a Department of Psychiatry and Psychotherapy , University Medical Center Göttingen , Göttingen , Germany.
b Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim , Central Institute of Mental Health, University of Heidelberg , Heidelberg , Germany.
World J Biol Psychiatry. 2018 Apr;19(3):236-242. doi: 10.1080/15622975.2017.1293296. Epub 2017 Mar 16.
Electroconvulsive therapy (ECT) is the most effective therapy for severe depressive and psychotic disorders. As patients may be subject to legal incapacity and lack of insight, treatment may be administered against the patient's will. There is only limited evidence on the use of ECT against the patient's non-autonomous will.
We report a series of eight patients who received ECT against their will in two German university medical hospitals between 2014 and 2016. The effectiveness, tolerability and patients' perspective are described.
Seven of eight patients were much or very much improved according to the Clinical Global Impression Scale. Capacity to consent was restored in seven patients. Transient side effects occurred in four patients. Seven patients agreed to receive further ECT in the treatment course.
This case series suggests that ECT may (and sometimes should) be administered to severely ill, non-consenting patients against their will with good effectiveness. Potential and mostly moderate and transient side effects have to be weighed up against the potentially life-saving character of ECT in patients with, e.g., suicidality and food refusal. Most importantly, the patients' retrospective appraisal also justifies the administration of ECT in situations of severe mental illness and legal incapacity.
电抽搐治疗（ECT）是治疗严重抑郁和精神病性障碍最有效的方法。由于患者可能存在法律上的无行为能力和缺乏洞察力，因此可能会违背患者的意愿进行治疗。目前仅有有限的证据表明可以在违背患者非自主性意愿的情况下使用 ECT。
我们报告了 2014 年至 2016 年间在两家德国大学附属医院中对 8 名违背其意愿接受 ECT 的患者进行的一系列治疗。描述了有效性、耐受性和患者的观点。
根据临床总体印象量表，8 名患者中有 7 名患者的病情明显或非常明显改善。7 名患者的同意能力得到恢复。4 名患者出现短暂的副作用。7 名患者同意在治疗过程中接受进一步的 ECT。
本病例系列研究表明，在严重疾病、不同意治疗的情况下，可以并且有时应该违背患者的意愿给予 ECT，其有效性良好。需要权衡潜在的、大多数是中度和短暂的副作用与 ECT 在自杀和拒食等情况下可能挽救生命的性质。最重要的是，患者的回顾性评估也证明了在严重精神疾病和法律无行为能力的情况下给予 ECT 的合理性。
