Abstract
<title>Abstract</title> <p>Objectives Electroconvulsive therapy (ECT) is highly effective for severe and treatment-resistant mental disorders, but concerns about cognitive side effects and enduring stigma continue to hinder its broader acceptance. Although treatment response and cognitive tolerability are both clinically important, their systematic assessment and documentation remain challenging in routine clinical practice. To address this gap, we developed the Clinical Global Impression–Stimulation Outcome Monitoring Tool (CGI-STIM), a clinician-rated framework that integrates both domains into a structured and clinically interpretable outcome assessment. Methods We retrospectively analyzed 21 ECT series in 15 patients. Two independent clinicians applied the CGI-STIM using routine clinical documentation to classify treatment outcomes based on clinical response and cognitive tolerability. Feasibility and interrater agreement were evaluated. Results The CGI-STIM was successfully applied to all 21 ECT series. Outcome classification was feasible in all cases using routinely available clinical information. Average completion time was approximately 5 minutes. Interrater agreement was excellent (quadratically weighted Cohen’s κ = 0.84). The resulting classifications reflected varying combinations of clinical improvement and cognitive tolerability, illustrating the instrument’s ability to capture multidimensional treatment outcomes. Conclusions The CGI-STIM is a feasible and pragmatic outcome monitoring tool for ECT that facilitates structured documentation of both treatment response and cognitive tolerability. Preliminary findings support its reliability, feasibility, and applicability in routine clinical practice. Future studies should prospectively evaluate the CGI-STIM in larger ECT samples and examine its validity, sensitivity to change, and utility for routine outcome monitoring.</p>