scholarly journals Understanding ‘significant impaired decision-making ability’ with regard to treatment for mental disorder: an empirical analysis

2010 ◽  
Vol 34 (6) ◽  
pp. 239-242 ◽  
Author(s):  
Evonne Shek ◽  
Donald Lyons ◽  
Mark Taylor
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Mental Disorder ◽  
Psychotic Symptoms ◽  
Clinical Implications ◽  
Definition Of

Aims and MethodTo capture psychiatrists' reasons for ‘significant impaired decision-making ability’ (SIDMA) as there is no definition of SIDMA in the Mental Health (Care and Treatment) (Scotland) Act 2003. One hundred consecutive mental health reports from January to February 2008 were examined using a questionnaire.ResultsMore than half the mental health reports noted lack of insight as the main cause of SIDMA. Other reasons for SIDMA included limited cognitive function and presence of psychotic symptoms.Clinical implicationsFive reasons for SIDMA were identified: lack of insight, cognitive impairment, presence of psychosis, severe depressive symptoms and learning disability. We recommend psychiatrists working in Scotland give full descriptions of SIDMA, indicating how this has an impact on the patient's ability to make decisions.

scholarly journals A comparison of mental health legislation in five developed countries: a narrative review

2017 ◽  
Vol 34 (4) ◽  
pp. 261-269 ◽  
Author(s):  
T. Cronin ◽  
P. Gouda ◽  
C. McDonald ◽  
B. Hallahan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Disorder ◽  
Developed Countries ◽  
International Standards ◽  
Mental Health Legislation ◽  
Patient Consent ◽  
The Republic ◽  
Definition Of ◽  
Health Legislation

ObjectivesTo describe similarities and differences in mental health legislation between five jurisdictions: the Republic of Ireland, England and Wales, Scotland, Ontario (Canada), and Victoria (Australia).MethodsAn in-depth examination was undertaken focussing on the process of involuntary admission, review of Admission Orders and the legal processes in relation to treatment in the absence of patient consent in each of the five jurisdictions of interest.ResultsAll jurisdictions permit the detention of a patient if they have a mental disorder although the definition of mental disorder varies between jurisdictions. Several additional differences exist between the five jurisdictions, including the duration of admission prior to independent review of involuntary detention and the role of supported decision making.ConclusionsAcross the five jurisdictions examined, largely similar procedures for admission, detention and treatment of involuntary patients are employed, reflecting adherence with international standards and incorporation of human rights-based principles. Differences exist in relation to the criteria to define mental disorder, the occurrence of automatic review hearings in a timely fashion after a patient is involuntarily admitted and the role for supported decision making under mental health legislation.

scholarly journals Psychopathy in Scotland

1999 ◽  
Vol 23 (2) ◽  
pp. 77-79 ◽  
Author(s):  
Martin Humphreys
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
Clinical Implications ◽  
Scottish Parliament ◽  
Narrow Definition ◽  
Definition Of ◽  
Special Hospital ◽  
Psychopathic Disorder

Aims and methodThe aim was to examine why the legal category of psychopathic disorder does not appear in the Mental Health (Scotland) Act 1984 and to review selected literature relating to differences between prison and special hospital populations in Scotland from those elsewhere.ResultsThere is now some emerging evidence to suggest that the legislation north of the border might reflect the notion that there may be fewer people with psychopathic disorders in Scotland.Clinical implicationsWith devolution and the advent of a Scottish Parliament the Mental Health (Scotland) Act 1984 is likely to be reviewed. At that time it would be inappropriate to consider including ‘psychopathic disorder’ but some alternative to the current rather narrow definition of ‘mental disorder’ may be required.

One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 2000

2010 ◽  
Vol 22 (7) ◽  
pp. 1154-1160 ◽  
Author(s):  
Hugo Lövheim ◽  
Ellinor Bergdahl ◽  
Per-Olof Sandman ◽  
Stig Karlsson ◽  
Yngve Gustafson
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Antidepressant Treatment ◽  
Antidepressant Drug ◽  
Institutional Care ◽  
Old People ◽  
Cross Sectional ◽  
Moderate Cognitive Impairment ◽  
Drug Treatments

ABSTRACTBackground: Dementia and depression are common in advanced age, and often co-exist. There are indications of a decreased prevalence of depressive symptoms among old people in recent years, supposedly because of the manifold increase in antidepressant treatment. Whether the prevalence of depressive symptoms has decreased among people in different stages of dementia disorders has not yet been investigated.Methods: A comparison was undertaken of two cross-sectional studies, conducted in 1982 and 2000, comprising 6864 participants living in geriatric care units in the county of Västerbotten, Sweden. Depressive symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and the cognitive score was measured with Gottfries’ cognitive scale. Drug data were obtained from prescription records.Results: There was a significant decrease in depressive symptom score between 1982 and 2000 in all cognitive function groups except for the group with moderate cognitive impairment. Antidepressant drug use increased in all cognitive function groups.Conclusion: The prevalence of depressive symptoms decreased between 1982 and 2000, in all levels of cognitive impairment except moderate cognitive impairment. This might possibly be explained by the depressive symptoms having different etiologies in different stages of a dementia disorder, which in turn might not be equally susceptible to antidepressant treatment.

scholarly journals The Association Between Depressive Symptoms and Cognitive Functioning in Older Hispanic/Latino Adults Enrolled in an Exercise Intervention: Results From the “¡Caminemos!” Study

2017 ◽  
Vol 30 (6) ◽  
pp. 843-862 ◽  
Author(s):  
Rosalba Hernandez ◽  
Elaine Cheung ◽  
Minli Liao ◽  
Seth W. Boughton ◽  
Lisett G. Tito ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Cognitive Functioning ◽  
Chronic Conditions ◽  
Exercise Intervention ◽  
Longitudinal Analyses ◽  
Symptoms Of Depression ◽  
Intervention Method

Objective: We examined the association between depressive symptoms and cognitive functioning in older Hispanics/Latinos enrolled in an exercise intervention. Method: We analyzed baseline, 1-year, and 2-year in-person interview data collected from Hispanics/Latinos aged ≥60 years participating in an exercise intervention across 27 senior centers ( N = 572). Results: Mean age was 73.13 years; 77% female. At baseline, older adults screening positive for depression were 1.58 times more likely to experience cognitive impairment ( p = .04); controlling for demographics and comorbid chronic conditions. Compared to peers with little to no depressive symptoms, lower cognitive functioning scores were evident at each follow-up assessment point where elevated depressive symptoms were present, but baseline depression was not associated with cognitive function in longitudinal analyses. Discussion: In older Hispanics/Latinos enrolled in an exercise intervention, though baseline depression did not predict cognitive function over time, elevated symptoms of depression were associated with greater cognitive impairment at every point in this study.

scholarly journals Values-Based Practice When Engaging with Voice-Hearers

2020 ◽  
pp. 297-304
Author(s):  
Rosalind Austin
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Definition Of

AbstractThis chapter explores the values issues arising in voice-hearing through the resources of a new skills-based approach to working with values called values-based practice. The chapter is focused on the experiences of two voice-hearers, Paul and Mary, so as to highlight the diversity of ways that people experience voice-hearing, and how a correspondingly nuanced way of supporting voice-hearers is needed. It employs an inclusive definition of values covering anything that matters or is important to the person concerned. The chapter demonstrates that values-based practice in voice-hearing supports shared decision-making when working with values challenges in health care. Both Paul’s and Mary’s stories offer illustrations of the complex and sometimes conflicting values associated with voice-hearing.

scholarly journals Measurement issues of shared decision making in mental health: challenges and opportunities

2017 ◽  
Vol 22 (3) ◽  
pp. 214-232 ◽  
Author(s):  
Lilisbeth Perestelo-Perez ◽  
Amado Rivero-Santana ◽  
Yolanda Alvarez-Perez ◽  
Yaara Zisman-Ilani ◽  
Emma Kaminskiy ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Shared Decision Making ◽  
Self Report ◽  
Psychometric Validation ◽  
Shared Decision ◽  
Deliberative Process ◽  
Content Type

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

Primary Care Pediatrics and Child Psychopathology: A Review of Diagnostic, Treatment, and Referral Practices

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1044-1051 ◽  
Author(s):  
Elizabeth J. Costello
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Primary Care Providers ◽  
Health Problems ◽  
Group Practices ◽  
Primary Care Pediatricians

The quality of mental health care for children depends not only on specialist mental health services, but also on how effectively primary care providers identify, treat, and refer children with emotional and behavioral problems. Recent research has shown that primary care practitioners are the sole providers of mental health care to the majority of people with a mental disorder. For example, Regier et al1 calculated that in 1975 54.1% of persons with a mental disorder were treated only in a primary care or outpatient medical setting, with another 6% receiving care from both specialist mental health and primary care medical facilities. An additional 21.5% were not in treatment or received treatment from nonmedical agencies. If the data were extrapolated for all age groups, these rates would imply that only one child in five with a mental disorder is receiving specialist treatment, three are in the care of a pediatrician, and one is receiving no treatment. This would lead to the conclusion that pediatricians are, according to Regier et al,1 the de facto mental health service for most children in need of such care. It would lend support to the drive to increase pediatricians' awareness of, and training for, the mental health component of their work.2 In this paper, we review the published evidence as it applies to children. SCOPE This review includes the published studies of mental health problems diagnosed by primary care pediatricians, family practitioners, or pediatric nurse practitioners working in outpatient settings in the United States. These include private pediatric practices, group practices, health maintenance organizations (HMOs), and other types of prepaid group practices. The questions addressed are: (1) What proportion of the children seen by primary care pediatricians and their colleagues are diagnosed by them as having a mental disorder? (2) What proportion of children are referred for specialist evaluation and treatment? (3) What risk factors are associated with a higher probability of receiving a diagnosis of psychopathology? (4) How accurate are primary care pediatricians' diagnoses of mental health problems?

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