1
|
Steinert T. Using coercion in mental disorders or risking the patient's death? An analysis of the protocols of a clinical ethics committee and a derived decision algorithm. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109578. [PMID: 38050143 DOI: 10.1136/jme-2023-109578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges exist for decision-making. Protocols of the central ethics committee responsible for four psychiatric hospitals over 7 years (N=17) were analysed. While four cases concerned suicide risk in the case of intended hospital discharge, the vast majority (N=13) concerned questions of whether the responsible physician should or should not initiate the use of coercion in patients lacking mental capacity. The committee's recommendations were non-uniform. Forced feeding and electroconvulsive therapy were endorsed in each one case. In two cases of intermittent loss of capacity due to heavy drinking or intermittent severe suicidal ideation, a self-binding contract was recommended and the use of coercion was considered as justified for a very limited period. In all other cases, most of which involved involuntary treatment, the use of coercion was not endorsed. Without exception, the recommendations were accepted with relief by the physicians and their treatment teams, who feared liability in the event of harm to the patient. Eventually, a model of a decision algorithm was derived from the ethical arguments in the protocols.
Collapse
Affiliation(s)
- Tilman Steinert
- Centers for Psychiatry Suedwuerttemberg, Ravensburg, Germany
- Ulm University, Ulm, Germany
| |
Collapse
|
2
|
Aftab A. Long-term impact of antipsychotics: settling the controversy requires more clarity. Psychol Med 2023; 53:1127-1128. [PMID: 33880986 DOI: 10.1017/s0033291721001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
- Northcoast Behavioral Healthcare (Ohio Department of Mental Health and Addiction Services), Northfield, OH, USA
| |
Collapse
|
3
|
Baldessarini RJ, Pinna M, Contu M, Vázquez GH, Tondo L. Risk factors for early recurrence after discontinuing lithium in bipolar disorder. Bipolar Disord 2022; 24:720-725. [PMID: 35319801 DOI: 10.1111/bdi.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Time to a new episode of bipolar disorder (BD) is shorter after discontinuing lithium rapidly. We now address this and other factors associated with the risk of early illness after discontinuing lithium. METHODS We compared factors for association with recurrences of BD within 12 months of discontinuing long-term lithium treatment, using bivariate and multivariable analyses, as well as survival analysis to evaluate latency to new episodes versus rate of lithium-discontinuation and prior treatment duration. RESULTS Among 227 BD subjects who received lithium for 4.47 [CI: 3.89-5.04] years and then discontinued, rapid treatment-discontinuation, and stopping for medical reasons were strongly associated with new illness-episodes within 12 months, as were diagnosis (BD-I > BD-II), greater morbidity during lithium-treatment, and less education, but neither longer treatment nor serum lithium concentrations. Discontinuation rate was strongly associated with shorter median latency to a new episode (rapid: 3.50; gradual [≥2 weeks]: 10.6 months), even with very early recurrences excluded to avoid potential contributions of emerging illness to treatment-discontinuation. Early recurrence was not associated with treatment-duration of ≥2 or ≥5 years or less. In multivariable logistic regression, rapid discontinuation, stopping for medical reasons, and BD-I diagnosis remained significantly, independently associated with early illness after lithium-discontinuation, with no effect of treatment duration. CONCLUSIONS Early recurrence risk was again much greater after rapid discontinuation of lithium and discontinuing for medical reasons, somewhat greater with BD-I than BD-II, and following greater morbidity during lithium-treatment, but not related to dose or duration of preceding treatment exposure.
Collapse
Affiliation(s)
- Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Pinna
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Rome, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Lucio Bini Mood Disorder Centers, Cagliari & Rome, Rome, Italy
| |
Collapse
|
4
|
Bergström T, Seikkula J, Köngäs-Saviaro P, Taskila JJ, Aaltonen J. Need adapted use of medication in the open dialogue approach for psychosis: a descriptive longitudinal cohort study. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2134444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
- Faculty of Health and Sport, University of Agder, Kristiansand, Norway
| | | | - Jyri J. Taskila
- Department of Psychiatry, Länsi-Pohja healthcare district, Kemi, Finland
| | - Jukka Aaltonen
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| |
Collapse
|
5
|
An observational study of antipsychotic medication discontinuation in first-episode psychosis: clinical and functional outcomes. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1329-1340. [PMID: 35041015 DOI: 10.1007/s00127-022-02230-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To study the impact of supervised antipsychotic medication discontinuation on clinical and functional outcomes in first-episode psychosis (FEP) in two different cultural environments. METHOD FEP patients(N = 253), treated in two early intervention services (Montreal, Canada and Chennai, India) for 2 years, were assessed for medication use, positive and negative symptom remission and social-occupational functioning at regular intervals. RESULTS Between months 4 and 24 of treatment, 107 patients discontinued medication ('Off'group) as compared to 146 who stayed on medication ('On'group). Medication discontinuation was higher in Chennai as compared to Montreal (n = 80, 49.07% vs n = 27, 16.87%; χ2 37.80, p < 0.001), with no difference in time to discontinuation [Means(SDs) = 10.64(6.82) and 10.04(5.43), respectively, p = 0.71). At month 24 (N = 235), there were no differences in the rate of positive symptom remission between the on and Off groups (81.5 vs 88.0%, respectively) at both sites. The rate of negative symptom remission was lower among patients in the On compared to the Off group (63.2 vs 87.9%, respectively, χ2 = 17.91, p < 0.001), but only in Montreal (55.4% vs 80.0%, respectively, χ2 = 4.12, p < 0.05). Social and Occupational Functioning Assessment Scale scores were equally high in both Off and On medication groups in Chennai [Means (SDs) = 79.43(12.95) and 73.59(17.63), respectively] but higher in the Off compared to the On group in Montreal Means (SDs) = 77.47(14.97) and 64.94(19.02), respectively; Time × site interaction F = 3.96(1,217), p < 0.05]. Medication status (On-Off) had no impact on the outcomes, independent of other variables known to influence outcomes. CONCLUSION Certain cultural environments and patient characteristics may facilitate supervised discontinuation of antipsychotic medication following treatment of an FEP without negative consequences.
Collapse
|
6
|
Oedegaard CH, Ruano AL, Blindheim A, Veseth M, Stige B, Davidson L, Engebretsen IMS. How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway. Int J Ment Health Syst 2022; 16:19. [PMID: 35379290 PMCID: PMC8978409 DOI: 10.1186/s13033-022-00529-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work. Trial registration: N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00529-8.
Collapse
|
7
|
Wand T, Glover S, Paul D. What should be the future focus of mental health nursing? Exploring the perspectives of mental health nurses, consumers, and allied health staff. Int J Ment Health Nurs 2022; 31:179-188. [PMID: 34679235 DOI: 10.1111/inm.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022]
Abstract
The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person-centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de-emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.
Collapse
Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Glover
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diane Paul
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Efthymiou D, Zekakos DX, Papatriantafyllou E, Ziagkas E, Petrelis AN, Vassilopoulou E. Gait Alterations in the Prediction of Metabolic Syndrome in Patients With Schizophrenia: A Pilot Study With PODOSmart ® Insoles. Front Psychiatry 2022; 13:756600. [PMID: 35153872 PMCID: PMC8829465 DOI: 10.3389/fpsyt.2022.756600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Second-generation antipsychotics (APs) are associated with metabolic syndrome (MetS), characterized by abnormal pro-inflammatory cytokine production and oxidative stress due to the reduced antioxidant systems, and neurological effects, including mobility impairment. This pilot study investigated relationships between inflammatory-metabolic biomarkers, MetS and gait alterations in patients with psychosis treated with APs. METHODS Patients with psychosis treated with APs, 20 with MetS (MPS group) and 20 without MetS (PS group) were studied, usinganthropometric data, blood measurements and gait analysis performed with the PODOSmart ® gait analysis device. RESULTS AND DISCUSSION The MPS group had significantly higher mean body mass index (BMI) and arterial blood pressure (BP) than the PS group. PODOSmart ® gait analysis recorded significant differences between groups in pronation-supination at Heel Off (HO), gaitline HO and gaitline Toe Off (TO). Multifactorial elastic net regression models demonstrated significant association with MetS of inflammatory markers, specific AP2 treatment, gender, age; BMI; BP and smoking (accuracy λ = 0.08), and in relation to gait parameters (accuracy λ = 0.750), the three pronation- supination variables, i.e., at HO, flat foot in (AP2 related) and TO, and propulsion speed. The gait parameters were at the edges of the model, thus indicating a more significant role of these parameters compared to the other clinical variables. Early diagnosis of MetS in patients with schizophrenia via identification of gait alterations can be a screening measure for serious cardiovascular complications related to psychosis and APs, to enable timely dietary intervention that can control the pro-inflammatory state and reduce oxidative stress.
Collapse
Affiliation(s)
- Dimitris Efthymiou
- Division of Neurosciences, Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Efthimis Ziagkas
- Laboratory of Motor Behaviour, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| |
Collapse
|
9
|
Chakraborty N. Medication‐free treatment for psychosis – an alternative to antipsychotics? PROGRESS IN NEUROLOGY AND PSYCHIATRY 2021. [DOI: 10.1002/pnp.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nandini Chakraborty
- Professor Chakraborty is a Consultant Psychiatrist in Early Intervention in Psychosis, Leicestershire Partnership NHS Trust, UK and an Honorary Professor with the University of Leicester, Department of Health Sciences
| |
Collapse
|
10
|
Cooper RE, Mason JP, Calton T, Richardson J, Moncrieff J. Opinion Piece: The case for establishing a minimal medication alternative for psychosis and schizophrenia. PSYCHOSIS 2021. [DOI: 10.1080/17522439.2021.1930119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ruth E. Cooper
- Newham Centre for Mental Health, Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - John P. Mason
- Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
- The International Society for Psychological and Social Approaches to Psychosis (ISPS), UK
| | - Tim Calton
- Louth Crisis Resolution and Home Treatment Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - John Richardson
- The International Society for Psychological and Social Approaches to Psychosis (ISPS), UK
| | - Joanna Moncrieff
- Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|