Electroconvulsive therapy in forensic psychiatry--ethical problems in daily practice

There is a widespread similarity between diagnoses in general psychiatry compared with those found in forensic psychiatry. Consequently, forensic psychiatrists face serious cases that need to undergo treatment by electroconvulsive therapy (ECT). Although it is a well known and valid treatment, ECT is rarely applied to forensic-psychiatric patients or prisoners as well. This might be due to the general assumption that detained individuals, either in forensic psychiatry or in prisons, will not be chosen for a therapy, which is merely looked on as an emergency treatment. Besides, informed consent might be estimated not valid in such persons. However, the use of ECT in forensic psychiatry or prisons cannot be denied anymore because diagnoses and indications for ECT parallel the situation in general psychiatry. With the numbers of schizophrenic and depressive patients considerably increasing in the past years in our forensic unit, we estimate the indication for ECT in forensic psychiatry of approximately 3% and 12.5%, respectively.