Decision-making Capacity for Treatment After Electroconvulsive Therapy for Depression.
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Authors
Loughran, Orlaith
Finnegan, Martha
Dud, Iulia
Galligan, Toni
Kennedy, Miriam
McLoughlin, Declan M
Issue Date
2022-Mar-01
Type
Journal Article
Language
en
Keywords
Research Subject Categories::MEDICINE::Psychiatry
Alternative Title
Abstract
Depression can impair decision-making capacity (DMC) for health care decisions. However, it is unclear whether DMC improves after treatments for depression such as electroconvulsive therapy (ECT). There is limited evidence available on DMC for treatment in patients with depression referred for ECT, and it is unknown whether ECT has any impact on DMC. We hypothesized that ECT will improve DMC in severely depressed patients and that this change will be associated with reduced depressive symptom severity.
Using the MacArthur Competence Assessment Tool-Treatment, 4 abilities related to DMC were evaluated: Understanding, Appreciation, Reasoning, and Expressing a choice. This prospective study compared DMC abilities, depression severity, and cognition scores in 24 patients hospitalized with a major depressive episode before and 3 to 5 days after a course of ECT.
Although Understanding scores significantly improved after ECT (P = 0.004, r = 0.41), there was no change in other abilities related to DMC or cognition scores. As expected, there was a large improvement in mood ratings after ECT, but the change in DMC abilities was not associated with change in depressive symptoms.
To our knowledge, this is the first study to provide data on the effects of ECT on DMC in patients with depression. Abilities related to DMC that may be affected in this group before treatment include Understanding and Reasoning. Findings indicate that DMC to consent to treatment mostly does not change after a course of ECT and some aspects can improve in patients with depression.
Using the MacArthur Competence Assessment Tool-Treatment, 4 abilities related to DMC were evaluated: Understanding, Appreciation, Reasoning, and Expressing a choice. This prospective study compared DMC abilities, depression severity, and cognition scores in 24 patients hospitalized with a major depressive episode before and 3 to 5 days after a course of ECT.
Although Understanding scores significantly improved after ECT (P = 0.004, r = 0.41), there was no change in other abilities related to DMC or cognition scores. As expected, there was a large improvement in mood ratings after ECT, but the change in DMC abilities was not associated with change in depressive symptoms.
To our knowledge, this is the first study to provide data on the effects of ECT on DMC in patients with depression. Abilities related to DMC that may be affected in this group before treatment include Understanding and Reasoning. Findings indicate that DMC to consent to treatment mostly does not change after a course of ECT and some aspects can improve in patients with depression.
Description
Citation
Loughran, O., Finnegan, M., Dud, I., Galligan, T., Kennedy, M., & McLoughlin, D. M. (2022). Decision-making Capacity for Treatment After Electroconvulsive Therapy for Depression. The journal of ECT, 38(1), 24–29. https://doi.org/10.1097/YCT.0000000000000804
Publisher
License
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Journal
The journal of ECT
Volume
38
Issue
1
PubMed ID
ISSN
1533-4112