Medicolegal Issues

ECT wipes out 30 years of memories

Current Psychiatry. 2006 August;5(8):84-86

References

1. American Psychiatric Association. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging, 2nd ed. Washington, DC: American Psychiatric Publishing; 2001.

2. Nobler MS, Sackeim HA, Moeller JR, et al. Quantifying the speed of symptomatic improvement with electroconvulsive therapy: comparison of alternative statistical methods. Convuls Ther 1997;13:208-21.

3. Slawson P. Psychiatric malpractice and ECT: a review of 1,700 claims. Convuls Ther 1991;7:255-61.

4. Freeman CP, Cheshire KE. Attitude studies on electroconvulsive therapy. Convuls Ther. 1986;2:31-42.

5. Pettinati HM, Tanburello TA, Ruetsch CR, et al. Patient attitudes toward electroconvulsive therapy. Psychopharmacol Bull. 1994;30:471-5.

6. Small JG, Kellams JJ, Milstein V, et al. Complications with electroconvulsive treatment combined with lithium. Biol Psychiatry 1980;15:103-12.

7. Sobin C, Sackeim HA, Prudic J, et al. Predictors of retrograde amnesia following ECT. Am J Psychiatry 1995;152:995-1001.

8. Donahue JC. Electroconvulsive therapy and memory loss: anatomy of a debate. J ECT 2000;16:133-43.

9. Sackeim HA. Memory and ECT: from polarization to reconciliation. J ECT 2000;16:87-96.

10. Lisanby SH, Maddox JH, Prudic J, et al. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry 2000;57:581-90.

11. Sackeim HA, Prudic J, Devanand DP, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993;328:839-46.

12. Coleman EA, Sackeim HA, Prudic J, et al. Subjective memory complaints before and after electroconvulsive therapy. Biol Psychiatry 1996;39:346-56.

Although ECT might impair memory, it can improve neuropsychological domains such as global cognitive status and measures of general intelligence.¹¹ Also, there is no evidence that ECT causes lasting problems in executive functioning, abstract reasoning, creativity, semantic memory, implicit memory, or skill acquisition or retention. Long-term negative effects on ability to learn and retain new information are unlikely.¹

Avoiding an ect related malpractice claim

To reduce the possibility of a malpractice claim after ECT:

Inform the patient about the risk of cognitive side effects as part of the informed consent process (Box).
Assess the patient’s orientation and memory functions before and throughout ECT. In the above case, the referring psychiatrist had a duty to inform the psychiatrist administering ECT about the patient’s memory problems and recommend decreasing or discontinuing ECT.
Consider a patient’s mood state, which may influence how ECT patients rate their memory.¹² Ask about symptoms of depression. Patients with cognitive complaints such as subjective memory loss are more likely than those without such problems to have depression symptoms.¹
Do not administer ECT more than 3 times per week. No evidence supports more frequent use, and daily ECT may increase cognitive problems.¹ The psychiatrist in the above case was negligent in providing a treatment frequency with no scientific support or medical rationale.
Verify that the physician is qualified to perform ECT. Hospitals must ensure ECT quality and safety and should have a written plan for providing and maintaining ECT privileges.
Involve the family when appropriate. Family members often care for patients during outpatient ECT. Give patients and family members literature describing ECT. Allow them time to consider the procedure, then schedule an appointment to answer questions.

Address patient and family concerns throughout treatment, not just before ECT. Uninformed family members may have strong negative opinions about ECT from books or movies and may instigate a malpractice action—such as a wrongful death claim if the patient dies while receiving ECT—or urge the patient to sue when complications develop. By contrast, a well-informed, supportive family might expedite the patient’s recovery and be less likely to file malpractice claims.

ECT wipes out 30 years of memories

References

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