Importance of electroconvulsive therapy (ECT) in forensic psychiatry

Abstract

Background and objective: Electroconvulsive therapy (ECT) is recommended in guidelines for the treatment of severe affective and psychotic disorders that also can be found in patients in forensic psychiatric commitment; however, there are no systematically collected data concerning the use of ECT in forensic psychiatry. The aim of this study was to investigate the current state and estimated need for ECT in forensic psychiatry in Germany. Material and methods: A questionnaire was designed consisting of questions about the current practice and estimated need for ECT in this population. This questionnaire was sent electronically (and by post if needed) to the forensic psychiatric hospitals in Germany. Results: We received replies from 52 hospitals (66%) and 29 of these hospitals stated that they were capable of treating patients with ECT. An indication for ECT treatment was seen in 3.4% of all detained patients across all forensic hospitals. In 1 year (2018) 32 ECT treatment courses were carried out with on average good effectiveness and a mean clinical global impressions (CGI) scale of 2.32. The most frequent reason for not using ECT was lack of structural requirements. Approximately one third of the forensic psychiatric hospitals stated that there was a medium or even high need for ECT in forensic psychiatry. Conclusion: The use of ECT in German forensic psychiatry is currently very limited. It is striking that the number of applied ECT treatments is eight times lower in comparison to the frequency of indications. Nevertheless, approximately two thirds of the forensic hospitals stated a medium or high need for ECT, which seems to suggest a shortage of ECT in the treatment of forensic psychiatry patients.