Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T10:26:08.793Z Has data issue: false hasContentIssue false

Refractory mania and inability to consent: an important role for involuntary ECT

Published online by Cambridge University Press:  19 March 2013

J. Lally*
Affiliation:
Department of Psychiatry, National University of Ireland Galway, and West Galway Mental Health Services, Health Service Executive West, Galway, Ireland
C. McDonald
Affiliation:
Department of Psychiatry, National University of Ireland Galway, and West Galway Mental Health Services, Health Service Executive West, Galway, Ireland
*
*Address for correspondence: Dr John Lally, Department of Psychosis Studies, Institute of Psychiatry, King's College, London King's Health Partners, De Crespigny Park, London, SE5 8AF England. (Email [email protected])

Abstract

We present the case of a 23-year-old man with a first episode of severe mania, which was refractory to pharmacotherapy. The case demonstrates a rapid response and full recovery after the use of electroconvulsive therapy (ECT). The ECT was administered involuntarily under Section 59(1) (b) of the Irish Mental Health Act 2001 as the patient was unable to consent to the treatment. The case highlights the benefits of ECT for this serious condition and emphasises the importance of retaining the legislative capacity to provide such an effective treatment for patients unable to consent because of severe psychotic illness.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bracken, P (2011). Drop the whole section. Irish Medical Times 15 April, p. 33.Google Scholar
College of Psychiatry of Ireland (2011). Electroconvulsive Therapy (ECT), Position Statement EAP01/2011, September.Google Scholar
Dunne, R, Kavanagh, A, McLoughlin, DM (2009). Electroconvulsive therapy, capacity and the law in Ireland. Irish Journal of Psychological Medicine 26, 35.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SE, McHugh, PR (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.CrossRefGoogle Scholar
Haddad, PM, Anderson, IM (2002). Antipsychotic-related QTc prolongation, torsade de pointes and sudden death. Drugs 62, 16491671.CrossRefGoogle ScholarPubMed
Keck, PE, Harrison, G, Pope, JRetal. (1989). Risk factors for neuroleptic malignant syndrome: a case–control study. Archives of General Psychiatry 46, 914918.CrossRefGoogle ScholarPubMed
Lisanby, SH (2007). Electroconvulsive therapy for depression. New England Journal of Medicine 357, 19391945.CrossRefGoogle ScholarPubMed
Mental Health Commission (2009). Rules Governing the Use of Electro-Convulsive Therapy. Mental Health Commission: Dublin.Google Scholar
Mental Health Commission (2010). Code of Practice on the Use of Electro-Convulsive Therapy for Voluntary Patients. Mental Health Commission: Dublin.Google Scholar
Mental Health Commission (2011). The Administration of Electro-Convulsive Therapy in Approved Centres: Activity Report 2009, February.Google Scholar
Mukherjee, S, Sackeim, HA, Schnur, DB (1994). Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience. American Journal of Psychiatry 151, 169176.Google ScholarPubMed
National Institute for Clinical Excellence (2003). Guidance on the Use of Electroconvulsive Therapy (Technology Appraisal 59). National Institute for Clinical Excellence: London.Google Scholar
Oireachtas na hEireann, Mental Health Act (MHA) (2001). Part 4, Section 59, Subsection 1.Google Scholar
Schirliu, D, Truszkowska, E, McDonald, C (2011). Prescribing ECT for patients involuntarily admitted under MHA 2001 – what do consultant psychiatrists think? Irish Journal of Psychological Medicine 28, 196200.CrossRefGoogle Scholar
Seanad Eireann, Mental Health (Involuntary Procedures) (Amendment) Bill (2008). An Act to amend the law on mental health in relation to the use of involuntary procedures, No 36 of 2008.Google Scholar
Small, JG, Small, IF, Milstein, V, Kellams, JJ, Klapper, MH (1985). Manic symptoms: an indication for bilateral ECT. Biological Psychiatry 20, 11251134.CrossRefGoogle ScholarPubMed
Small, JG, Klapper, MH, Kellams, JJ, Miller, MJ, Milstein, V, Sharpley, PHetal. (1988). Electroconvulsive therapy compared with lithium in the management of manic states. Archives of General Psychiatry 45, 727732.CrossRefGoogle ScholarPubMed
Statement on ECT Section & 59(1) (b) of Mental Health Act (MHA) 2001 (2010). Submission of The College of Psychiatry of Ireland to Seanad, March 2010.Google Scholar
Tombaugh, TN, McIntyre, NJ (1992). The mini-mental state examination: a comprehensive review. Journal of the American Geriatric Society 40, 922935.CrossRefGoogle ScholarPubMed