Electroconvulsive therapy without consent from patients: One-year follow-up study: ECT without consent from patients
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.
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Both capacitous and incapacitous patients generally improved in their psychiatric symptoms following ECT treatment.
“Both capacitous and incapacitous patients generally improved in their psychiatric symptoms following treatment.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Chiu et al., 2014
For ECT, more than half of patients lacked capacity (between 51.7% to 75.1%).
“They found that more than half of patients lacked capacity (between 51.7% to 75.1%).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Chiu et al., 2014
Patients who had longer hospital admissions were more likely to lack capacity.
“Finally, patients who had longer hospital admissions were more likely to lack capacity (Chiu et al., 2014;Fraguas et al., 2007).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Chiu et al., 2014
Bipolar affective disorder of the manic type was the next diagnosis associated with high rates of incapacity.
“followed by bipolar affective disorder (BPAD) of the manic type (Chiu et al., 2014;Mandarelli et al., 2018b;G. Owen et al., 2009;G. S. Owen et al., 2011;Skipworth et al., 2013;Tor et al., 2020)”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Chiu et al., 2014
Cites
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
ECT Remission Rates in Psychotic Versus Nonpsychotic Depressed Patients: A Report from CORE
Petrides, G., Fink, M., Husain, M. M., Knapp, R. G., Rush, A. J., Mueller, M., Rummans, T. A., O’Connor, K. M., Rasmussen, K. G., Bernstein, H. J., et al. (2001) · Journal of Ect · doi:10.1097/00124509-200112000-00003 · Cited by 493 · see citing works
Assessing Decisional Capacity for Clinical Research or Treatment: A Review of Instruments
Dunn, L. B., Nowrangi, M. A., Palmer, B. W., Jeste, D. V., & Saks, E. R. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.8.1323 · Cited by 464 · see citing works
Husain, M. M., Rush, A. J., Fink, M., Knapp, R. G., Petrides, G., Rummans, T. A., Biggs, M. M., O’Connor, K. M., Rasmussen, K. G., Litle, M., et al. (2004) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v65n0406 · Cited by 455 · see citing works
The Effects of Electroconvulsive Therapy on Memory of Autobiographical and Public Events
Lisanby, S. H. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.6.581 · Cited by 360 · see citing works
Major Depressive Disorder Treatment Guidelines in America and Europe
Davidson, J. R. T. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.9058se1c.04gry · Cited by 344 · see citing works
Convulsive therapy: a review of the first 55 years
Fink, M. (2001) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00367-0 · Cited by 264 · see citing works
Use of ECT for the Inpatient Treatment of Recurrent Major Depression
Olfson, M., Marcus, S. C., Sackeïm, H. A., Thompson, J., & Pincus, H. A. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.1.22 · Cited by 134 · see citing works
Feske, U., Mulsant, B. H., Pilkonis, P. A., Soloff, P., Dolata, D., Sackeïm, H. A., & Haskett, R. F. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.11.2073 · Cited by 121 · see citing works
Assessing Decisional Capacity for Clinical Research or Treatment: A Review of Instruments
Dunn, L. B. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.8.1323 · Cited by 108 · see citing works
McFarquhar, T. F., & Thompson, J. (2008) · The Journal of ECT · doi:10.1097/yct.0b013e318168be4a · Cited by 81 · see citing works
DeBattista, C., & Mueller, K. K. (2001) · Journal of Ect · doi:10.1097/00124509-200106000-00002 · Cited by 67 · see citing works
Electroconvulsive therapy in the treatment of mixed states in bipolar disorder
Valentí, M., Benabarre, A., García-Amador, M., Molina-Andreu, O., Bernardo, M., & Vieta, E. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2007.10.011 · Cited by 65 · see citing works
Bates, W. J., & Smeltzer, D. J. (1982) · American Journal of Psychiatry · doi:10.1176/ajp.139.10.1355 · Cited by 52 · see citing works
Taïeb, O., Flament, M. F., Chevret, S., Jeammet, P., Allilaire, J., Mazet, P., & Cohen, D. (2002) · European Psychiatry · doi:10.1016/s0924-9338(02)00668-5 · Cited by 48 · see citing works
Efficacy of electroconvulsive therapy in treatment-resistant schizophrenia: a prospective open trial
Tang, W. K., & Ungvari, G. S. (2003) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/s0278-5846(02)00354-8 · Cited by 45 · see citing works
McCall, W. V., Reboussin, B. A., Cohen, W., & Lawton, P. (2001) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00167-1 · Cited by 45 · see citing works
Electroconvulsive Therapy in First-Episode Schizophrenia
ok, A., & akr, S. (2006) · Journal of Ect · doi:10.1097/00124509-200603000-00008 · Cited by 37 · see citing works
The Depiction of Electroconvulsive Therapy in Hindi Cinema
Andrade, C., Shah, N., & Venkatesh, B. K. (2010) · Journal of Ect · doi:10.1097/yct.0b013e3181d017ba · Cited by 36 · see citing works
The First-line Use of Electroconvulsive Therapy in Major Affective Disorders
Maletzky, B. M. (2004) · Journal of Ect · doi:10.1097/00124509-200406000-00007 · Cited by 32 · see citing works
To treat or not to treat: the legal, ethical and therapeutic implications of treatment refusal.
Wear, A. N., & Brahams, D. (1991) · Journal of Medical Ethics · doi:10.1136/jme.17.3.131 · Cited by 24 · see citing works
Maintenance electroconvulsive therapy (ECT) for treatment-resistant disorganized schizophrenia
Shimizu, E., Imai, M., Fujisaki, M., et al. (2006) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2006.11.014 · Cited by 22 · see citing works
Informed consent in the electroconvulsive treatment of geriatric patients.
Levine, S., Blank, K., Schwartz, H. I., et al. (1991) · PubMed · Cited by 10 · see citing works
Repeated electroconvulsive therapy for a patient with Capgras syndrome and Parkinsonism
Chiu, N. (2009) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2009.06.003 · Cited by 9 · see citing works
Self-citationA Statewide Survey of ECT Policies and Procedures
Westphal, J. R., & Rush, J. (2000) · Journal of Ect · doi:10.1097/00124509-200009000-00009 · Cited by 6 · see citing works
Legal Issues in the Treatment of a Violent Manic Patient in a Non-Gazetted Setting: A Case Report
Lp, K., Tan, C., Lek, S., & Ong, T. (2005) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v34n1p134 · Cited by 3 · see citing works
McCall, W. V. (2006) · Journal of Ect · doi:10.1097/00124509-200606000-00001 · Cited by 2 · see citing works
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Spencer, B. W. J., Shields, G., Gergel, T., Hotopf, M., & Owen, G. S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000502 · Cited by 43 · see citing works
Outcomes in patients with and without capacity in electroconvulsive therapy
Tor, P.-C., Tan, F. J. S., Martin, D., & Loo, C. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.150 · Cited by 27 · see citing works
Marcó-García, S., Ariyo, K., Owen, G. S., & David, A. S. (2024) · Psychological Medicine · doi:10.1017/s0033291724000242 · Cited by 18 · see citing works
- Authors
- Chiu, N.-M., Lee, Y., & Lee, W.-K.
- Affiliations
- Chang Gung University (TW)
- Department of Psychiatry; Armed Forces Beitou Hospital; Taipei Taiwan
- Corresponding author
- Chiu, Nien-Mu
- ORCID
- Venue
- Asia-Pacific Psychiatry
- Publisher
- Wiley
- Published
- 2012-07-18
- Volume
- 6
- Issue
- 1
- Pages
- 83-90
- ISSN
- 1758-5864 (ISSN-L)
- OpenAlex
- W1847393604
- Cited by
- 17
- References
- 27
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 5 · 2018: 1 · 2017: 2 · 2016: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Asia-Pacific Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- electroconvulsive therapy, informed consent, treatment refusal, surrogate consent, decisional incapacity, psychosis, bipolar disorder, major depressive disorder with psychotic features, schizoaffective disorder, hospital readmission, remission, one-year outcomes
- MeSH terms
- Adolescent, Adult, Aged, Bipolar Disorder, Depressive Disorder, Major, Major Depressive Disorder, Electroconvulsive Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychotic Disorders, Retrospective Studies, Taiwan, Mental Competency, Age of Onset, Third-Party Consent, Young Adult
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