The role of electroconvulsive therapy in the treatment of violence in patients with major mental illness: A systematic literature review

Abstract

Objective

Major mental illness can be associated with violent or aggressive behaviour. Electroconvulsive therapy (ECT) plays a role in managing violence in clinical practice, but there is limited evidence in the literature demonstrating its efficacy. This systematic literature review therefore sought to highlight the available data on ECT and violence in patients with major mental illness.

Method

A search of MEDLINE, Embase, and PsycInfo identified 10 relevant papers. The studies were predominantly retrospective and analysed small study populations of participants with psychotic disorders, as well as one study looking at affective disorders, who had received ECT.

Results

All studies found a reduction in violence following ECT, although there was substantial variation in methodology and outcome measures. Of the five papers using clear quantitative measures, four noted a statistically significant improvement in violence and the fifth demonstrated a non-statistically significant improvement. The remaining papers respectively demonstrated an improvement in general psychopathology, an overall reduction in assaultive behaviour, and a reduction in the use of restraint.

Conclusion

Although it is difficult for this review to draw definitive conclusions due to the low quality and heterogeneity of studies included, ECT may play a role in reducing violence in patients with severe mental illness.