Palliative ECT: A Descriptive Cohort Study

 

Palliative Electroconvulsive Therapy: A Descriptive Cohort Study.

Robbins-Welty GA, Slauer RD, Brown MM, Nakatani MM, Shalev D, Feigal J.J Acad Consult Liaison Psychiatry. 2024 Dec 9:S2667-2960(24)00134-4. doi: 10.1016/j.jaclp.2024.12.001. Online ahead of print.PMID: 39662871

The abstract is copied below:

Introduction: Palliative care (PC) is the standard of care for patients with serious medical illnesses, or those conditions associated with high risk of mortality and negative impact on quality of life (QOL). Electroconvulsive therapy (ECT) is the gold standard treatment for certain psychiatric conditions, which may co-occur with serious medical illnesses. However, the use of "palliative ECT" (PECT) in this context is understudied.

Methods: We conducted a descriptive retrospective cohort study reviewing the indications, outcomes, and regimens of PECT. We included patients who had an ECT consultation, in addition to either a PC consultation or a do-not-attempt-resuscitation (DNAR) code status between 2018 and 2023.

Results: Thirty-one patients met our inclusion criteria and 21 received ECT. The cohort was predominantly female (70%) with a mean age of 67.6 (range 25-90). Catatonia (64.5%) and treatment-resistant depressive disorder (35.5%) were the most common indications for ECT. At the time of ECT consultation, 16 patients (51.6%) had a serious medical illness, including cancer (19.4%) or end-organ disease (22.6%). Fourteen patients had major neurocognitive disorder (MNCD) (45.2%). Surrogate decision-makers consented for ECT in 64.5% of cases. All 21 patients who received ECT experienced psychiatric symptom improvement. ECT was associated with reduced mortality risk in five (23.8%) cases. Five patients initially misdiagnosed with MNCD experienced recovery in cognitive function after ECT and the diagnosis was revised to depression-related cognitive dysfunction (DRCD). Eight patients retained a comorbid MNCD diagnosis but experienced a mean Montreal Cognitive Assessment (MoCA) improvement of five points (range 0 to 17) with ECT.

Discussion: This work highlights the use of ECT among patients with serious medical illnesses, identifying cases when ECT was beneficial or deemed unsuitable. Patients with serious medical illnesses who also had an indication for ECT experienced improved QOL with ECT. Misdiagnoses, such as confusing DRCD and catatonia for MNCD, were effectively addressed through ECT. The findings underscore the importance of cross-specialty collaboration between C-L psychiatry and PC.

Conclusions: Patients who receive PECT experience reduced suffering and improved QOL. PECT may be helpful in scenarios of life-threatening psychiatric illnesses, terminal medical illness with comorbid treatment-refractory psychiatric illness, and diagnostic uncertainty with MNCD.

Keywords: Catatonia; Electroconvulsive Therapy; Hospice; Major Neurocognitive Disorder; Palliative Care; Serious Mental Illness.

The article is here.

And from the text:

This is an interesting and important paper. It may be the first to coin the acronym "PECT" for palliative ECT.

One striking finding is the cohort of patients with presumed dementia who responded remarkably well to ECT, some recovering cognition completely. Again, I want to add back the term "pseudodementia" to this discussion. Not to forget the strikingly counterintuitive concept that ECT may be restorative to the brain in actual dementia.

Kudos to these authors.