title: Practical and Legal Challenges to Electroconvulsive Therapy in Malignant Catatonia.
abstract: In cases of malignant catatonia, prompt administration of electroconvulsive therapy (ECT) can decrease mortality, whereas delays to initiating ECT have resulted in adverse outcomes, including death. We present a clinical vignette of malignant catatonia that required court-ordered ECT, followed by a discussion of practical and legal obstacles to expediting emergent ECT when patients cannot provide consent. We review particularly exacting mandates for involuntary ECT from three states: California, Texas, and New York. As compared to standard practice for other clinical interventions when a patient lacks decision-making capacity, ECT is highly regulated; in some cases, these regulations can interfere with life-saving treatment.
authors.affiliation: From the Western Psychiatric Institute and Clinic Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Neeta
authors.initials: N
authors.lastname: Shenai
authors.forename: Crystal D
authors.initials: CD
authors.lastname: White
authors.forename: Pierre N
authors.initials: PN
authors.lastname: Azzam
authors.forename: Priya
authors.initials: P
authors.lastname: Gopalan
authors.forename: LalithKumar K
authors.initials: LK
authors.lastname: Solai
mesh_terms: D000328:Adult; D002389:Catatonia / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000331:legislation & jurisprudence* / Q000592:standards*; D006801:Humans