title: Electroconvulsive therapy without consent from patients: one-year follow-up study.
abstract: BACKGROUND
  No previous study has been designed to analyze the reasons for electroconvulsive therapy (ECT) without patients' consent. In the present study we compared the clinical characteristics and one-year outcomes between patients with refusal to undergo ECT and patients without competency for ECT consent.
  
  
  METHODS
  In a retrospective cohort study, 29 patients were treated with ECT without providing consent between 1 January 2006 and 31 August 2010. A surrogate family member gave informed consent for ECT to meet current legal requirements. Patients were assigned to one of two groups: a consent-refusal group comprising patients who refused to give consent for ECT and could clearly say "no" or argue with psychiatric staff about receiving ECT; and a consent-incompetent group comprising patients who were incompetent for consent but underwent ECT passively or reluctantly without argument.
  
  
  RESULTS
  The patients were clinically diagnosed with schizoaffective disorder (n = 6), psychotic disorder (n = 12), bipolar I disorder (n = 8) and major depressive disorder with psychotic features (n = 3). The consent-incompetent patients had longer hospital stays and more recurrence in one year than the consent-refusal patients, which may be because the former group had more psychotic disorders and fewer mood disorders. All patients improved rapidly and efficiently. However, remission was temporal in two-thirds of patients and the rehospitalization rate in one year was 66% (n = 19).
  
  
  CONCLUSIONS
  ECT can be applied early, emergently and successfully to patients who have a wide range of psychiatric disorders and life-threatening conditions without threat of lawsuits, even during their first hospitalization.
authors.affiliation: Departments of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Nien-Mu
authors.initials: NM
authors.lastname: Chiu
authors.forename: Yu
authors.initials: Y
authors.lastname: Lee
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000941:ethics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D012189:Retrospective Studies; D013624:Taiwan; D020458:Third-Party Consent / Q000941:ethics*; D055815:Young Adult
keywords: electroconvulsive therapy; informed consent; mental competence; suicide; violence