Electroconvulsive therapy and autobiographical memory

When a patient has no insight into their major mental illness and need for treatment and refuses electroconvulsive therapy (ECT), involuntary treatment may be the only option. Despite considerable advances in ECT treatment, patients are often concerned about possible adverse effects, particularly memory impairment. In Re FYS [2023] QMHC 3, the Queensland Mental Health Court considered whether a patient with bipolar disorder complicated by psychosis had decision-making capacity to refuse ECT. Since the patient had also indicated his particular fear that ECT treatment would affect his autobiographical memory, the Court considered whether the patient had been provided with an adequate explanation of the proposed treatment including the risks and benefits and whether ECT was an appropriate treatment for his mental illness. In cases like Re FYS when there is an appeal from a decision to authorise involuntary ECT, clinicians must be cognisant of the current position statements and professional practice guidelines for the administration of ECT and be able to explain memory function, memory testing and the types of memory loss which may be associated with ECT.