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Tully S, Bucci S, Alkotob Y, Penn G, Berry K. Sex differences in functional outcome after hospitalisation: A systematic review and meta-analysis. Psychiatry Res 2023; 323:115095. [PMID: 36889159 DOI: 10.1016/j.psychres.2023.115095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
The aims of this review were to determine: i) how many studies have examined global functioning outcomes from a psychiatric inpatient stay disaggregated by sex; and ii) if women have worse global functioning outcomes than men following an admission. A systematic review following PRISMA guidance and meta-analysis were conducted. Thirty-six studies met eligibility criteria for inclusion in the review. Of these, eleven papers provided sufficient data to conduct a meta-analysis of global functioning outcomes comparing men and women. Overall, differences between men and women were small. The meta-analysis revealed either no difference or a small significant difference in global functioning outcomes in favour of women, contrary to expectations. As many as 93% of otherwise eligible studies had to be excluded for not disaggregating data by sex. Women may have slightly superior functioning outcomes than men suggesting that inpatient services should be more heavily focused on applying principles of gender-informed care for men as well as women. The finding that so many potential studies had to be excluded for not reporting sex differences is consistent with other mental health literature and highlights a need for better reporting practices in relation to sex differences.
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Affiliation(s)
- S Tully
- School of Health Sciences, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - S Bucci
- School of Health Sciences, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Y Alkotob
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - G Penn
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - K Berry
- School of Health Sciences, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Jones N, Gius BK, Shields M, Collings S, Rosen C, Munson M. Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2017-2027. [PMID: 33751175 PMCID: PMC10105343 DOI: 10.1007/s00127-021-02048-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Few studies have focused on the experience of involuntary psychiatric hospitalization among youth, especially the impact of these experiences on engagement with mental health services post-discharge. In this study, we contribute to a deeper understanding of youth experiences of involuntary hospitalization (IH) and its subsequent impacts on trust, help-seeking, and engagement with clinicians. METHODS The study utilized a grounded theory approach, conducting in-depth interviews with 40 youth and young adults (ages 16-27) who had experienced at least one prior involuntary hospitalization. RESULTS Three quarters of the youth reported negative impacts of IH on trust, including unwillingness to disclose suicidal feelings or intentions. Selective non-disclosure of suicidal feelings was reported even in instances in which the participant continued to meet with providers following discharge. Factors identified as contributing to distrust included perceptions of inpatient treatment as more punitive than therapeutic, staff as more judgmental than empathetic, and hospitalization overall failing to meet therapeutic needs. Conversely, participants reporting more mixed experiences of hospitalization and simultaneously strong indirect benefits, including greater family support, diminished family judgement members and greater access to care. CONCLUSION Findings draw attention to the ways in which coercive experiences may impact youth pathways to and through care. Additional research is needed to understand the impact of these experiences across larger samples, and their influence on downstream outcomes including engagement and long-term wellbeing. Finally, these data may inform the development and testing of inpatient and post-discharge interventions designed to mitigate potential harm.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA.
| | - Becky K Gius
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Morgan Shields
- Department of Psychiatry, Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Shira Collings
- Department of Counseling, Troy University, Tampa, FL, USA
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle Munson
- Silver School of Social Work, New York University, New York, NY, USA
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Casetta C, Oloyede E, Whiskey E, Taylor DM, Gaughran F, Shergill SS, Onwumere J, Segev A, Dzahini O, Legge SE, MacCabe JH. A retrospective study of intramuscular clozapine prescription for treatment initiation and maintenance in treatment-resistant psychosis. Br J Psychiatry 2020; 217:506-513. [PMID: 32605667 DOI: 10.1192/bjp.2020.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clozapine is uniquely effective in treatment-resistant psychosis but remains underutilised, partly owing to psychotic symptoms leading to non-adherence to oral medication. An intramuscular formulation is available in the UK but outcomes remain unexplored. AIMS This was a retrospective clinical effectiveness study of intramuscular clozapine prescription for treatment initiation and maintenance in treatment-resistant psychosis over a 3-year period. METHOD Successful initiation of oral clozapine after intramuscular prescription was the primary outcome. Secondary outcomes included all-cause clozapine discontinuation 2 years following initiation, and 1 year after discharge. Discontinuation rates were compared with a cohort prescribed only oral clozapine. Propensity scores were used to address confounding by indication. RESULTS Among 39 patients prescribed intramuscular clozapine, 19 received at least one injection, whereas 20 accepted oral clozapine when given an enforced choice between the two. Thirty-six (92%) patients successfully initiated oral clozapine after intramuscular prescription; three never transitioned to oral. Eight discontinued oral clozapine during the 2-year follow-up, compared with 83 out of 162 in the comparator group (discontinuation rates of 24% and 50%, respectively). Discontinuation rates at 1-year post-discharge were 21%, compared with 44% in the comparison group. Intramuscular clozapine prescription was associated with a non-significantly lower hazard of discontinuation 2 years after initiation (hazard ratio 0.39, 95% CI 0.14-1.06) and 1 year after discharge (hazard ratio 0.37, 95% CI 0.11-1.24). The only reported adverse event specific to the intramuscular formulation was injection site pain and swelling. CONCLUSIONS Intramuscular clozapine prescription allowed transition to oral maintenance in an initially non-adherent cohort. Discontinuation rates were similar to patients only prescribed oral clozapine and comparable to existing literature.
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Affiliation(s)
- Cecilia Casetta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
| | - Ebenezer Oloyede
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Pharmacy Dept, South London and Maudsley NHS Foundation Trust, UK
| | - Eromona Whiskey
- Pharmacy Dept, South London and Maudsley NHS Foundation Trust, UK
| | | | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
| | - Sukhi S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
| | - Juliana Onwumere
- National Psychosis Service, South London and Maudsley NHS Foundation Trust; and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Aviv Segev
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Olubanke Dzahini
- Pharmacy Dept, South London and Maudsley NHS Foundation Trust, UK
| | - Sophie E Legge
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - James Hunter MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
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Yang Y, Li W, Lok KI, Zhang Q, Hong L, Ungvari GS, Bressington DT, Cheung T, Xiang YT. Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2020; 48:101902. [PMID: 31896433 DOI: 10.1016/j.ajp.2019.101902] [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] [Received: 09/27/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
AIMS Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia. METHOD PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model. RESULTS Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %). Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily. Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate. CONCLUSION Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia. With the continuing liberalization of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.
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Affiliation(s)
- Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau; Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Ka-In Lok
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Liu Hong
- Department of Psychiatry and Mental Health, Guangdong Medical University, Guangdong, China; Department of Psychiatry, Shunde WuZhongpei Memorial Hospital, Foshan, Guangdong, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | | | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau.
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Li W, Yang Y, Hong L, An FR, Ungvari GS, Ng CH, Xiang YT. Prevalence of aggression in patients with schizophrenia: A systematic review and meta-analysis of observational studies. Asian J Psychiatr 2020; 47:101846. [PMID: 31715468 DOI: 10.1016/j.ajp.2019.101846] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Aggression is common in patients with schizophrenia and is clinically significant, but its prevalence is inconsistent across studies. This is a meta-analysis of the prevalence of aggression and its associated factors in patients with schizophrenia. METHODS PubMed, EMBASE, PsycINFO, the Cochrane Library, Medline and Web of Science databases were systematically searched. Studies that reported the prevalence of aggression in patients with schizophrenia using the Modified Overt Aggression Scale (MOAS) were included and analyzed using the random-effects model. RESULTS Fifteen studies with 4855 patients were initially included; of these, 13 studies with 3929 patients were pooled in the final meta-analysis. The pooled prevalence of aggression was 33.3% (95%CI: 21.5%-47.7%); specifically, the estimated prevalence of verbal, property-oriented, auto and physical aggression were 42.6% (95%CI: 17.0%-72.9%), 23.8% (95%CI: 10.1%-46.4%), 23.5% (95%CI: 6.5%-57.7%), and 23.7% (95%CI: 10.4%-45.3%), respectively. Subgroup analyses revealed that different MOAS cut-off values (P < 0.001) and source of patients (inpatients vs. community-dwelling patients) significantly moderated the results (P < 0.001). Meta-regression analyses found that studies published recently reported higher aggression rate, while higher quality assessment score was associated with lower aggression rate (both P < 0.01). CONCLUSIONS This meta-analysis confirmed that aggression is common in schizophrenia patients. Considering the significant clinical risk issues, appropriate treatments and effective management of aggression in this population need to be developed.
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Affiliation(s)
- Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China; Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Liu Hong
- Department of Psychiatry, WuZhongpei Memorial Hospital, Guangdong province, China; Graduate School of Guangdong Medical University, Guangdong province, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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Koch HJ. [Empirical investigation to assess the quality of psychiatric treatment]. MMW Fortschr Med 2019; 161:13-20. [PMID: 31313268 DOI: 10.1007/s15006-019-0741-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality of treatment is of increasing importance in psychiatry. Since the 1950s psychiatry has developed plenty of psychological and occupational approaches in addition to an arsenal of biological procedures. These treatment options have contributed to markedly lower the residence times in psychiatric medical centers to about 3 or 4 weeks. METHOD The quality of treatment of a psychiatric clinic was evaluated on the basis of a limited number of parameters and in a short time. The data of 657 patients were evaluated. RESULTS The patients profited significantly from the treatment, particularly when specific therapies were available as in depression or schizophrenia. About ¼ of the patients received no psychoactive drugs. Most of the patients could be discharged from hospital within 3 weeks. The legal basis of hospitalization did not play a decisive role in the success of treatment. Most of the patients were after-treated by general practitioners. CONCLUSION The result underlines the effectiveness of psychiatric treatment, but also the importance of cooperation between inpatient and outpatient treatment.
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Affiliation(s)
- Horst J Koch
- Klinik für Psychiatrie und Psychotherapie, Heinrich-Braun-Klinikum Zwickau, Karl-Keil-Straße 35, 08060, Zwickau, Deutschland.
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Balikci A, Erdem M, Zincir S, Bolu A, Zincir SB, Ercan S, Uzun O. Adherence with Outpatient Appointments and Medication: A Two-Year Prospective Study of Patients with Schizophrenia. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20121130085931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Adem Balikci
- Gulhane School of Medicine, Department of Psychiatry, Ankara - Turkey
| | - Murat Erdem
- Gulhane School of Medicine, Department of Psychiatry, Ankara - Turkey
| | - Serkan Zincir
- Golcuk Military Hospital, Department of Psychiatry, Golcuk, Kocaeli - Turkey
| | - Abdullah Bolu
- Eskisehir Military Hospital, Department of Psychiatry, Eskisehir- Turkey
| | | | - Sarper Ercan
- Erzurum Military Hospital, Department of Psychiatry, Erzurum-Turkey
| | - Ozcan Uzun
- Gulhane School of Medicine, Department of Psychiatry, Ankara - Turkey
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Sonesson O, Arvidsson H, Tjus T. Exploring Outcome and Validity of the GAF in Psychiatric Inpatient Care. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2015. [DOI: 10.1027/1015-5759/a000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. A small number of studies have investigated predictive factors in relation to the Global Assessment of Functioning (GAF) scale. This study aimed to explore the influence of clinical and socio-demographic factors in a psychiatric inpatient setting in relation to treatment outcome measured by the GAF. The studied psychiatric inpatient sample consisted of 816 episodes of care, with GAF ratings made at both admission and discharge. Multiple linear regressions were performed to analyze what variables predicted GAF scores at admission and at discharge. Significant predictors of GAF scores at admission were age, schizophrenia, other psychotic disorders, and no registered diagnosis. GAF scores at admission, patients’ diagnoses, and ward affiliation were able to significantly predict GAF at discharge. Specialized wards did not necessarily deliver the best treatment results in spite of their diagnostic specialization. This study provides support to the construct validity of the GAF when used as a measure of outcome.
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Affiliation(s)
- Ove Sonesson
- Department of Psychology, University of Gothenburg, Sweden
| | - Hans Arvidsson
- Department of Psychology, University of Gothenburg, Sweden
| | - Tomas Tjus
- Department of Psychology, University of Gothenburg, Sweden
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Rehospitalization risk of former voluntary and involuntary patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1719-27. [PMID: 24806950 DOI: 10.1007/s00127-014-0892-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 04/22/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of the study was to examine the differences between former involuntary and voluntary patients with a schizophrenic disorder with regard to time to and frequency of rehospitalization. METHODS In this prospective observational study, 374 patients with a diagnosis of schizophrenia or schizoaffective disorder were included. At the time of inclusion, 290 (77.5 %) were hospitalized voluntarily and 84 (22.5 %) involuntarily. Follow-up assessments were conducted half-yearly over a 2-year period with measures of PANSS, GAF, sociodemographic data and cognitive functioning. These data served as covariates for adjustment in statistical models that included a Cox regression model, a random-effect logit model and a random-effect tobit model. RESULTS After adjustment for other relevant covariates, the Cox regression showed that involuntary treatment is a significant risk factor of subsequent rehospitalization (HR = 1.53; CI = 1.06, 2.19; p = 0.02). The involuntary group had higher half-year incidence rates of rehospitalization, and in case of rehospitalization the duration of hospital stay was longer. CONCLUSIONS Involuntary hospitalization seems to be associated with a higher risk of rehospitalization and longer subsequent hospital stays in patients with schizophrenia and schizoaffective disorders. Further studies are needed to examine in detail the processes and interventions that are suitable for interrupting circles of repeated hospitalizations, especially in former involuntary patients.
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Feiring E, Ugstad KN. Interpretations of legal criteria for involuntary psychiatric admission: a qualitative analysis. BMC Health Serv Res 2014; 14:500. [PMID: 25344295 PMCID: PMC4209226 DOI: 10.1186/s12913-014-0500-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 10/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The use of involuntary admission in psychiatry may be necessary to enable treatment and prevent harm, yet remains controversial. Mental health laws in high-income countries typically permit coercive treatment of persons with mental disorders to restore health or prevent future harm. Criteria intended to regulate practice leave scope for discretion. The values and beliefs of staff may become a determinating factor for decisions. Previous research has only to a limited degree addressed how legal criteria for involuntary psychiatric admission are interpreted by clinical decision-makers. We examined clinicians' interpretations of criteria for involuntary admission under the Norwegian Mental Health Care Act. This act applies a status approach, whereby involuntary admission can be used at the presence of mental disorder and need for treatment or perceived risk to the patient or others. Further, best interest assessments carry a large justificatory burden and open for a range of extra-legislative factors to be considered. METHODS Deductive thematic analysis was used. Three ideal types of attitudes-to-coercion were developed, denoted paternalistic, deliberative and interpretive. Semi-structured, in-depth interviews with 10 Norwegian clinicians with experience from admissions to psychiatric care were carried out. Data was fit into the preconceived analytical frame. We hypothesised that the data would mirror the recent shift from paternalism towards a more human rights focused approach in modern mental health care. RESULTS The paternalistic perspective was, however, clearly expressed in the data. Involuntary admission was considered to be in the patient's best interest, and patients suffering from serious mental disorder were assumed to lack decision-making capacity. In addition to assessment of need, outcome effectiveness and risk of harm, extra-legislative factors such as patients' functioning, experience, resistance, networks, and follow-up options were told to influence decisions. Variation in how these multiple factors were taken into consideration was found. Some of the participants' statements could be attributed to the deliberative perspective, most of which concerned participants' beliefs about an ideal decision-making situation. CONCLUSIONS Our data suggest how a deliberative-oriented ideal of reasoning about legal criteria for involuntary admission lapses into paternalism in clinical decision-making. Supplementary professional guidelines should be developed.
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Affiliation(s)
- Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Blindern, Oslo 0317, Norway.
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Andersen TH, Kappers D, Sneider B, Uggerby P, Nielsen J. Involuntary treatment of schizophrenia patients 2004-2010 in Denmark. Acta Psychiatr Scand 2014; 129:312-9. [PMID: 23662670 DOI: 10.1111/acps.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Treatment of schizophrenia is frequently complicated by patients' ambivalence and lack of insight into the disease, occasionally warranting involuntary treatment. This study aims to describe involuntary treatment in Danish schizophrenia patients. METHOD Patients diagnosed with a lifetime ICD-10 F20 schizophrenia diagnosis and alive in the period 2004-2010 were identified in the Danish Psychiatric Central Research Register, and data were linked to The Registry of Coercive Measures in Psychiatric Treatment. RESULTS Within the study period, a total of 18,599 admitted patients were identified, 3078 of which underwent involuntary treatment. The incidence rate for any involuntary treatment was 2.1 per in-patient year and 1.7 and 0.3 per in-patient year for rapid tranquilization and involuntary treatments, respectively. Somatic diseases comprised 34.5% of all involuntary treatments. Psychotropics comprised 56.9% with antipsychotics as the most common drug class (99.5%). Olanzapine was the most commonly used antipsychotic drug (33.2%). Treatment with depot injection and clozapine comprised only 13% and 4.8% of the antipsychotics used, respectively. Electroconvulsive therapy comprised 4.8% of all involuntary treatment. CONCLUSION Involuntary treatment involved a wide range of somatic treatment. Antipsychotic medicine was the most common psychotropic used. Involuntary treatment with depot antipsychotics and clozapine were rare.
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Affiliation(s)
- T H Andersen
- Centre for Schizophrenia, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
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12
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Molodynski A, Turnpenny L, Rugkåsa J, Burns T, Moussaoui D. Coercion and compulsion in mental healthcare-an international perspective. Asian J Psychiatr 2014; 8:2-6. [PMID: 24655618 DOI: 10.1016/j.ajp.2013.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/31/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coercion has always existed in psychiatry and is increasingly debated. The 'move into the community' in many countries over recent decades and the evolution of community services have substantially altered the locus of coercion. In many countries psychiatric services remain poorly funded and patchy. Substantial differences between regions and countries in the provision of services, the role of the family, and the wider economic and political climate are likely to lead to different sources and experiences of coercion. DISCUSSION This paper explores a number of factors that may affect the prevalence and type of coercion in psychiatric services and in society and their impact upon those with severe mental illnesses. Differences in service provision are explored and wider societal issues that may impact are considered along with relevant evidence. CONCLUSIONS Coercion is commonly experienced by those with severe mental illnesses but is poorly understood. The vast majority of research relates to High Income Group countries with developed community services and formal mental health legislation that adopt the so-called 'medical model'. Further research and collaboration is urgently required to increase our understanding of these issues, which are difficult to define and measure. An evidence base that is relevant worldwide, not just to a small group of countries, is needed to inform training and the care of all patients. A particular focus must be expanding our knowledge and understanding of coercion in cultures outside those where such research has traditionally taken place to date.
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Affiliation(s)
- Andrew Molodynski
- Oxford Health NHS Foundation Trust, UK; Oxford University, Department of Psychiatry, UK.
| | - Lucinda Turnpenny
- Social Psychiatry Group, Oxford University, Department of Psychiatry, UK
| | - Jorun Rugkåsa
- Social Psychiatry Group, Oxford University, Department of Psychiatry, UK
| | - Tom Burns
- Social Psychiatry Group, Oxford University, Department of Psychiatry, UK
| | - Driss Moussaoui
- Department of Psychiatry, Ibn Rushd University Psychiatric Centre, Casablanca, Morocco; World Association of Social Psychiatry (WASP), Morocco
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Diseth RR, Høglend PA. Compulsory mental health care in Norway: the treatment criterion. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:168-173. [PMID: 24268447 DOI: 10.1016/j.ijlp.2013.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.
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Affiliation(s)
- Rigmor R Diseth
- Division of Mental Health and Addiction, University of Oslo, Norway.
| | - Per A Høglend
- Division of Mental Health and Addiction, University of Oslo, Norway
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Lincoln TM, Heumann K, Teichert M. Das letzte Mittel? Ein Überblick über die politische Diskussion und den Forschungsstand zum Einsatz medikamentöser Zwangsbehandlung in der Psychiatrie. VERHALTENSTHERAPIE 2013. [DOI: 10.1159/000357649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Janssen WA, Noorthoorn EO, Nijman HLI, Bowers L, Hoogendoorn AW, Smit A, Widdershoven GAM. Differences in seclusion rates between admission wards: does patient compilation explain? Psychiatr Q 2013; 84:39-52. [PMID: 22581029 DOI: 10.1007/s11126-012-9225-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Comparison of seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and duration of seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences in patient characteristics, as these are expected to have a large impact on these seclusion rates. Nurses assume more admissions of severely ill patients are related to higher seclusion rates. In order to test this hypothesis, we investigated differences in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and ward characteristics and the wards' number of seclusion hours per 1,000 admission hours. In a multivariate and a multilevel analysis, various characteristics turned out to be related to the number of seclusion hours per 1,000 admission hours as well as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences in seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest deal of the difference between wards in seclusion rates could not be explained by characteristics measured in this study. We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of seclusion.
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Affiliation(s)
- W A Janssen
- Board Agency, GGNet Mental Healthcare, Box 2003, NL-7230 GC Warnsveld, The Netherlands.
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16
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Affiliation(s)
- Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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17
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Kjellin L, Wallsten T. Accumulated coercion and short-term outcome of inpatient psychiatric care. BMC Psychiatry 2010; 10:53. [PMID: 20584301 PMCID: PMC2912798 DOI: 10.1186/1471-244x-10-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 06/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care METHODS 233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables RESULTS Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores CONCLUSION The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.
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Affiliation(s)
- Lars Kjellin
- School of Health and Medical Sciences, Psychiatric Research Centre, Orebro University, Orebro, Sweden.
| | - Tuula Wallsten
- Centre for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden
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18
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Høyer G. Involuntary hospitalization in contemporary mental health care. Some (still) unanswered questions. J Ment Health 2009. [DOI: 10.1080/09638230802156723] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Recovery Orientation in Hospital and Community Settings. J Behav Health Serv Res 2008; 37:385-99. [DOI: 10.1007/s11414-008-9158-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 11/06/2008] [Indexed: 11/27/2022]
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20
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Jarrett M, Bowers L, Simpson A. Coerced medication in psychiatric inpatient care: literature review. J Adv Nurs 2008; 64:538-48. [DOI: 10.1111/j.1365-2648.2008.04832.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Kallert TW, Glöckner M, Schützwohl M. Involuntary vs. voluntary hospital admission. A systematic literature review on outcome diversity. Eur Arch Psychiatry Clin Neurosci 2008; 258:195-209. [PMID: 18080170 DOI: 10.1007/s00406-007-0777-4] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 10/11/2007] [Indexed: 01/12/2023]
Abstract
This article systematically reviews the literature on the outcome of acute hospitalization for adult general psychiatric patients admitted involuntarily as compared to patients admitted voluntarily. Inclusion and exclusion criteria qualified 41 out of 3,227 references found in Medline and PSYNDEXplus literature searches for this review. The authors independently rated these articles on six pre-defined indicators of research quality, carried out statistical comparisons ex-post facto where not reported, and computed for each adequate result the effect size index d for the comparison of means, and the Phi- or contingency coefficient for cross-tabulated data. Methodological quality of the studies, coming mostly from North American and European countries, showed significant variation and was higher concerning service-related than clinical or subjective outcomes. Main deficits appeared in sample size estimation, lack of clear follow-up time-points, and the absence of standardized instruments used to assess clinical outcomes. Length of stay, readmission risk, and risk of involuntary readmission were at least equal or greater for involuntary patients. Involuntary patients showed no increased mortality, but did have higher suicide rates than voluntary patients. Further, involuntary patients demonstrated lower levels of social functioning, and equal levels of general psychopathology and treatment compliance; they were more dissatisfied with treatment and more frequently felt that hospitalization was not justified. Future methodologically-sound studies exploring this topic should focus on patient populations not represented here. Further research should also clarify if the legal admission status is sufficiently valid for differentiating the outcome of acute hospitalization.
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Affiliation(s)
- Thomas W Kallert
- Department of Psychiatry and Psychotherapy, University Hospital, Dresden University of Technology, Dresden, Germany.
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22
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DeWolf Bosek MS, Ring ME, Cady RF. Do psychiatric advance directives protect autonomy? JONA'S HEALTHCARE LAW, ETHICS AND REGULATION 2008; 10:17-26. [PMID: 18388537 DOI: 10.1097/01.nhl.0000312546.62165.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A psychiatric advance directive (PAD) is a legal resource that allows a person to document his or her wishes about receiving mental health services in the event that he or she is unable to provide consent at a future time. Advantages for completing a PAD include promoting the person's autonomy and authentic self, minimizing harms, and promoting beneficence. However, more research is needed to describe the positive and negative consequences associated with completing and implementing a PAD in the clinical setting.
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Schulte PFJ, Stienen JJ, Bogers J, Cohen D, van Dijk D, Lionarons WH, Sanders SS, Heck AH. Compulsory treatment with clozapine: a retrospective long-term cohort study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2007; 30:539-545. [PMID: 17928054 DOI: 10.1016/j.ijlp.2007.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Clozapine is the gold standard in treatment of treatment-resistant psychotic patients. We know little about the effects of compulsory treatment in patients unwilling to accept the necessary treatment. AIMS To assess the effectiveness, tolerability and safety of compulsory treatment with clozapine (CTC). METHOD A cohort of 17 consecutive patients given compulsory treatment with clozapine were rated retrospectively by their treating psychiatrists on the basis of their case notes. RESULTS CGI-S decreased significantly over time until last observation after a mean of more than 15 months. No patient deteriorated as measured by CGI-I. At last observation as many as ten of the 11 patients still on clozapine were classified as much to very much improved. The degree of custodial restriction at last observation showed improvement in 11 patients and no change in six. No serious adverse events were observed. CONCLUSION A trial of compulsory treatment with clozapine showed this treatment to be feasible, effective, safe and well tolerated.
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Affiliation(s)
- Peter F J Schulte
- Department De Dijk, Mental Health Services North-Holland North, Kennemerstraatweg 464, 1851 NG Heiloo, The Netherlands.
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Abstract
Measuring the process of delivering recovery oriented services is a necessary complement to measuring recovery outcomes. Programs that are recovery oriented promote partnerships with consumers, emphasize consumer choice, and instill hope. This study examined the psychometric properties of the provider version of the Recovery Self Assessment (RSA) in a sample of hospital workers. The RSA demonstrated good to excellent internal consistency, test-retest reliability, and adequate convergent and discriminant validity. The RSA may be a reliable and valid measure of recovery orientation that can be used to assess a variety of mental health programs.
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Wallsten T, Kjellin L, Lindström L. Short-term outcome of inpatient psychiatric care--impact of coercion and treatment characteristics. Soc Psychiatry Psychiatr Epidemiol 2006; 41:975-80. [PMID: 17080321 DOI: 10.1007/s00127-006-0131-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2006] [Indexed: 11/28/2022]
Abstract
AIMS Little is known about the outcome of brief inpatient treatment interventions in routine psychiatric practice. The aim of this article was to study if subjective and assessed outcome of brief psychiatric inpatient care are related to patient characteristics, coercion at admission and during care, and other treatment characteristics. METHOD A total of 233 involuntarily and voluntarily admitted patients were interviewed within 5 days from admission and at discharge or after 3 weeks of care. Outcome was measured as reported by patients and by change in GAF (Global Assessment Scale) scores. RESULTS Predictors for a positive subjective outcome were if the patients reported that they had been well treated by the staff and had contact persons at the ward. Predictors for a GAF improvement were a low GAF score at admission and a mood disorder diagnosis. CONCLUSIONS Subjectively reported outcome and outcome measured by assessing change in level of functioning differed. Coercion was not related to outcome. The way the patient perceived they had been treated by the staff was strongly related to subjective outcome.
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Affiliation(s)
- Tuula Wallsten
- Centre for Clinical Research, University of Uppsala, Central Hospital, Västerås, Sweden.
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Salize HJ, Dressing H. Coercion, involuntary treatment and quality of mental health care: is there any link? Curr Opin Psychiatry 2005; 18:576-84. [PMID: 16639122 DOI: 10.1097/01.yco.0000179501.69053.d3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW This paper summarizes major results and debates in the field of coercive or involuntary treatment of the mentally ill and how these relate to the quality of care, as published in literature during 2002 and 2003. RECENT FINDINGS Studies focus on four major issues: involuntary hospital placement and treatment of mentally ill patients, compulsory outpatient treatment, attitudes towards or perceived coercion, and ethics of coercive measures in mental health care. Studies suggest a complex correlation between the involuntary placement of mentally ill patients, coercive measures, and outcomes. Outcome indicators for the quality of mental health care are not standardized, but vary with the point of view of the individual or collective assessor. None of the results question the necessity or the legality of involuntary treatments or conclude to refrain from employing coercive measures in mental health care if these cannot be avoided. Many results of research on attitudes towards involuntary treatments or perceived coercion suggest an acceptance of the application of coercive measures, even by the persons concerned, if the legal conditions are clearly defined. Research standards or study designs may benefit from some improvement. Study samples usually are small and only in rare cases has their selection been representative. SUMMARY Research activities are remarkably few in number, especially considering the frequency of involuntary measures and the controversial perception or discussion of these measures among the persons concerned, professionals, or a wider public. Many basic research questions still remain to be adequately addressed, such as the long-term effects of involuntary treatment.
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Steinert T, Lepping P, Baranyai R, Hoffmann M, Leherr H. Compulsory admission and treatment in schizophrenia: a study of ethical attitudes in four European countries. Soc Psychiatry Psychiatr Epidemiol 2005; 40:635-41. [PMID: 16133746 DOI: 10.1007/s00127-005-0929-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 03/05/2005] [Indexed: 10/25/2022]
Abstract
This study was conducted to compare attitudes of psychiatrists, other professionals, and laypeople towards compulsory admission and treatment of patients with schizophrenia in different European countries. Three case reports of patients with schizophrenia were presented to N=1,737 persons: 235 in England, 622 in Germany, 319 in Hungary, and 561 in Switzerland; 298 were psychiatrists, 687 other psychiatric or medical professionals, and 752 laypeople. The case reports presented typical clinical situations with refusal of consent to treatment (first episode and social withdrawal, recurrent episode and moderate danger to others and patient with multiple episodes and severe self-neglect). The participants were asked whether they would agree with compulsory admission and compulsory neuroleptic treatment. The rates of agreement varied between 50.8 and 92.1% across countries and between 41.1 and 93.6% across the different professional groups. In all countries, psychologists and social workers supported compulsory procedures significantly less than the psychiatrists who were in tune with laypeople and nurses. Country differences were highly significant showing more agreement with compulsion in Hungary and England and less in Germany and Switzerland (odds ratios up to 4.33). Own history of mental illness and having mentally ill relatives had no major impact on the decisions. Evidence suggests that compulsory procedures are based on traditions and personal attitudes to a considerable degree. Further research should provide empirical data and more definite criteria for indications of compulsive measures to achieve a common ethical framework for those critical decisions across Europe.
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Affiliation(s)
- Tilman Steinert
- Centre for Psychiatry Weissenau, Postfach 2044, 88214, Weissenau, Germany.
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