TY - JOUR
T1 - Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis
AU - Gergel, Tania
AU - Takamiya, Akihiro
AU - Sienaert, Pascal
AU - Gather, Jakov
AU - Kishimoto, Taishiro
AU - Zilles-Wegner, David
N1 - Funding Information:
Takamiya A is supported by the Japan Agency for Medical Research and Development ( AMED ) under Grant Number JP21dm0307102h0003 , and JSPS KAKENHI (Grant Number 21K20911 and 22K15756 ). Gergel T is supported by the Wellcome Trust (grant number 203376/Z/16/Z ). Gather J is supported by the German Federal Ministry of Education and Research (research group SALUS; grant number 01GP1792 ).
Publisher Copyright:
© 2022 The Authors
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Background: Electroconvulsive therapy (ECT) is provided for patients with severe and often life-threatening illness, who lack decision making capacity to consent to treatment (DMC-T) in clinical settings. Objective: The aim of this study is to summarize previous studies investigating clinical outcomes of ECT in patients lacking DMC-T. Methods: A systematic review and meta-analysis of studies reporting clinical outcomes of ECT in patients lacking DMC-T with any psychiatric diagnoses was conducted. The primary outcome was clinical improvement. Secondary outcomes were cognitive outcomes and six month readmission rate. Hedges’ g and odds ratios were calculated using a random-effects model. The protocol was registered in Open Science Framework (https://osf.io/rxjkm). Results: Of 3552 identified articles, 41 studies (n = 1299) were included. Approximately 80% of patients lacking DMC-T responded to ECT, and part of the patients regained capacity to consent and consented to further treatment with ECT. A total of seven studies (n = 1081) were included for meta-analysis. Patients without DMC-T showed superior clinical improvement and less cognitive side effects compared with those with DMC-T, whereas the groups did not show any difference in readmission rate. Several clinical characteristics at baseline and ECT techniques were significantly different between the groups. Conclusion: ECT is equally, if not superiorly, effective in patients lacking DMC-T compared to patients with DMC-T. ECT can potentially enhance patients’ autonomy, without increasing the risk of cognitive side effects. These results support the clinical and ethical legitimacy of ECT provision for patients with the most severe illness who lack DMC-T at start of treatment.
AB - Background: Electroconvulsive therapy (ECT) is provided for patients with severe and often life-threatening illness, who lack decision making capacity to consent to treatment (DMC-T) in clinical settings. Objective: The aim of this study is to summarize previous studies investigating clinical outcomes of ECT in patients lacking DMC-T. Methods: A systematic review and meta-analysis of studies reporting clinical outcomes of ECT in patients lacking DMC-T with any psychiatric diagnoses was conducted. The primary outcome was clinical improvement. Secondary outcomes were cognitive outcomes and six month readmission rate. Hedges’ g and odds ratios were calculated using a random-effects model. The protocol was registered in Open Science Framework (https://osf.io/rxjkm). Results: Of 3552 identified articles, 41 studies (n = 1299) were included. Approximately 80% of patients lacking DMC-T responded to ECT, and part of the patients regained capacity to consent and consented to further treatment with ECT. A total of seven studies (n = 1081) were included for meta-analysis. Patients without DMC-T showed superior clinical improvement and less cognitive side effects compared with those with DMC-T, whereas the groups did not show any difference in readmission rate. Several clinical characteristics at baseline and ECT techniques were significantly different between the groups. Conclusion: ECT is equally, if not superiorly, effective in patients lacking DMC-T compared to patients with DMC-T. ECT can potentially enhance patients’ autonomy, without increasing the risk of cognitive side effects. These results support the clinical and ethical legitimacy of ECT provision for patients with the most severe illness who lack DMC-T at start of treatment.
KW - Electroconvulsive therapy (ECT)Severe mental illnessAffective and psychotic disorders decision making capacityMedical ethics
UR - http://www.scopus.com/inward/record.url?scp=85137660566&partnerID=8YFLogxK
U2 - 10.1016/j.brs.2022.09.001
DO - 10.1016/j.brs.2022.09.001
M3 - Article
SN - 1876-4754
VL - 15
SP - 1246
EP - 1253
JO - Brain Stimulation
JF - Brain Stimulation
IS - 5
M1 - doi.org/10.1016/j.brs.2022.09.001
ER -