Short-Term and Long-Term Outcomes of Electroconvulsive Therapy in Patients With Impaired Decision-Making Capacity

Evidence about nonvoluntary electroconvulsive therapy (ECT) is limited. Observational studies have suggested that nonvoluntary ECT is equally effective as voluntary ECT in treating psychotic and mood disorders. However, prior studies with short follow-up periods of ∼6 months have been inconclusive regarding long-term clinical outcomes following nonvoluntary ECT, particularly in patients with schizophrenia-spectrum disorders.

We conducted a retrospective chart review and included patients who received ECT treatment between 2016 and 2023 at our hospital. The patients were assigned to the nonvoluntary and voluntary groups. We compared the short-term and long-term outcomes between the 2 groups over a 1-year period.

In total, 227 patients were included in this study: 58 in the nonvoluntary group and 169 in the voluntary group. No significant intergroup differences were observed in short-term outcomes, such as the clinical global impressions-improvement scale score, number of discharged patients, and duration of admission. Furthermore, the Cox proportional hazard model found that the nonvoluntary group was not significantly associated with treatment failure 1 year after discharge (hazard ratio: 0.94, 95% CI: 0.55-1.61). However, 6 patients in the nonvoluntary ECT group underwent the procedure again, representing a statistically significant difference.

Nonvoluntary ECT may be an effective treatment option for patients with life-threatening conditions when no alternative is available. However, further investigation is needed to explore ways to improve patient acceptance of future treatments.