Effectiveness of ECT in a Forensic Psychiatric Setting: A Case Study

Susan Elizabeth Ezzell, Fordham University


Aggression among forensic psychiatric patients is relatively common. An average of 45% to 60% of patients commit acts of while hospitalized, but a small proportion of patients are responsible for most aggressive incidents. These aggressive acts can cause serious harm to staff, other patients, and property; however, little is known about effective treatment for this particular subgroup of chronically aggressive patients. Finding effective treatment for these individuals can be difficult, but one promising modality involves electroconvulsive therapy (ECT). The goal of the current study is to more thoroughly examine the impact of ECT in a forensic setting. Medical records were examined for one male patient at a maximum-security forensic hospital who was referred for ECT due to treatment resistant psychotic symptoms and aggression. Data was extracted on aspects of each individual ECT session and the frequency of aggressive incidents. The patient received 116 sessions of ECT over an 17-month period prior to starting maintenance ECT (biweekly ECT), 97 (83.6%) of which were bifrontal ECT. During the three months prior to starting ECT, the patient had 77 incidents of aggressive behavior, most commonly physical aggression against others (21 incidents) and self-harm (22 incidents). During the three months after beginning maintenance ECT, he had no incidents of aggression and during the one year follow-up he had 6 total incidents of aggression, most commonly self-harm (4 incidents). In sum, ECT reduced the frequency of aggression in this case. This effect appears to be stable over time and occurred quickly after the start of ECT. These results indicate promise for ECT as a viable option for reducing the frequency of aggression among forensic psychiatric patients.

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Recommended Citation

Ezzell, Susan Elizabeth, "Effectiveness of ECT in a Forensic Psychiatric Setting: A Case Study" (2018). ETD Collection for Fordham University. AAI10816458.