Joanne E Plahouras1,2, Gerasimos Konstantinou2,3, Tyler S Kaster2,3, Daniel Z Buchman4,5,6,7, George Foussias1,2,3,8, Zafiris J Daskalakis1,2,3,9, Daniel M Blumberger1,2,3,9. 1. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 2. Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada. 3. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 4. Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada. 5. Bioethics Department, Toronto Western Hospital, University Health Network, Toronto, ON, Canada. 6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 7. Krembil Brain Institute, University Health Network, Toronto, ON, Canada. 8. Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada. 9. Centre for Addiction and Mental Health, Campbell Family Mental Health Institute, Toronto, ON, Canada.
Abstract
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.
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.
Authors: Georgios Petrides; Chitra Malur; Raphael J Braga; Samuel H Bailine; Nina R Schooler; Anil K Malhotra; John M Kane; Sohag Sanghani; Terry E Goldberg; Majnu John; Alan Mendelowitz Journal: Am J Psychiatry Date: 2014-10-31 Impact factor: 18.112
Authors: Roumen V Milev; Peter Giacobbe; Sidney H Kennedy; Daniel M Blumberger; Zafiris J Daskalakis; Jonathan Downar; Mandana Modirrousta; Simon Patry; Fidel Vila-Rodriguez; Raymond W Lam; Glenda M MacQueen; Sagar V Parikh; Arun V Ravindran Journal: Can J Psychiatry Date: 2016-08-02 Impact factor: 4.356
Authors: A Preti; P Rucci; G Santone; A Picardi; R Miglio; R Bracco; B Norcio; G de Girolamo Journal: Psychol Med Date: 2008-06-26 Impact factor: 7.723