Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium.
Brain Stimul. 2022 Sep-Oct;15(5):1246-1253. doi: 10.1016/j.brs.2022.09.001. Epub 2022 Sep 8.
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.
The aim of this study is to summarize previous studies investigating clinical outcomes of ECT in patients lacking DMC-T.
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).
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.
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.
电痉挛疗法（ECT）用于治疗患有严重且常常危及生命的疾病、缺乏临床治疗决策能力的患者（无决策能力患者）。
本研究旨在总结既往研究中无决策能力患者接受 ECT 治疗的临床结局。
对报告无决策能力患者（任何精神诊断）接受 ECT 治疗的临床结局的研究进行系统回顾和荟萃分析。主要结局是临床改善。次要结局是认知结局和 6 个月再入院率。使用随机效应模型计算 Hedges'g 和优势比。该方案已在开放科学框架（https://osf.io/rxjkm）上注册。
在 3552 篇已识别的文章中，纳入了 41 项研究（n=1299）。大约 80%的无决策能力患者对 ECT 有反应，部分患者恢复了同意治疗的能力，并同意进一步接受 ECT 治疗。共有 7 项研究（n=1081）纳入荟萃分析。与有决策能力患者相比，无决策能力患者的临床改善更优，认知副作用更少，但两组的再入院率没有差异。两组在基线和 ECT 技术方面的几个临床特征存在显著差异。
与有决策能力患者相比，无决策能力患者接受 ECT 的效果同样好，如果不是更好的话。ECT 可以潜在地增强患者的自主性，而不会增加认知副作用的风险。这些结果支持在治疗开始时就缺乏决策能力的最严重疾病患者中提供 ECT 的临床和伦理合法性。
