Besse Matthias, Belz Michael, Hachtel Henning, Simon Alfred, Hesse Dirk, Müller Jürgen, Friese Aniela, Zilles-Wegner David
Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, von-Siebold-Strasse 5, D-37075, Göttingen, Germany.
Department of Forensic Psychiatry, University Medical Center Basel, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland.
Eur Arch Psychiatry Clin Neurosci. 2025 Jun 23. doi: 10.1007/s00406-025-02044-6.
Patients with treatment resistant schizophrenia (TRS) may benefit from electroconvulsive therapy (ECT). Although TRS is a frequent problem in forensic hospitals, ECT is rarely used in this setting. This study investigates the availability and implementation of ECT in forensic hospitals in Germany and Switzerland. Moreover, we collected anonymized clinical data of patients treated with ECT.
A digital survey was sent to all forensic psychiatric hospitals in Germany and Switzerland. The questionnaire comprised general information (hospital structure, use of ECT) and an optional second part for patients treated with ECT during the last 12 months.
41 German and 4 Suisse hospitals responded, of which the majority stated to have the possibility to offer ECT. The estimated percentage of patients with ECT indication was 7.35% (360 patients) and 7.5% (13 patients), respectively. However, only 38 patients were actually treated with ECT over a period of 12 months. Slightly over 50% of the patients were responders according to the Clinical Global Impression Improvement Scale.
Our study presents the largest population of patients with TRS treated with ECT in forensic hospitals to date. Compared to 2018, there was a marked increase in the proportion of patients for whom ECT was considered indicated. Patients treated with ECT experienced a reduction in both symptom severity and the need for restraints. The response rate aligns with matching data from non-forensic populations. In view of these promising results, prospective controlled observational studies are needed to further strengthen the evidence regarding the effectiveness of ECT in forensic populations.
难治性精神分裂症（TRS）患者可能从电休克治疗（ECT）中获益。尽管TRS在法医医院是一个常见问题，但ECT在这种情况下很少使用。本研究调查了德国和瑞士法医医院中ECT的可用性和实施情况。此外，我们收集了接受ECT治疗患者的匿名临床数据。
向德国和瑞士所有法医精神病医院发送了一项数字调查问卷。问卷包括一般信息（医院结构、ECT的使用）以及一个可选的第二部分，用于询问过去12个月内接受ECT治疗的患者的情况。
41家德国医院和4家瑞士医院做出了回应，其中大多数表示有可能提供ECT。估计有ECT适应症的患者比例分别为7.35%（360例患者）和7.5%（13例患者）。然而，在12个月的时间里，实际只有38例患者接受了ECT治疗。根据临床总体印象改善量表，略超过50%的患者有反应。
我们的研究展示了迄今为止法医医院中接受ECT治疗的最大规模的TRS患者群体。与2018年相比，被认为适合接受ECT治疗的患者比例有显著增加。接受ECT治疗的患者症状严重程度降低，约束需求也减少。反应率与非法医人群的匹配数据一致。鉴于这些有前景的结果，需要进行前瞻性对照观察研究，以进一步加强关于ECT在法医人群中有效性的证据。
