Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study
Background Electroconvulsive therapy (ECT) is often used to treat severe mental disorders in individuals with impaired capacity to consent to the treatment. Little is known about how different types of electrode placement are used in consensual and nonconsensual ECT. Aims To investigate whether...
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Cambridge University Press
2025-07-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472425100537/type/journal_article |
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| author | Hye-Sang Shin Naveen Thomas Yiting Amanda Gong Rajeev Krishnadas Alby Elias |
| author_facet | Hye-Sang Shin Naveen Thomas Yiting Amanda Gong Rajeev Krishnadas Alby Elias |
| author_sort | Hye-Sang Shin |
| collection | DOAJ |
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Background
Electroconvulsive therapy (ECT) is often used to treat severe mental disorders in individuals with impaired capacity to consent to the treatment. Little is known about how different types of electrode placement are used in consensual and nonconsensual ECT.
Aims
To investigate whether there was an association between ECT consent status and electrode placement, given that ECT electrode placement affects efficacy and cognitive outcomes.
Method
Using a statewide database across 3 years in Victoria, Australia, we performed chi-squared tests to determine whether consent status (consensual versus nonconsensual) was associated with particular electrode placements. A three-way log–linear analysis was then conducted to examine whether age, gender, level of education and psychiatric diagnosis influenced the relationship between consent status and electrode placement. Given the comparable cognitive outcomes of right unilateral and bifrontal ECT, these electrode placements were combined in the analysis.
Results
In total, 3882 participants received ECT in the Victorian public health service during the study period. In the nonconsensual ECT group, 722 of 1576 individuals (45.81%) received bitemporal ECT, compared with 555 of 2306 (24.06%) in the consensual group (χ
2 = 200.53; P < 0.0001; odds ratio: 2.6673, 95% CI: 2.3244–3.0608). This association remained significant after adjustment for gender, age, level of education and diagnosis.
Conclusion
Significantly more participants in the nonconsensual ECT group received bitemporal ECT rather than right unilateral or bifrontal ECT compared with those in the consensual group. As bitemporal ECT is associated with more cognitive impairment, this choice of electrode placement in vulnerable patients who lack capacity to consent raises ethical considerations in the practice of ECT.
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| format | Article |
| id | doaj-art-e4edc9e3cbc641e7a0fa45f2980a2a71 |
| institution | Kabale University |
| issn | 2056-4724 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj-art-e4edc9e3cbc641e7a0fa45f2980a2a712025-08-20T03:26:34ZengCambridge University PressBJPsych Open2056-47242025-07-011110.1192/bjo.2025.10053Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review studyHye-Sang Shin0Naveen Thomas1Yiting Amanda Gong2Rajeev Krishnadas3https://orcid.org/0000-0001-6845-5894Alby Elias4https://orcid.org/0000-0002-7494-1028Division of Mental Health and Wellbeing, Western Health, Melbourne, AustraliaDivision of Mental Health and Wellbeing, Western Health, Melbourne, AustraliaFaculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, AustraliaDepartment of Psychiatry, University of Cambridge, Cambridge, UKDivision of Mental Health and Wellbeing, Western Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia Background Electroconvulsive therapy (ECT) is often used to treat severe mental disorders in individuals with impaired capacity to consent to the treatment. Little is known about how different types of electrode placement are used in consensual and nonconsensual ECT. Aims To investigate whether there was an association between ECT consent status and electrode placement, given that ECT electrode placement affects efficacy and cognitive outcomes. Method Using a statewide database across 3 years in Victoria, Australia, we performed chi-squared tests to determine whether consent status (consensual versus nonconsensual) was associated with particular electrode placements. A three-way log–linear analysis was then conducted to examine whether age, gender, level of education and psychiatric diagnosis influenced the relationship between consent status and electrode placement. Given the comparable cognitive outcomes of right unilateral and bifrontal ECT, these electrode placements were combined in the analysis. Results In total, 3882 participants received ECT in the Victorian public health service during the study period. In the nonconsensual ECT group, 722 of 1576 individuals (45.81%) received bitemporal ECT, compared with 555 of 2306 (24.06%) in the consensual group (χ 2 = 200.53; P < 0.0001; odds ratio: 2.6673, 95% CI: 2.3244–3.0608). This association remained significant after adjustment for gender, age, level of education and diagnosis. Conclusion Significantly more participants in the nonconsensual ECT group received bitemporal ECT rather than right unilateral or bifrontal ECT compared with those in the consensual group. As bitemporal ECT is associated with more cognitive impairment, this choice of electrode placement in vulnerable patients who lack capacity to consent raises ethical considerations in the practice of ECT. https://www.cambridge.org/core/product/identifier/S2056472425100537/type/journal_articleElectroconvulsive therapyelectrode placementECTMental Health Actconsent |
| spellingShingle | Hye-Sang Shin Naveen Thomas Yiting Amanda Gong Rajeev Krishnadas Alby Elias Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study BJPsych Open Electroconvulsive therapy electrode placement ECT Mental Health Act consent |
| title | Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study |
| title_full | Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study |
| title_fullStr | Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study |
| title_full_unstemmed | Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study |
| title_short | Differences in electrode placements between consensual and nonconsensual electroconvulsive therapy: retrospective chart review study |
| title_sort | differences in electrode placements between consensual and nonconsensual electroconvulsive therapy retrospective chart review study |
| topic | Electroconvulsive therapy electrode placement ECT Mental Health Act consent |
| url | https://www.cambridge.org/core/product/identifier/S2056472425100537/type/journal_article |
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