Ethical challenges in the use of coercion

2016 ◽  
Vol 33 (S1) ◽  
pp. S22-S22
Author(s):  
M. Kastrup
Keyword(s):  
Minority Groups ◽  
Psychiatric Patients ◽  
Ethical Challenges ◽  
Ethnic Minority Groups ◽  
Physical Restraints ◽  
Ethical Problems ◽  
Coercive Measures ◽  
Human Rights Organizations ◽  
Competing Interest

The use of coercive measures remains one of the great challenges in psychiatry.Increased focus on patient rights and autonomy, concern from user and relatives organizations as well as from human rights organizations all have contributed to that the use of all kinds of coercion is high on the agenda. And yet, we are still faced with that a number of psychiatric patients will experience that coercive measures are used as part of their treatment.The EPA Ethical Committee carried out a survey comprising the European associations of psychiatry in which a questionnaire was circulated regarding what the different associations found were the major ethical challenges in their respective countries.Among the issues that have given rise to particular concern are the use of physical restraints including why some countries avoid physical restraints while other – e.g. Denmark – use it extensively. Why do we find such large differences? Is this due to different approaches to coercion, different traditions? Shortage of resources?Another concern is that certain groups seem more likely to be subject to coercion compared to others. Thus, it has been demonstrated that patients belonging to ethnic minority groups are more likely to experience this.The paper will focus on ethical problems and issues of concern related to the use of coercion. The focus will be on facets of international relevance with the aim to remain critical towards the use and when needed to strengthen the quality of coercive treatment care. URL:http://www.mariannekastrup.dkDisclosure of interestThe author has not supplied his declaration of competing interest.

Participation in Clinical Trials May Improve Care of Acute Schizophrenia Inpatients in a General Hospital

CNS Spectrums ◽  
2008 ◽  
Vol 13 (9) ◽  
pp. 757-761 ◽  
Author(s):  
Uriel Halbreich ◽  
Nancy Smail ◽  
Xin Tu ◽  
Judith Halbreich
Keyword(s):  
Quality Of Care ◽  
Clinical Research ◽  
Psychiatric Patients ◽  
Diagnostic Interview ◽  
Physical Restraints ◽  
Double Blind ◽  
Acute Schizophrenia ◽  
Hospital Wards ◽  
Study Inclusion

AbstractIntroduction: This report demonstrates parameters of quality of care and treatment outcome of acute schizophrenia patients who were involved as subjects in a clinical trial of two marketed widely used antipsychotics compared with their fellow patients who received routine clinical hospital care.Methods: Patients were newly admitted severely agitated schizophrenia patients who agreed to participate in a double-blind randomized trial of short-term (5 days) rate of improvement in response to two second-generation oral antipsychotics. Treatment outcomes as measured by the Clinical Global Impression and parameters of quality of care were compared with the general population of inpatients in the same county hospital.Results: Of 145 patients screened, 109 patients did not meet study inclusion and exclusion criteria. It is of note that systematic diagnostic interview did not confirm the clinical diagnosis of schizophrenia in 17 patients (11.7%). Study patients had shorter length of stay (6.75 days vs 15.3 days of total psychiatric patients at the hospital during the study period), no physical restraints (vs 21.9%), no use of antipsychotics as chemical restraints (vs 19.8%), and less recidivism following the trial (28.1%) compared with prior to the trial (64.3%).Conclusion: Patients who participate in structured clinical research with well-delineated procedures, clinical outcome measures, and clear expectations, faired better than their fellow patients in the same non-research hospital wards. Application of some characteristics of clinical research to the diagnosis and treatment of clinical non-research patients may be considered.

scholarly journals Quality of Follow-Up After Hospitalization for Mental Illness Among Patients From Racial-Ethnic Minority Groups

2014 ◽  
Vol 65 (7) ◽  
pp. 888-896 ◽  
Author(s):  
Nicholas J. Carson ◽  
Andrew Vesper ◽  
Chih-nan Chen ◽  
Benjamin Lê Cook
Keyword(s):  
Mental Illness ◽  
Ethnic Minority ◽  
Minority Groups ◽  
Ethnic Minority Groups ◽  
Racial Ethnic

Anti-psychotics: To withdraw or not to withdraw?

2017 ◽  
Vol 41 (S1) ◽  
pp. S752-S752
Author(s):  
C. Ferreira ◽  
S. Alves ◽  
C. Oliveira ◽  
M.J. Avelino
Keyword(s):  
Side Effects ◽  
Scientific Literature ◽  
Psychiatric Patients ◽  
Careful Consideration ◽  
Online Searching ◽  
Cardiac Side Effects ◽  
Scientific Papers ◽  
Competing Interest ◽  
Few Data

IntroductionAnti-psychotics constitute a class of psychotropic drugs used for the treatment and prophylaxis of several disorders, including schizophrenia, bipolar disorder and psychotic depression. Frequently, clinicians are asked by their patients to withdraw this medication. In some cases, that may be related to notable side effects. However, it may actually indicate an inadequate control of the psychiatric disorder with poor insight.AimsThe goal of this work is to systematically review the scientific literature in order to understand if there are consistent data that support anti-psychotics withdraw in specific clinical situations.MethodsThe literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “anti-psychotics” and “withdraw” in the title and/or abstract, published in English.Results and discussionAnti-psychotics improve prognosis and enhance patients’ quality of life. There are few data in the literature regarding recommendations that support anti-psychotic withdraw in psychiatric patients. Very specific conditions must exist for withdrawing anti-psychotics, like neuroleptic malignant syndrome, cardiac side effects, and change of diagnosis or prolonged remission after a first and single psychotic event. When that decision is made, it should be done slowly and carefully and both the patient and his family should be involved.ConclusionsThere is no evidence in the literature that supports withdraw of anti-psychotics for the majority of psychiatric situations. When specific conditions are present that possibility must then be considered, however, with careful consideration and after discussion with the patient and parties involved in patient's care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Predictors of aggressive behavior among acute psychiatric patients: 5 years clinical study

2016 ◽  
Vol 33 (S1) ◽  
pp. S626-S627
Author(s):  
T. Aparicio Reinoso ◽  
S. Gonzalez Parra
Keyword(s):  
Psychiatric Patients ◽  
Therapeutic Option ◽  
Violent Behavior ◽  
Nursing Assistants ◽  
Psychotic Symptoms ◽  
Admission Diagnosis ◽  
Psychiatric Ward ◽  
Competing Interest ◽  
In The Beginning

IntroductionThe problem of violence and aggressive behaviour among patients with psychiatric disorders need careful assessment to improve the quality of psychiatric care.ObjectiveThe aim of this paper is to describe the characteristics of repeated episodes of violence among patients admitted to a Psychiatric Ward, which is a total of 66 beds at Doctor Rodriguez Lafora Hospital from January 2009 to December 2014.MethodsWe designed a retrospective, longitudinal and observational study over a 5-year period in two brief hospitalization units of Doctor Rodriguez Lafora Hospital in Madrid. The main variables studied were: type of admission, diagnosis, age, trigger and shift.ResultsIn our study, we analyzed the prototypical person who carries out these episodes of aggression: a male between 31–40 years, diagnosed with psychotic disorder or personality disorder, involuntary admitted. This episode is associated as a main trigger to mood disturbances, lack of acceptance of standards and psychotic symptoms. These episodes occur more frequently in the afternoon shift one business day and often processed without injuries or minor bruises to other patients and/or nursing assistants. In our practice, we have observed that in most cases adequate verbal restraint in the beginning is sufficient to prevent the episode of aggression.ConclusionsUnderstand the aggressive factors can influence the production of violent behavior and the use of appropriate containment techniques may be considered a therapeutic option to prevent and address violent behavior in psychiatric patients hospitalized in brief hospitalization units.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Does Social Disadvantage Explain the Higher Risk of Psychosis in Immigrants? Results from the Eugei Study in London

2017 ◽  
Vol 41 (S1) ◽  
pp. S65-S66
Author(s):  
S.A. Stilo ◽  
C. Gayer-Anderson ◽  
S. Beards ◽  
F. Bourque ◽  
V. Mondelli ◽  
...  
Keyword(s):  
Minority Groups ◽  
Local Population ◽  
Social Disadvantage ◽  
Psychotic Experiences ◽  
Ethnic Minority Groups ◽  
Psychotic Experience ◽  
Additive Interaction ◽  
Competing Interest ◽  
And Migration ◽  
Main Effects

Evidence indicates that migrant and ethnic minority groups have an elevated risk of psychosis in a number of countries. Social disadvantage is one of the hypotheses put forward to explain these findings. The aim of this study is to investigate main effects, association and synergism between social disadvantage and migration on odds of psychotic experiences. We collected information on social disadvantage and migration from 332 patients and from 301 controls recruited from the local population in South London. Two indicators of social disadvantage in childhood and six indicators of social disadvantage in adulthood were analyzed. We found evidence that the odds of reporting psychotic experience were higher in those who experienced social disadvantage in childhood (OR= 2.88, 95% CI 2.03-4.06), social disadvantage in adulthood (OR= 9.06, 95% CI 5.21–15.74) and migration (OR = 1.46, 95% CI 1.05–2.02). When both social disadvantage and migration were considered together, the association with psychosis was slightly higher for social disadvantage in childhood and migration (OR 3.46, 95% CI 2.12–5.62) and social disadvantage in adulthood and migration (OR 9.10, 95% CI 4.63-17.86). Migrant cases were not more likely than non-migrant cases to report social disadvantage (p = 0.71) and no evidence of an additive interaction between migration and social disadvantage was found (ICR 0.32 95% CI -4.04–4.69). Preliminary results support the hypothesis that the association between social disadvantage and psychosis is independent of migration status.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Health-related quality of life of infants from ethnic minority groups: the Generation R Study

2012 ◽  
Vol 22 (3) ◽  
pp. 653-664 ◽  
Author(s):  
Ilse J. E. Flink ◽  
Tinneke M. J. Beirens ◽  
Caspar Looman ◽  
Jeanne M. Landgraf ◽  
Henning Tiemeier ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ethnic Minority ◽  
Minority Groups ◽  
Health Related Quality ◽  
Ethnic Minority Groups ◽  
Related Quality ◽  
Health Related

ADDRESSING MULTI-CULTURAL EDUCATION AND EDUCATION FOR ETHIC MINORITY GROUPS THROUGH VALUE-ADDING TO THE LEARNING OF VIETNAMESE STUDENTS

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Tony Richardson
Keyword(s):  
Multicultural Education ◽  
Minority Groups ◽  
Quality Of Education ◽  
Viet Nam ◽  
Ministry Of Education ◽  
Ethnic Minority Groups ◽  
Cultural Education ◽  
Teacher's Knowledge ◽  
And Training

This paper acknowledges the truly exceptional performance of Viet Nam’s students, the success of Viet Nam’s educationsystem, and the achievements of its committed educationalprofessionals. The purpose of this paper is to encourage someglobal dialogue by focusing on strategies that could be used tofurther enhance the effectiveness of schools in Viet Nam, via multicultural education and the education of ethnic minority groups,through value-adding to the learning of students. The facilitation ofthis global dialogue is addressed by emphasising three key areas;the value-adding to the learning of students, the value-adding tothe learning of students through a teacher’s knowledge of practiceand knowledge for practice, and the value-adding to the learningof students by the filling of gaps-in-contextual knowledge.It is envisaged that the discussions generated from this papermight contribute to the global dialogue on Viet Nam’s schooleffectiveness, which in turn may assist in promulgating, andenhancing, the excellent quality of education provided by VietNam’s Ministry of Education and Training (MOET).

Quality of life between two groups of psychiatric patients in Baghdad, Iraq

2017 ◽  
Vol 41 (S1) ◽  
pp. S511-S511
Author(s):  
H. Abdullah
Keyword(s):  
Quality Of Life ◽  
Teaching Hospital ◽  
Mental Hospital ◽  
Clinical Characteristics ◽  
Psychiatric Patients ◽  
Life Quality ◽  
Subjective Rating ◽  
Significant Difference ◽  
Competing Interest

ObjectivesTo assess and compare the subjective rating of quality of life (QOL) in psychiatric patients who attended two psychiatric outpatient clinics in Baghdad city [Al-Rashad psychiatric teaching hospital and Baghdad teaching hospital]. In addition, it also aims at studying the effect of socio-demographic and clinical characteristics on the patients’ life qualities.MethodA sample of one hundred patients divided equally into two groups (fifty patient) from each hospital were interviewed and diagnosed in accordance with the DSM-IV diagnostic criteria, for the period (from the 1st of March to the 1st of September 2011). The Arabic modified version of WHOQOL-BREF questionnaire (modified by WHO) was applied on each patient.ResultsData gathered from completed hundred forms showed that 50% of patients from Baghdad teaching hospital responded and scored (fair, acceptable) to describe their satisfaction in overall QOL, while (38%) of patients from Al-Rashad teaching mental hospital scored (bad) and (16%) scored (very bad). There was no significant difference in the four domains of QOL between the two studied groups. The findings were discussed accordingly.ConclusionsThis study showed that although the overall satisfaction of the patients’ life quality was higher in patients from Baghdad teaching hospital than those of Al-Rashad teaching mental hospital, a non-significant difference in the four domains between the two hospitals was found. The socio-demographic and clinical characteristics were not significantly correlated to the QOL domains except for the educational level, which was significantly correlated, with the physical health domain in patients from Al-Rashad teaching mental hospital.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Racial Differences in Oral Health-Related Quality of Life: A Multilevel Analysis in Brazilian Children

2015 ◽  
Vol 26 (6) ◽  
pp. 689-694 ◽  
Author(s):  
Bruno Emmanuelli ◽  
Ângela Aniszewski Kucner ◽  
Marjana Ostapiuck ◽  
Fernanda Tomazoni ◽  
Bernardo Antonio Agostini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minority Groups ◽  
Health Related Quality ◽  
Ethnic Minority Groups ◽  
White Children ◽  
Related Quality ◽  
Health Related ◽  
Racial Ethnic ◽  
Brazilian Children

This cross-sectional study aimed to assess the influence of race/ethnicity on Brazilian children' oral health-related quality of life (OHRQoL). A multistage random sampling selected a representative sample of 1,134 twelve-years-old children from public schools of Santa Maria, a city in Southern Brazil. Participants were examined by 4 calibrated clinicians (minimum Kappa-value for inter-examiner agreement of 0.8) and the Brazilian short version of the Child Perceptions Questionnaire (CPQ11-14) was administered. The children's parents or guardians answered questions regarding their demographics and socioeconomic status. Associations were analyzed using multilevel Poisson regression models. Children from racial/ethnic minority groups had poorer OHRQoL. The mean CPQ11-14 score was 1.08 times higher for non-white children than their white counterparts' score. "Social" and "Emotional well-being" were the most affected domains for non-white children, with significantly higher mean scores as compared to white children (RR 1.19, 95% CI, 1.07-1.33; and RR 1.14; 95% CI 1.04-1.24). This association remained significant even after adjusting for individual and contextual covariates. OHRQoL disparities are prevalent among children from racial/ethnic minority groups. Non-white children have lower OHRQoL compared to white children.

scholarly journals Culturally Sensitive Care: Definitions, Perceptions, and Practices of Health Care Professionals

2020 ◽  
pp. 104365962097062
Author(s):  
Ann Claeys ◽  
Saloua Berdai-Chaouni ◽  
Sandra Tricas-Sauras ◽  
Liesbeth De Donder
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Cultural Awareness ◽  
Care Setting ◽  
Minority Groups ◽  
Culturally Sensitive ◽  
Ethnic Minority Groups ◽  
Culturally Sensitive Care ◽  
Depth Interviews

Introduction Research highlights that patients from ethnic minority groups often receive lower quality of care. This study contributes to the knowledge and understanding of culturally sensitive care and explores health care professionals’ definitions and perceptions of this concept and how they deliver this in practice. Method This qualitative study conducted a total of six focus groups ( n = 34) and four in-depth interviews with six categories of health care professionals in Belgium. Thematic content analysis was used. Results The results indicate that the concept of culturally sensitive care is perceived quite narrowly. Professionals are likely to portray their own frame of reference and find it challenging to show empathy with patients with a different background. Othering (micro-racism by defining “the other”) is a powerful example. Discussion The discussion reveals the significance of increasing cultural awareness and understanding, sensitizing about current narrow perceptions, and enhancing culturally sensitive care in the Belgian health care setting.

Sign in / Sign up

Export Citation Format

Share Document