Practical and Legal Challenges to Electroconvulsive Therapy in Malignant Catatonia.

In cases of malignant catatonia, prompt administration of electroconvulsive therapy (ECT) can decrease mortality, whereas delays to initiating ECT have resulted in adverse outcomes, including death. We present a clinical vignette of malignant catatonia that required court-ordered ECT, followed by a discussion of practical and legal obstacles to expediting emergent ECT when patients cannot provide consent. We review particularly exacting mandates for involuntary ECT from three states: California, Texas, and New York. As compared to standard practice for other clinical interventions when a patient lacks decision-making capacity, ECT is highly regulated; in some cases, these regulations can interfere with life-saving treatment.