Nien-Mu Chiu1, Yu Lee, Wen-Kuei Lee. 1. Departments of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Abstract
INTRODUCTION: No previous study has been designed to analyze the reasons for electroconvulsive therapy (ECT) without patients' consent. In the present study we compared the clinical characteristics and one-year outcomes between patients with refusal to undergo ECT and patients without competency for ECT consent. METHODS: In a retrospective cohort study, 29 patients were treated with ECT without providing consent between 1 January 2006 and 31 August 2010. A surrogate family member gave informed consent for ECT to meet current legal requirements. Patients were assigned to one of two groups: a consent-refusal group comprising patients who refused to give consent for ECT and could clearly say "no" or argue with psychiatric staff about receiving ECT; and a consent-incompetent group comprising patients who were incompetent for consent but underwent ECT passively or reluctantly without argument. RESULTS: The patients were clinically diagnosed with schizoaffective disorder (n = 6), psychotic disorder (n = 12), bipolar I disorder (n = 8) and major depressive disorder with psychotic features (n = 3). The consent-incompetent patients had longer hospital stays and more recurrence in one year than the consent-refusal patients, which may be because the former group had more psychotic disorders and fewer mood disorders. All patients improved rapidly and efficiently. However, remission was temporal in two-thirds of patients and the rehospitalization rate in one year was 66% (n = 19). DISCUSSION: ECT can be applied early, emergently and successfully to patients who have a wide range of psychiatric disorders and life-threatening conditions without threat of lawsuits, even during their first hospitalization.
INTRODUCTION: No previous study has been designed to analyze the reasons for electroconvulsive therapy (ECT) without patients' consent. In the present study we compared the clinical characteristics and one-year outcomes between patients with refusal to undergo ECT and patients without competency for ECT consent. METHODS: In a retrospective cohort study, 29 patients were treated with ECT without providing consent between 1 January 2006 and 31 August 2010. A surrogate family member gave informed consent for ECT to meet current legal requirements. Patients were assigned to one of two groups: a consent-refusal group comprising patients who refused to give consent for ECT and could clearly say "no" or argue with psychiatric staff about receiving ECT; and a consent-incompetent group comprising patients who were incompetent for consent but underwent ECT passively or reluctantly without argument. RESULTS: The patients were clinically diagnosed with schizoaffective disorder (n = 6), psychotic disorder (n = 12), bipolar I disorder (n = 8) and major depressive disorder with psychotic features (n = 3). The consent-incompetent patients had longer hospital stays and more recurrence in one year than the consent-refusal patients, which may be because the former group had more psychotic disorders and fewer mood disorders. All patients improved rapidly and efficiently. However, remission was temporal in two-thirds of patients and the rehospitalization rate in one year was 66% (n = 19). DISCUSSION: ECT can be applied early, emergently and successfully to patients who have a wide range of psychiatric disorders and life-threatening conditions without threat of lawsuits, even during their first hospitalization.
Authors: Joanne E Plahouras; Gerasimos Konstantinou; Tyler S Kaster; Daniel Z Buchman; George Foussias; Zafiris J Daskalakis; Daniel M Blumberger Journal: Schizophr Bull Date: 2021-03-16 Impact factor: 9.306