuntary ECTwas 90%. For patients receiving involuntary ECT, the 1-year mortality rate ratios were 3.1 (95% confidence interval, 1.9-5.2) and 5.8 (95% confidence interval, 4.0-8.2) compared with those receiving voluntarily ECT and to the population-based controls, respectively. Risk factors for early death among patients receiving involuntary ECT were male sex, being 70 years or older and having organic mental disorder as the treatment indication. Conclusions:Treatment with involuntary ECT is associated with a high survival rate, suggesting that the intervention is effective. However, patients receiving involuntary ECT constitute a high-risk population that should be monitored closely after this treatment.

Electroconvulsive therapy following incident bipolar disorder: When, how, and for whom?

“…Also, we found that involuntary ECT was rarely used for patients with incident BD. In Denmark, involuntary ECT can only be used when a patient is at imminent risk of dying due to severe states of, for example, dehydration following refusal/inability to eat/drink, malignant catatonia or delirium, for which ECT can be life‐saving 16,22 …”

“…How—the administration of the first ECT treatment : For this purpose, we extracted information on the following characteristics of the first ECT session, that is, setting (outpatient or inpatient), electrode placement (unilateral [procedure code: BRTB10, BRXA10], bilateral [procedure code: BRTB11, BRXA11] or unspecified [procedure code: BRTB1, BRXA1]), and consent (voluntary [procedure code: BRXA*] or involuntary [procedure code: BRTB*]). 16 …”

“…How-the administration of the first ECT treatment: For this purpose, we extracted information on the following characteristics of the first ECT session, that is, setting (outpatient or inpatient), electrode placement (unilateral [procedure code: BRTB10, BRXA10], bilateral [procedure code: BRTB11, BRXA11] or unspecified [procedure code: BRTB1, BRXA1]), and consent (voluntary [procedure code: BRXA*] or involuntary [procedure code: BRTB*]). 16 For whom-the indication for ECT: We retrieved information on the indication diagnosis for the first course of ECT and grouped them as follows: hypomania (ICD-10: F30.0, F31.0), mania without psychotic symptoms (ICD-10: F30.1, F31.1, F30.8, F30.9), mania with psychotic symptoms (ICD-10: F30.2; F31.2), depression without psychotic symptoms (ICD-10: F31.3, F31.4, F32.0-F32.2, F32.8, F32.9, F33.0-F33.2, F33.4, F33.8, F33.9), depression with psychotic symptoms (ICD-10: F31.5, F32.3, F33.3), mixed episode (ICD-10: F31.6), other bipolar episodes (ICD-10: F31.7, F31.8, F31.9), psychotic disorders (ICD-10: F20-F29), organic mental disorder (ICD-10: F00-F09), and any other indication.…”

Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis

“…Our literature search revealed only one study that reported a sudden death four days after the fourth ECT in an patient who lacked DMC-T [47], most likely unrelated to ECT. It is important to note that patients without DMC-T who need ECT constitute a highrisk population, which is reflected by a three times higher mortality rate in comparison to age-and sex-matched patients with DMC-T [73]. For instance, mortality rate from acute malignant catatonia as an example of patients without DMC-T is reported up to 20% if an adequate treatment were not provided [74,75].…”

What Can We Tell About the Effect of Electroconvulsive Therapy on the Human Hippocampus?

“…Indeed, this practice is conducted all over the world. 8,36,37 Although psychiatrists may be reluctant to provide ECT to such patients, 38 ECT showed a similar effectiveness 39 and survival rate 40 in both patients with/without the capacity for consent. In addition, patients who lack the capacity for consent showed a similar satisfaction with ECT, compared with those with the capacity for consent.…”