Clinical Effectiveness, Cognitive Effects, and Caregiver Attitudes Toward Modified Electroconvulsive Therapy: A Prospective Observational Study

IntroductionElectroconvulsive therapy (ECT) is effective across several severe psychiatric disorders, yet families who consent to it often fear it.We examined caregiver attitudes toward modified ECT and the early clinical and cognitive outcomes of treatment in an Indian tertiary care setting. MethodsIn this prospective observational study, consecutive inpatients prescribed modified bitemporal ECT and their primary caregivers were enrolled between April 2020 and December 2021.Caregivers completed the 22-item Modified ECT Attitudes Questionnaire (EAQ; range 0-44) at baseline.Patients were rated on the Clinical Global Impression-Severity (CGI-S), the Mini-Mental State Examination (MMSE), and diagnosis-specific scales before the first session and after 5-7 sessions. ResultsOf the 60 dyads enrolled, 58 completed follow-up (mean patient age 42.8 ± 8.8 years; 60.3% male).Treatment-resistant depression and treatment-resistant schizophrenia were the most common indications (29.3% each).After a mean of 5.7 sessions, CGI-S fell from 5.4 ± 1.0 to 3.5 ± 0.9 (p < 0.001; dz = 1.69).Hamilton Depression Rating Scale scores fell by 49.0% (n = 27), Bush-Francis Catatonia Rating Scale scores by 61.3% (n = 6), Young Mania Rating Scale scores by 30.0%(n = 8), and Positive and Negative Syndrome Scale scores by 37.1% (n = 21) (all p < 0.01).Overall, 23 patients (39.7%) met response criteria.Mean MMSE did not change in the full sample (23.9 to 23.5; p = 0.19), but fell by 1.0 point in patients without catatonic features (p < 0.001).Memory complaints were the most frequent predominant adverse effect (24.1%).The mean caregiver EAQ score was 22.9 ± 6.9, near the scale midpoint, and half of caregivers named films or television as their main source of information about ECT.Attitude scores did not differ by information source, caregiver sex, caregiver education, or previous ECT exposure. ConclusionsModified ECT was associated with rapid early symptomatic improvement and a small short-term decline in MMSE scores, although the MMSE may underestimate memory effects and, without a control group, these changes cannot be attributed solely to ECT.Caregiver attitudes were ambivalent, and half of caregivers relied on films or television for information, which argues for structured, clinician-led education during the consent process.