Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

Background.

Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

Methods.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

Results.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

Conclusions.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

VITAMIN D STATUS IN PATIENTS WITH MENTAL DISORDERS: A CROSS-SECTIONAL ANALYSIS OF SINGLE COHORT FROM ROUTINE PRACTICE

Context

Clinical research suggests that vitamin D deficiency correlates with mental illnesses.

Objective

The aim was to prove that the patients from the psychiatric health care service in Serbia had higher vitamin D deficiency than patients from general practice.

Design

The study had a cross-sectional design.

Methods

The study included 47 patients aged 19 - 76 of both sexes with different mental disorders. We performed sample size calculation on available data for vitamin D deficiency in patients in health care facilities compared with the general population. The concentrations of vitamin D in serums were measured by HPLC (high performance/pressure liquid chromatography).

Results

The mean value of vitamin D (standard deviation) in the whole group of study subjects was 16.27(10.62) ng/mL; 68.1% of the patients had a deficiency of vitamin D (25(OH)D<20 ng/mL). The difference is statistically significant from expected proportion of people with vitamin D deficiency in general practice (p=0.040). Serum concentrations of 25(OH)D were significantly correlated with serum concentrations of phosphorus (ϱ=0.336, p=0.024) and sodium (ϱ=0.304, p=0.038).

Conclusions

The patients of psychiatry health care had significantly higher frequency of vitamin D deficiency than expected. There is a significant association between serum levels of vitamin D, and phosphate and sodium.

Posttraumatic insomnia and structural dimensions of personality in adolescents

Sleeping disorders are being manifested, after being exposed to stressor, by initial insomnia and/or transitory insomnia, rarely terminal insomnia, which depends also on personality characteristics.

Objective of the work was to establish the most common forms of insomnia in population of psycho traumatized adolescents, and also the connection between the forms of insomnia, its severity and structural dimensions of personality.

The examined group was consisted of 46 adolescent persons who have evinced some form of insomnia under influence of stressor. The diagnosis was made based on the DSM-IV criteria, structural dimensions of personality were evaluated by MMPI-201 test, and the severity of insomnia was evaluated by ISI scale.

Under influence of stressor 41% of examined persons had the initial insomnia, 27% had mixed insomnia, 20% had transitory insomnia, and 12% had terminal insomnia. Regarding the structural dimensions of personality Hs, Hy, D and Pt (p < 0,01) there is a difference between basic and control group, and as far as the forms of insomnia are concerned the examined persons make different population compared to structural dimensions: Hs, Hy, D and Pt (p < 0,01). It also has been established that severity of insomnia correlates with the demonstration of dimensions Hs, Hy, D and Pt (p < 0,01).

The results are showing that the profile of personality plays a role in onset, form, and severity of posttraumatic insomnia.

The principles of chemotherapy of colorectal cancer in elderly

The prevalence of colorectal cancer (CRC) increases significantly with age, with 40% of patients in Europe being older than 74 years of age at the time of initial diagnosis. The individualized management of the older-aged patient with cancer is based on the answers to the following questions: 1) will the patient die of cancer or with cancer; 2) will the patient suffer cancer-related morbidity; and 3) is the patient able to handle the toxicity of treatment? More than chronological age, the following parameters are important when elderly patients are to be treated with antineoplastic agents: general condition, liver function, kidney function and bone marrow status. Frail elderly with malignant disease should not be treated with cytostatic therapy. In the case of fit elderly, the standard chemotherapy (i.e. FOLFOX) regimen could be administered. In elderly ineligible for combination chemotherapy, the capecitabine used orally, as a single-agent therapy, is an important therapeutic option for colorectal cancer.