[Erratum to: Effectiveness and tolerability of electroconvulsive therapy : Influence of clinical response from the patient's point of view]. / Erratum zu: Wirksamkeit und Verträglichkeit der Elektrokonvulsionstherapie : Einfluss des klinischen Ansprechens aus Patientensicht.

BACKGROUND: Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients' view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response. MATERIAL AND METHODS: In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI­II) RESULTS: Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients' rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate. CONCLUSION: Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients' perspective.

[Effectiveness and tolerability of electroconvulsive therapy : Influence of clinical response from the patient's point of view]. / Wirksamkeit und Verträglichkeit der Elektrokonvulsionstherapie : Einfluss des klinischen Ansprechens aus Patientensicht.

Background: Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients' view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response. Material and Methods: In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI-II). Results: Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients' rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate. Conclusion: Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients' perspective.

[Treatment against the patient's will exemplified by electroconvulsive therapy : Clinical, legal and ethical aspects]. / Behandlung gegen den natürlichen Willen am Beispiel der Elektrokonvulsionstherapie : Klinische, juristische und ethische Aspekte.

BACKGROUND: Severe affective and psychotic disorders may be accompanied by legal incapacity. If in this case the patient refuses treatment and in parallel there is a risk of serious damage to health, treatment can be carried out against the patient's non-autonomous will under defined prerequisites. Due to its good and partly superior effectiveness in the treatment of severe and pharmacotherapy-resistant affective and psychotic disorders, electroconvulsive therapy (ECT) is an important treatment option in such constellations. AIM: Description of the general principles and prerequisites of therapeutic measures against the patient's will. METHODS: Based on a case report, the application of ECT as a medical measure against the patient's will is discussed and assessed in an interdisciplinary approach from clinical, legal, and ethical perspectives. RESULTS AND DISCUSSION: The (empirical) evidence on the general effectiveness of ECT, as well as its application against the will of patients with legal incapacity, clearly shows a positive benefit-risk ratio. When performed against the patient's will, ECT as all compulsory medical interventions, represents a severe encroachment on the individual's fundamental rights of both physical integrity and self-determination. Nevertheless, its application may be medically indicated, legally admissible and ethically appropriate in individual cases to prevent the threat of serious damage to the patient's health. Ethical and legal prerequisites of treatment against the patient's will should be evaluated by a multiprofessional team and the patient's legal guardian should be involved from an early stage.

[Electroconvulsive therapy in nonconsenting patients]. / Elektrokonvulsionstherapie gegen den natürlichen Patientenwillen.

BACKGROUND: Electroconvulsive therapy (ECT) is a potent and successful method for the treatment of severe psychiatric disorders. Severe depressive and psychotic disorders may lead to legal incapacity and inability to consent. In Germany, administration of ECT against the patient's will is feasible under certain constellations and is regulated under the terms of the guardianship law. OBJECTIVE: This article outlines the prevalence, effectiveness and tolerability of ECT when applied in nonconsenting patients. MATERIAL AND METHODS: Case report and literature review. RESULTS: The literature on ECT as a treatment in nonconsenting patients is relatively sparse. In 2008 the prevalence in Germany was less than 0.5 % of all patients receiving ECT. Case reports and case series suggest a good and equal level of effectiveness when compared to consenting patients. In the course of treatment the majority of patients consented to receive further ECT and retrospectively judged ECT as helpful. CONCLUSION: The use of ECT is a highly effective treatment in severe psychiatric disorders even when administered as treatment in nonconsenting patients. It can be lifesaving and lead to a rapid improvement of symptoms and relief from severe suffering also from the patients' perspective. Thus, it seems unethical not to consider ECT as a treatment against the nonautonomous will of legally incompetent patients in individual cases. Nevertheless, physicians should always seek to obtain the patients' consent as soon as possible for both legal and ethical reasons.