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Five years of ECT: the relationship between consent status and treatment experiences

Published online by Cambridge University Press:  13 June 2014

Susanna Enriquez ,
Sheila Tighe ,
Noreen Fitzgibbon ,
Seamus Ó Flaithbheartaigh  and
David Meagher
Susanna Enriquez
Affiliation:
Limerick Mental Health Services
Sheila Tighe
Affiliation:
Cork University Hospital
Noreen Fitzgibbon
Affiliation:
Limerick Mental Health Services
Seamus Ó Flaithbheartaigh
Affiliation:
Midwestern Regional Hospital, Limerick
David Meagher*
Affiliation:
University of Limerick, Medical School
*
*Correspondence E-mail: [email protected].Also: Department of Psychiatry, Midwestern Regional Hospital, Limerick, Ireland
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Abstract

Objectives:

ECT has received limited systematic study in the Irish setting. Amendments to the Mental Health Act (2001) propose limiting the use of ECT to patients who can provide written informed consent. We report on the use of ECT in Limerick specifically addressing the issue of patient consent and how it relates to response rate.

Method:

Since 2003, the use of ECT within Limerick Mental Health Services has been monitored by a data gathering process that includes the documentation of mood disturbance before and after the procedure.

Results:

In the five years between 2003 and 2007, 153 courses of ECT were given to 126 different patients (frequency 16.7/100,000; Female:Male = 2:1). The principal indication for ECT was depressive illness (95%). Bilateral electrode application was the preferred mode comprising 83% of use. A total of 60% experienced at least a 50% reduction in MADRS score over the course of ECT with 78% experiencing a reduction of 10 points or more on the MADRS. Higher response rate was linked to use of bilateral ECT (p = 0.007; 95% CI 1.3-13.6). A total of 14% of patients were unable to provide written informed consent and these patients had more severe depression at outset (p = 0.007; 95% CI 1.8-11.1) and a trend towards greater reduction in MADRS scores during ECT (p = 0.08). The commonest adverse incident associated with ECT was cognitive impairment (33 patients). The risk of cognitive problems was not related to age, ECT dose, number of treatments, severity of depressive symptoms, treatment response, or consent status.

Conclusions:

Frequency of use, response and adverse effect rates for ECT in Limerick Mental Health Services are similar to other centres. Cognitive impairment was the most frequent adverse event. The choice of electrode placement for ECT requires further consideration. Restricting ECT to patients that can provide written informed consent would prevent its use in many patients with severe illness who experience significant response to treatment.

Keywords

Electroconvulsive therapy (ECT)ConsentLegislation
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 27 , Issue 3 , September 2010 , pp. 117 - 122
Copyright
Copyright © Cambridge University Press 2010

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References

1.Rose, D, Wykes, T, Leese, Met al.Patients' perspectives on electro-convulsive therapy: systematic review. BMJ 2003; 326:1363–1365.CrossRefGoogle Scholar
2.Fergusson, G, Cullen, L, Freeman, C, Hendry, J.Electroconvulsive therapy in Scottish clinical practice: a national audit of demographics, standards and outcome. J ECT 2004; 20:166–173.CrossRefGoogle Scholar
3.Royal College of Psychiatrists. Psychiatrists' Special Committee on ECT (Council Report CR128). The ECT Handbook. 2nd Ed. The Third Report of the Royal College of Psychiatrists. London: Royal College of Psychiatrists, 2005.Google Scholar
4.UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361: 799–808.CrossRefGoogle Scholar
5. National Institute for Clinical Excellence. The clinical effectiveness and cost effectiveness of electroconvulsive Therapy (ECT) for depressive illness, schizophrenia, catatonia and mania, 2003. www.nice.org.uk/TA059Google Scholar
6. Mental Health Commission. Annual Report including the Report of the Inspector of Mental Health Services 2005.Google Scholar
7. Mental Health Commission. Annual Report including the Report of the Inspector of Mental Health Services 2006.Google Scholar
8. Mental Health Commission. Annual Report including the Report of the Inspector of Mental Health Services 2007.Google Scholar
9.Daly, A, Walsh, D, Moran, R, Kartalova-O'Doherty Y. Activities of Irish psychiatric services 2003. Dublin: Health Research Board, 2004.Google Scholar
10.Mental Health Commission. Rules governing the use of electro-convulsive therapy. Reference number R-S59(2)/01/2006. Mental Health Commission, November 2006.Google Scholar
11.Mental Health Commission. Code of practice governing the use of electro-convulsive therapy for voluntary patients. Mental Health Commission, January 2008.Google Scholar
12. Mental Health Act, 2001.Google Scholar
13.O'Shea, B.Important editorial notice. Irish Psychiatrist 2008; 9(3): 137.Google Scholar
14.Montgomery, SA, Asberg, M.A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–38.CrossRefGoogle ScholarPubMed
15.Breeding, J.Electroshock and informed consent. J Humanistic Psychol 2000; 40: 65–79.CrossRefGoogle Scholar
16.Rush, G, McCarron, S, Lucey, J.Patient attitudes to electroconvulsive therapy. Psychiatric Bull 2007; 31: 212–214.CrossRefGoogle Scholar
17.Sienaert, P, Dierick, M, Degraeve, G, Peuskens, J.Electroconvulsive therapy in Belgium: a nationwide survey on the practice of electroconvulsive therapy. J Affect Dis 2006; 90: 67–71.CrossRefGoogle ScholarPubMed
18.Chanpattana, W.A questionnaire survey of ECT practice in Australia. J ECT 2007; 23: 89–92.CrossRefGoogle ScholarPubMed
19.Chanpattana, W, Kojima, K, Kramer, BA, Intakorn, A, Sasaki, S, Kitphati, R.ECT practice in Japan. J ECT 2005; 21:139–44.CrossRefGoogle ScholarPubMed
20.Gazdag, G, Kocsis, N, Lipcsey, A.Rates of electroconvulsive therapy use in Hungary in 2002. J ECT 2004; 20: 42–4.CrossRefGoogle ScholarPubMed
21.Eranti, S, McLoughlin, D.Electroconvulsive therapy – state of the art. Br J Psychiatry 2003; 182:8–9.CrossRefGoogle ScholarPubMed
22.Scott, AI, Fraser, T.Decreased usage of electroconvulsive therapy: implications. Br J Psychiatry 2008; 192: 476.CrossRefGoogle ScholarPubMed
23.Glen, T, Scott, A.Variation in rates of electroconvulsive therapy use among consultant teams in Edinburgh. J Affect Dis 2000; 58: 75–78.CrossRefGoogle ScholarPubMed
24.Rush, G, Kimmich, O, Lucey, J.Electroconvulsive therapy: International guidelines, clinical governance and patient selection. Ir J Psychol Med 2007; 24: 103–107.CrossRefGoogle ScholarPubMed
25.Meagher, D, Murray, D.Depression. Supplement on women's health. Lancet 1997; 349: SI 17–20.CrossRefGoogle Scholar
26.American Psychiatric Association. The practise of electroconvulsive therapy, Recommendations for treatment, training and privileging. 2nd Ed. A task force report of the American Psychiatric Association, 2001.Google Scholar
27.National Institute for Clinical Excellence. Appraisal of Electroconvulsive Therapy: Decision of the Appeal Panel, 26. March 2003. www.nice.org.uk/pdf/ECT_final_panel_response.pdf.Google Scholar
28.Wheeldon, T, Robertson, C, Eagles, J, Reid, I.The views and outcomes of consenting and non-consenting patients receiving ECT. Psychol Med 1999; 29: 221–223.CrossRefGoogle ScholarPubMed
29.Myers, DH.A questionnaire study of patients' experience of electroconvulsive therapy. J ECT 2007; 23:169–74.CrossRefGoogle ScholarPubMed
30.Rose, DS, Wykes, TH, Bindman, JP, Fleishmann, PS.Information, consent and perceived coercion: patients' perspectives on electroconvulsive therapy. Br J Psychiatry 2005; 186: 54–59.CrossRefGoogle ScholarPubMed
31.Sackeim, H, Prudic, J, Devanand, Pet al.A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities Arch Gen Psychiat 2000; 57: 425–434.Google Scholar
32.Stoppe, A, Louza, M, Rosa, M, Gil, G, Rigonatti, S.Fixed high-dose electroconvulsive therapy in the elderly with depression: a double-blind, randomized comparison of efficacy and tolerability between unilateral and bilateral electrode placement. J ECT 2006; 22: 92–99.CrossRefGoogle ScholarPubMed
33.McCall, V, Reboussin, D, Weiner, R, Sackeim, H.Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy – Acute antidepressant and cognitive effects. Arch Gen Psychiat 2000; 57: 438–444.CrossRefGoogle ScholarPubMed
34.Frey, R, Schreinzer, D, Heiden, A, Kasper, S.Use of electroconvulsive therapy in psychiatry. Nervenarzt 2001; 72(9): 661–676.CrossRefGoogle ScholarPubMed
35.Scott, A.What I would say to a patient who asked me about this article. Invited commentary on: Memory and cognitive effects of ECT. Adv Psychiat Treat 2005; 12: 237–238.CrossRefGoogle Scholar
36.Mangaoang, MA, Lucey, JV.Cognitive rehabilitation: assessment and treatment of persistent memory impairments following ECT. Adv Psychiat Treat 2007; 13: 90–100.CrossRefGoogle Scholar