Refractory mania and inability to consent: an important role for involuntary ECT

2013 ◽  
Vol 30 (1) ◽  
pp. 73-76
Author(s):  
J. Lally ◽  
C. McDonald
Keyword(s):  
Mental Health ◽  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Rapid Response ◽  
Full Recovery ◽  
First Episode ◽  
Psychotic Illness ◽  
Mental Health Act

We present the case of a 23-year-old man with a first episode of severe mania, which was refractory to pharmacotherapy. The case demonstrates a rapid response and full recovery after the use of electroconvulsive therapy (ECT). The ECT was administered involuntarily under Section 59(1) (b) of the Irish Mental Health Act 2001 as the patient was unable to consent to the treatment. The case highlights the benefits of ECT for this serious condition and emphasises the importance of retaining the legislative capacity to provide such an effective treatment for patients unable to consent because of severe psychotic illness.

Inadequate Provision for Electoconvulsive Therapy in the New South Wales Mental Health Act 1983

1988 ◽  
Vol 22 (4) ◽  
pp. 404-411 ◽  
Author(s):  
James Durham
Keyword(s):  
Mental Health ◽  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
New South ◽  
New South Wales ◽  
Considerable Proportion ◽  
Treatment Principles ◽  
Mental Health Act ◽  
South Wales ◽  
Division 2

Division 2 of Part X of the NSW Mental Health Act 1983 lays down a set of conditions which must be satisfied before electroconvulsive therapy (ECT) can be given. These provisions are too restrictive and would deny ECT to a considerable proportion of the patients who are most likely to benefit from it. For many of them it would be the only effective treatment. Principles which should govern the authorisation of ECT are proposed.

scholarly journals The impact of COVID-19 on an inpatient mother and baby unit: a service evaluation

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S316-S316
Author(s):  
Joanna Cranshaw ◽  
Gertrude Seneviratne ◽  
Ranga Rao ◽  
Julia Ogunmuyiwa ◽  
Rebecca McMillin ◽  
...  
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Social Services ◽  
Unit Length ◽  
Perinatal Period ◽  
Service Evaluation ◽  
Psychotic Illness ◽  
Mental Health Act ◽  
Mother And Baby Unit ◽  
The Impact

AimsUnique challenges have been faced by women in the perinatal period during the COVID-19 pandemic and the impact of this is compounded for women suffering from mental illness. This service evaluation looked at different aspects of the treatment pathway on a specialist inpatient psychiatric Mother and Baby Unit during the pandemic to identify what changes occurred.MethodData were collected for all admissions to the unit between January 2019 and October 2020, with the beginning of the pandemic being defined as on or after 1st March 2020. Information was collected retrospectively from electronic clinical notes on ethnicity, length of stay, diagnosis, mental health act use and restrictive practice, medication, psychology, occupational therapy and social services involvement.ResultThere were 114 admissions to the MBU during the study period. 4 were parenting assessments rather than acute psychiatric admissions and were excluded from the analysis, giving a sample of 110 women. 58% (62/110) were classed as “pre-pandemic” and 43.6% (48/110) were “during pandemic”. 95.45% (105/110) of women were postpartum 4.55% (5/110) were pregnant. Mean length of stay was shorter during the pandemic at 44 days, compared to 61 pre-pandemic. There was greater use of the mental health act during the pandemic: only 43.75% of patients were informal throughout admission, compared to 70.97% pre-pandemic. Mean duration of detention was shorter at 25 days (32 pre-pandemic). Psychotic illness made up a greater proportion of diagnoses during the pandemic: 56% (27/48) compared to 44% (27/62) pre-pandemic. The next most common diagnostic group was mood and anxiety disorders, which made up 29% (14/48) of diagnoses during the pandemic, but 43% (27/62) pre-pandemic. Outcomes as measured using the Health of the Nation Outcome Scale showed a mean improvement between admission and discharge of 6.65, compared to 5.15 pre-pandemic. HONOS scores were higher on admission during the pandemic (12.83, vs 10.88), suggesting a higher level of acuity.ConclusionDuring the COVID-19 pandemic on this Mother and Baby Unit, length of stay was shorter, a greater proportion of patients were detained under the mental health act (although length of detention was shorter) and psychotic illness was more prevalent. This study demonstrates that there were differences in this perinatal inpatient population during the pandemic and this may be a reflection on the wider impact of COVID-19 on perinatal mental health.

ECT in schizophrenia: a review of the evidence

2018 ◽  
Vol 31 (03) ◽  
pp. 115-127 ◽  
Author(s):  
Sandeep Grover ◽  
Swapnajeet Sahoo ◽  
Anjumoni Rabha ◽  
Raman Koirala
Keyword(s):  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Suicidal Behaviour ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
First Episode ◽  
Treatment Resistant ◽  
Predictors Of Response ◽  
First Episode Schizophrenia

AbstractElectroconvulsive therapy (ECT) was initially used for the treatment of schizophrenia, but over the years with the advent of antipsychotics, its use in schizophrenia has been limited. Treatment guidelines vary in their recommendations for the use of ECT in schizophrenia. The usual indications of its use among patients with schizophrenia include treatment resistance, to augment pharmacotherapy, to manage catatonia, suicidal behaviour, severe agitation and clozapine-resistant schizophrenia. Available literature, including meta-analysis and systematic reviews, suggest that ECT is a safe and effective treatment in patients with schizophrenia. However, despite the available evidence, it is highly underutilised and is often used as one of the last resort among patients with schizophrenia. This review focuses on the indications of use of ECT in schizophrenia, studies evaluating its effectiveness, efficacy in certain special situations like first episode schizophrenia, adolescents, catatonia etc., predictors of response to ECT in schizophrenia and influence of various ECT-related parameters on efficacy/effectiveness among patients with schizophrenia. From the review, it can be concluded that ECT is not only is beneficial as an augmenting strategy in treatment-resistant schizophrenia but also can be used effectively in patients with schizophrenia in various other situations.

Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001

2014 ◽  
Vol 31 (2) ◽  
pp. 143-148 ◽  
Author(s):  
E. Bainbridge ◽  
F. Byrne ◽  
B. Hallahan ◽  
C. McDonald
Keyword(s):  
Mental Health ◽  
Case Report ◽  
Community Treatment ◽  
Residential Setting ◽  
Community Treatment Orders ◽  
Psychotic Illness ◽  
Persistent Symptoms ◽  
Mental Health Act ◽  
Clinical Stability

IntroductionWe present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.MethodCase Report.ConclusionThe case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.

Insight and capacity to consent to electroconvulsive therapy

2019 ◽  
Vol 27 (5) ◽  
pp. 428-434 ◽  
Author(s):  
Russ Scott ◽  
Steve Prowacki
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Supreme Court ◽  
Electroconvulsive Therapy ◽  
Chronic Schizophrenia ◽  
Capacity To Consent ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
Insight Into ◽  
Administrative Tribunal

Objective: To critically examine a recent decision of the Victorian Supreme Court that found that the Mental Health Tribunal and the Victorian Civil and Administrative Tribunal erred in the application of the capacity test in the Mental Health Act 2014 (Vic) and that compulsory electroconvulsive therapy would infringe upon the human rights of two patients who had no insight into their chronic schizophrenia. Conclusions: After considering the concepts of insight and capacity to consent to treatment, the paper concludes that the decision in NJE and PBU v Mental Health Tribunal [2018] VSC 564 is problematic clinically.

scholarly journals A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis

2021 ◽  
Author(s):  
Donal O’Keeffe ◽  
Ann Sheridan ◽  
Aine Kelly ◽  
Roisin Doyle ◽  
Kevin Madigan ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Service Users ◽  
Personal Recovery ◽  
Potential Influence ◽  
Psychotic Illness ◽  
Clinical Recovery ◽  
Episode Psychosis

Abstract Purpose Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). Methods Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full ‘functional recovery criteria’ (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. Results Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. Conclusion Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

An evaluation of the practice of electroconvulsive therapy (ECT) in a Victorian health service before and after the Mental Health Act 2014

2020 ◽  
Vol 28 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Jia L Lee ◽  
Kuruvilla George ◽  
Leah Price ◽  
Jeremy Couper
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Electroconvulsive Therapy ◽  
Eastern Health ◽  
Mental Health Act ◽  
Number Of Patients ◽  
Significant Difference ◽  
Before And After ◽  
Clinical File

Objective: The aim of the project was to identify changes in the practice of electroconvulsive therapy (ECT) in a metropolitan mental health service before and after the Mental Health Act 2014 (2014 Act) in Victoria. Method: Retrospective clinical file audit of ECT administration across all three sites at Eastern Health (EH) two years before and two years after introduction of the 2014 Act. Results: There was a statistically significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT across the three hospitals at EH in the two years following the 2014 Act compared to the two years prior to the 2014 Act. There was no significant difference in the number of voluntary ECT treatments and in the number of patients who had voluntary ECT. Conclusion: The review showed that there has been a significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT after the introduction of the 2014 Act. Potential reasons for the changes are discussed.

Is There a Change in Electroconvulsive Therapy Practice Following the New Mental Health Act 2014 in Victoria?

2019 ◽  
Vol 35 (4) ◽  
pp. 245-250 ◽  
Author(s):  
Partha Das ◽  
Karuppiah Jagadheesan ◽  
Frances Walker ◽  
Vinay Lakra ◽  
Nicola T. Lautenschlager ◽  
...  
Keyword(s):  
Mental Health ◽  
Electroconvulsive Therapy ◽  
Mental Health Act
Sign in / Sign up

Export Citation Format

Share Document