scholarly journals Regaining mental capacity for treatment decisions following psychiatric admission: a clinico-ethical study

2010 ◽  
Vol 41 (1) ◽  
pp. 119-128 ◽  
Author(s):  
G. S. Owen ◽  
I. Chis. Ster ◽  
A. S. David ◽  
G. Szmukler ◽  
P. Hayward ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Odds Ratio ◽  
Psychiatric Treatment ◽  
Bipolar Affective Disorder ◽  
Interaction Model ◽  
Treatment Decisions ◽  
Mental Capacity ◽  
Psychiatric Admission ◽  
Legal Concept ◽  
Affective Symptoms

BackgroundMental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains uncertain. We sought to investigate the associations of regaining capacity to make treatment decisions following approximately 1 month of in-patient psychiatric treatment.MethodWe followed up 115 consecutive patients admitted to a psychiatric hospital who were judged to lack capacity to make treatment decisions at the point of hospitalization. We were primarily interested in whether the diagnosis of schizophrenia and schizoaffective disorder associated with reduced chances of regaining capacity compared with other diagnoses and whether affective symptoms on admission associated with increased chances of regaining capacity. In addition, we examined how change in insight was associated with regaining capacity in schizophrenia, bipolar affective disorder (BPAD)-mania, and depression.ResultsWe found evidence that the category of ‘schizophrenia or schizoaffective disorder’ associated with not regaining capacity at 1 month compared with BPAD-mania [odds ratio (OR) 3.62, 95% confidence intervals (CI) 1.13–11.6] and depression (OR 5.35, 95% CI 1.47–9.55) and that affective symptoms on admission associated with regaining capacity (OR 1.23, 95% CI 1.02–1.48). In addition, using an interaction model, we found some evidence that gain in insight may not be a good indicator of regaining capacity in patients with depression compared with patients with schizophrenia and BPAD-mania.ConclusionsWe suggest that clinico-ethical studies using mental capacity provide a way of assessing the validity of nosological and other clinical concepts in psychiatry.

scholarly journals Retrospective views of psychiatric in-patients regaining mental capacity

2009 ◽  
Vol 195 (5) ◽  
pp. 403-407 ◽  
Author(s):  
Gareth S. Owen ◽  
Anthony S. David ◽  
Peter Hayward ◽  
Genevra Richardson ◽  
George Szmukler ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Psychiatric Treatment ◽  
Treatment Decisions ◽  
Mental Capacity ◽  
Self Determination ◽  
Surrogate Decision Making ◽  
People With Mental Illness ◽  
Surrogate Decision ◽  
Few Data

BackgroundAn individual's right to self-determination in treatment decisions is a central principle of modern medical ethics and law, and is upheld except under conditions of mental incapacity. When doctors, particularly psychiatrists, override the treatment wishes of individuals, they risk conflicting with this principle. Few data are available on the views of people regaining capacity who had their treatment wishes overridden.AimsTo investigate individuals' views on treatment decisions after they had regained capacity.MethodOne hundred and fifteen people who lacked capacity to make treatment decisions were recruited from a sample of consecutively admitted patients to a large psychiatric hospital. After 1 month of treatment we asked the individuals for their views on the surrogate treatment decisions they received.ResultsEighty-three per cent (95% CI 66–93) of people who regained capacity gave retrospective approval. Approval was no different between those admitted informally or involuntarily using Mental Health Act powers (χ2 = 1.52, P = 0.47). Individuals were more likely to give retrospective approval if they regained capacity (χ2 = 14.2, P = 0.001).ConclusionsMost people who regain capacity following psychiatric treatment indicate retrospective approval. This is the case even if initial treatment wishes are overridden. These findings moderate concerns both about surrogate decision-making by psychiatrists and advance decision-making by people with mental illness.

scholarly journals Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study

2008 ◽  
Vol 39 (8) ◽  
pp. 1389-1398 ◽  
Author(s):  
G. S. Owen ◽  
A. S. David ◽  
G. Richardson ◽  
G. Szmukler ◽  
P. Hayward ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Assessment Tool ◽  
Bipolar Affective Disorder ◽  
Cross Sectional Study ◽  
Mental Capacity ◽  
Diagnostic Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Legal Concept ◽  
Complex Relationships

BackgroundMental capacity is now a core part of UK mental health law and clinicians will increasingly be expected to assess it. Because it is a legal concept there is a need to clarify associations with variables that clinicians are more familiar with, especially insight.MethodIn this cross-sectional study we recruited consecutive psychiatric admissions to the Maudsley Hospital, London. We carried out structured assessments of decision making using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), resulting in a clinical judgement about capacity status. We analysed associations with a range of sociodemographic and clinical variables, including insight score on the Expanded Schedule for the Assessment of Insight (SAI-E). The same variables were compared in an analysis stratified according to diagnostic group: psychotic disorders/bipolar affective disorder (BPAD)/non-psychotic disorders.ResultsPsychotic disorders and manic episodes of BPAD are most strongly associated with incapacity. In such patients, insight is the best discriminator of capacity status. In patients with non-psychotic disorders, insight is less strongly associated with capacity; in this group depressed mood discriminates capacity status whereas it does not in psychotic disorders. Cognitive performance does not discriminate capacity status in patients with psychotic disorders.ConclusionsMental capacity has complex relationships with psychopathological variables, and these relationships are different according to diagnostic group. Insight is the best discriminator of capacity status in psychotic disorders and BPAD but not in non-psychotic disorders.

scholarly journals Quality of life and Social Support Among Diagnose Bipolar Patients

2021 ◽  
Vol 15 (5) ◽  
pp. 932-935
Author(s):  
M Adnan ◽  
T Khan ◽  
B Razzaq ◽  
R Ghaffar ◽  
S Batool ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Psychiatric Treatment ◽  
Bipolar Affective Disorder ◽  
Well Being ◽  
Recovery Phase ◽  
Cross Sectional ◽  
Quality Of Life Scale ◽  
Bipolar Patients

Aim: To ascertain the relationship between quality of life and social support in bipolar patients who have been diagnosed. STUDY DESIGN: cross-sectional research design Place and duration of the study: The research was performed impatiently on the Sheikh Zayed Medical College, Rahim Yar Khan at the Department of Psychiatry and Behavioral Sciences, which ran from January 2018 to July of 2019. Method: Data was retrieved from 100 patients, with diagnosed patients of bipolar affective disorder. Quality of life and social support were assessed by quality of life scale (QOLS) developed by Burckhardt and Berline social support scale (BSSS) developed by Berline. Results: Research claims a close relationship between the presence of such things as quality of life and social help for people with Bipolar Disorder. Conclusion: Bipolar is linked to inadequate health and quality of life and social isolation, mostly due to ineffective social skills. Social support is critical to emotional stability and quality of life. It may help patients deal with difficulties and reduce depression and help in both the recovery phase and positive results of psychiatric treatment. What is currently being sought to be learned is how social care has an impact on the level of well-being for bipolar patients. Keywords: Quality of life, bipolar, validation, generalization

scholarly journals 59 “Lithium Damaged My Spine” Might not Be a Delusion After All

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 206-207
Author(s):  
Muhammad Zaidi ◽  
Anurag Prabhu ◽  
Jose Perez Martell ◽  
Sakshi Dhir
Keyword(s):  
Affective Disorder ◽  
Schizoaffective Disorder ◽  
Patient Population ◽  
Bipolar Affective Disorder ◽  
Extensive Literature ◽  
Negative Effects ◽  
Mesh Terms ◽  
First Choice ◽  
History Of ◽  
Bipolar Affective Disorders

AbstractBackgroundLithium remains to be the drug of choice for treating BPAD for the past few decades. There is extensive literature showing the effectiveness of Lithium when used as a mood stabilizing agent in bipolar spectrum disorders. However significant number of articles show that a third of the patients who receive lithium for their symptomology not only do not show any response but also may show deterioration of their clinical symptoms. (However, research shows that Lithium may negatively affect a third of the patients depending on various factors). The side effect profile of Lithium and especially its neurotoxic effects were discussed in depth in literature over the last decade. Although Lithium remains first choice as maintenance treatment for bipolar affective disorder, about half of all individuals may stop their treatment at some point, despite its proven benefits concerning the prevention of severe affective episodes and suicide.MethodsThe authors performed a systematic literature review to recognize the significance of negative effects of Lithium in a minority of patient population and also comment on the factors influencing patient compliance. We ran a literature search on Pubmed using the following terms: “Lithium” AND (“schizoaffective disorder [MeSH terms]” OR “Bipolar Affective disorder [MeSH terms]” ). Our inclusion criteria were studies which have observed effects of Lithium in schizoaffective patient population or bipolar affective patient population. Studies with other concurrent diagnoses were excluded.Case presentationWe discuss a fifty nine year old male with a history of multiple admissions to a forensic hospital care setting. He initially endorsed a diagnosis of Psychotic disorder NOS which was later changed to schizoaffective disorder during his subsequent admissions. He presented with affective psychotic features where his mood was labile shifting from melancholic to euphoric and a concurrent history of auditory verbal hallucinations. He displayed paranoid non-bizarre persecutory delusions and also alleged that one of his doctors had hated him and put him on Lithium as a form of punishment. He claims that Lithium, as a result, has significantly affected him negatively and also damaged his nerves. This led the authors to explore the significance of use of Lithiumin people with schizoaffective disorders and also bipolar affective disorders. We also discuss the disease course in the patient and his clinical response to use of various psychotropic medications.ConclusionsThe case exemplifies the negative effects of Lithium when used as a mood stabilizer in patient population that is susceptible to its adverse effects due to various factors.

Misdiagnosis of Bipolar Affective Disorder as Personality Disorder

1993 ◽  
Vol 38 (9) ◽  
pp. 587-589 ◽  
Author(s):  
Stephen P. Tyrer ◽  
Andrew D. Brittlebank
Keyword(s):  
Personality Disorder ◽  
Affective Disorder ◽  
Interpersonal Relationships ◽  
Bipolar Affective Disorder ◽  
Behavioural Disturbance ◽  
The Past ◽  
Affective Symptoms ◽  
Personality Disturbance

Patients with longstanding recurrent behavioural disturbance, unstable interpersonal relationships and periodic affective symptoms are often diagnosed as having a cluster B personality disturbance using DSM-III-R criteria. Two women are described who were diagnosed as having a personality disorder on several admissions to hospital, but in whom closer inquiry revealed evidence of bipolar affective disorder. Since treatment with lithium and adjunctive mood-stabilizing drugs neither patient has required further admissions to hospital within the past five years.

Law-breaking attitudes among mentally ill people

2011 ◽  
Vol 26 (S2) ◽  
pp. 787-787
Author(s):  
E. Gorniak ◽  
K. Furczyk ◽  
K. Krysta ◽  
I. Krupka-Matuszczyk
Keyword(s):  
Psychiatric Treatment ◽  
Bipolar Affective Disorder ◽  
Previous Treatment ◽  
Manic Episode ◽  
Mental Illnesses ◽  
Common View ◽  
Mentally Disordered ◽  
The Public ◽  
Paranoid Personality Disorder ◽  
Violent Acts

IntroductionIt is a common view that mental illnesses are widely associated with dangerous, threat-posing behavior and law-breaking.AimsThe paper analyzes the problem of law-breaking by the mentally disordered.MethodsThe analysis of cases concerning compulsory psychiatric treatment or confinement in a medical institution on the grounds of mental incompetence to commit an offence or mental unfitness to stand the trial obtained from the court and the public prosecutor’s office in Silesia Region from 2007 to 2009.Results14 cases were analyzed. All the offenders were male, mean age was 44,6. All the offenders were diagnosed by psychiatrists, most of them with schizophrenia (n = 10 cases). Other diagnoses included paranoid personality disorder (n = 1), bipolar affective disorder with manic episode (n = 1), schizoaffective disorder (n = 1), delusional disorder (n = 1). 9 out of 14 offenders were diagnosed prior to the offence, some of whom were also hospitalized (n = 5). 8 of analyzed cases concerned use of violence, 3 concerned larceny, 2 concerned posing a threat to others’ life or health and 1 concerned fraud. 2 of the offenders were previously sentenced for other offences. 12 of the offenders were compulsory treated by psychiatrists, 10 out of whom is still hospitalized.ConclusionsThe small number of the cases analyzed (14 cases in the whole of 5000) suggests that mentally disordered persons do not break law often. There seems to be a higher risk associated with male gender, though. Also, the frequency of violent acts and offences committed despite previous treatment is disturbing.

The role of stigma resistance in persons with schizophrenia and schizoaffective disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 1420-1420
Author(s):  
W. Kollmann ◽  
M. Amering ◽  
B. Schrank ◽  
I. Sibitz
Keyword(s):  
Schizoaffective Disorder ◽  
Psychiatric Treatment ◽  
Qualitative Interviews ◽  
Theory Approach ◽  
Crucial Step ◽  
Stigma Resistance ◽  
Persons With Schizophrenia ◽  
Grounded Theory Approach ◽  
Theoretical Saturation

IntroductionThe stigma of schizophrenia is well established as a complicating feature of psychiatric treatment. The fight against stigma and discrimination may benefit from individuals’ capacity to counteract stigma (=stigma resistance). In our recently published study[i] stigma resistance emerged as a separate construct. The very nature of stigma resistance, however, is still not fully revealed.AimsThe aim of our study is to shed more light on stigma resistance and gain a better insight in its genesis and impact.MethodsQualitative interviews are carried out with patients with schizophrenia and schizoaffective disorder following a semi-structured guideline. Transcripts of recorded interviews are coded and analysed thematically using a modified grounded theory approach. Interviews are continued until theoretical saturation is achieved.ResultsPreliminary results relating to the genesis of stigma resistance, its contribution to auto-protection and the concepts of life of a patient, as well as their influence on recovery will be presented.ConclusionFinding out more about determinants and consequences of stigma resistance could be a crucial step in improving the effectiveness of interventions targeting stigma and social exclusion.

Communication between community mental health services and primary care

2011 ◽  
Vol 28 (3) ◽  
pp. 134-137
Author(s):  
Vincent IO Agyapong ◽  
Olorunfemi Ahmodu ◽  
Allys Guerandel
Keyword(s):  
Primary Care ◽  
Odds Ratio ◽  
Bipolar Affective Disorder ◽  
Community Mental Health Services ◽  
Psychiatric Services ◽  
P Value ◽  
Primary Care Teams ◽  
Psychiatric Outpatient Clinic ◽  
The Mean ◽  
Clinical Records

AbstractObjectives: This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication.Methods: A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months.Results: A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, ‘changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00.Conclusion: A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.

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