scholarly journals Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

2021 ◽  
Vol 12 ◽  
Author(s):  
Julia Stoll ◽  
Martina A. Hodel ◽  
Florian Riese ◽  
Scott A. Irwin ◽  
Paul Hoff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Mental Illness ◽  
Anorexia Nervosa ◽  
Cross Sectional Survey ◽  
Persistent Mental Illness ◽  
Decision Making Capacity ◽  
Case Vignettes ◽  
Persistent Depression

Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm.Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression.Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment.Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations.

scholarly journals Attitudes toward assisted suicide requests in the context of severe and persistent mental illness: A survey of psychiatrists in Switzerland

2019 ◽  
Vol 17 (6) ◽  
pp. 621-627 ◽  
Author(s):  
Martina A. Hodel ◽  
Paul Hoff ◽  
Scott A. Irwin ◽  
Nikola Biller-Andorno ◽  
Florian Riese ◽  
...  
Keyword(s):  
Mental Illness ◽  
Anorexia Nervosa ◽  
Assisted Suicide ◽  
Psychiatric Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Refractory Depression ◽  
Persistent Mental Illness ◽  
German Speaking ◽  
Case Vignettes

AbstractObjectiveSwitzerland is among the few countries worldwide where a request for assisted suicide (AS) can be granted on the basis of a primary psychiatric diagnosis. Psychiatrists play an increasingly important role in this regard, especially when the request for AS arises in the context of suffering caused by severe and persistent mental illness (SPMI). The objective of the survey was to assess general attitudes among psychiatrists in Switzerland regarding AS requests from patients with SPMI.MethodIn a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about their attitude to AS for patients with SPMI, based on three case vignettes of patients diagnosed with anorexia nervosa, treatment-refractory depression, or severe persistent schizophrenia.ResultFrom a final sample of 457 psychiatrists (a response rate of 34.9%) whose mean age was 57.8 years, 48.6% of respondents did not support access to AS for persons diagnosed with SPMI, 21.2% were neutral, and 29.3% indicated some degree of support for access. In relation to the case vignettes, a slightly higher percentage of respondents supported the patient's wish to seek AS: 35.4% for those diagnosed with anorexia nervosa, 32.1% for those diagnosed with depression, and 31.4% for those diagnosed with schizophrenia.Significance of resultsAlthough a majority of the responding psychiatrists did not support AS for SPMI patients, about one-third would have supported the wishes of patients in the case vignettes. In light of the increasing number of psychiatric patients seeking AS and the continuing liberalization of AS practices, it is important to understand and take account of psychiatrists’ perspectives.

Quality of Life, Physical Activity Level and Psychological Profile of Nigerians with Serious Mental Illness and Healthy Psychotropic Naive Subjects (Preprint)

2020 ◽  
Author(s):  
Christian Arinze Okonkwo ◽  
Peter Olarenwaju Ibikunle ◽  
Izuchukwu Nwafor ◽  
Andrew Orovwigho
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Activity Level ◽  
Psychological Profile ◽  
Cross Sectional Survey ◽  
Significant Difference ◽  
Apparently Healthy

BACKGROUND Quality of life (QoL), physical activity (PA) level and psychological profile (PF) of patients with serious mental illness have been neglected during patient’s management OBJECTIVE The purpose of this study was to determine the effect of selected psychotropic drugs on the QoL, PA level and PF of patients with serious mental illness METHODS A cross sectional survey involving one hundred and twenty-four subject [62 Serious Mental Illness (SMI) and 62 apparently healthy subjects as control] using purposive and consecutive sampling respectively .Questionnaires for each of the constructs were administered to the participants for data collation. Analysis of the data was done using non parametric inferential statistics of Mann-Whitney U independent test and Spearman’s rho correlation with alpha level set as 0.05. RESULTS Significant difference was recorded in the QoL (p<0.05) of patient with SMI and apparently healthy psychotropic naive participants. There was a significant correlation between the QoL (p<0.05) and PF of participants with SMI. Participants with SMI had significantly lower QoL than apparently healthy psychotropic naive subject. QoL of the healthy psychotropic naive group was better than those of the participants with SMI. Female participants with SMI had higher PA than their male counterparts CONCLUSIONS Psychological profiles of male participants with SMI were lower than male healthy psychotropic naive participants. Clinicians should take precaution to monitor the QoL, PA level and PF because the constructs are relevant in evaluation of treatment outcome.

scholarly journals Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model

2020 ◽  
Vol 29 (8) ◽  
pp. 2073-2087 ◽  
Author(s):  
Anne Berghöfer ◽  
Luise Martin ◽  
Sabrina Hense ◽  
Stefan Weinmann ◽  
Stephanie Roll
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Care Model ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Care Model

The Relationship Between Employment Status and Quality of Life For Individuals with Severe and Persistent Mental Illness

1997 ◽  
Vol 28 (4) ◽  
pp. 4-8 ◽  
Author(s):  
Donna C. Vanden Boom ◽  
Daniel C. Lustig
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
Effect Size ◽  
Employment Status ◽  
Community Treatment ◽  
Living Situation ◽  
Persistent Mental Illness ◽  
Global Quality Of Life ◽  
The Relationship

The relationship between quality of life and employment status for individuals with severe and persistent mental illness was investigated. Forty individuals in the Program for Assertive Community Treatment (PACT) participated in the study. PACT is a community-based program for persons with severe and persistent mental illness which emphasizes the importance of employment in rehabilitation. Participants were interviewed using Lehman's Quality of Life Interview. A large effect size for difference between individuals who were employed and those who were unemployed was found for assessment of global quality of life. Medium and small effect sizes were found for satisfaction with family, financial situation, health and social relations, safety, and daily activities. Minimal effect size was found for satisfaction with living situation.

The Quality of Life of Persons with Severe and Persistent Mental Illness: A Typology Based on Cluster Analysis

2000 ◽  
Vol 31 (3) ◽  
pp. 22-29 ◽  
Author(s):  
Daniel C. Lustig ◽  
Michelle Crowder
Keyword(s):  
Quality Of Life ◽  
Cluster Analysis ◽  
Mental Illness ◽  
Mental Health Professionals ◽  
Community Integration ◽  
Subjective Assessment ◽  
Persistent Mental Illness ◽  
Quality Of Life Index ◽  
Life Improvement

Recently rehabilitation and mental health professionals have placed increased emphasis on quality of life as a service outcome for individuals with severe and persistent mental illness. Research has indicated that when services are based on quality of life improvement, consumers are able to achieve higher levels of independence, satisfaction, production, and community integration. Individuals with severe and persistent mental illness completed Lehman's Quality of Life Index. Respondents were grouped based on their subjective assessment of quality of life in specific life domains. Although cluster analysis revealed that most respondents viewed quality of life as satisfactory, the heterogeneous nature of the groups suggested that it is important to view quality of life from a multifaceted perspective. The multifaceted nature of quality of life is discussed in terms of implications for rehabilitation counselors, administrators, and policy makers.

scholarly journals 320 - Barriers to Deprescribing in Older Adults with Dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 78-78
Author(s):  
Mariana Duarte-Mangas ◽  
Gonçalo A. Santos ◽  
Beatriz Jorge ◽  
Catarina Pedro Fernandes
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Chronic Illnesses ◽  
Negative Consequences ◽  
Inappropriate Drugs ◽  
People With Dementia ◽  
Decision Making Capacity ◽  
Multiple Morbidities ◽  
Over Time

Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.

Applying futility in psychiatry: a concept whose time has come

2020 ◽  
pp. medethics-2020-106654
Author(s):  
Sarah Levitt ◽  
Daniel Z Buchman
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Illness ◽  
Terminal Illness ◽  
Psychiatric Illness ◽  
Decision Makers ◽  
Benefit Ratio ◽  
Persistent Mental Illness ◽  
Substitute Decision Makers

Since its introduction in the 1980s, futility as a concept has held contested meaning and applications throughout medicine. There has been little discussion within the psychiatric literature about the use of futility in the care of individuals experiencing severe and persistent mental illness (SPMI), despite some tacit acceptance that futility may apply in certain cases of psychiatric illness. In this paper, we explore the literature surrounding futility and argue that its connotation within medicine is to describe situations where patients (or their substitute decision-makers) believe that interventions will almost certainly provide no meaningful benefit. We then provide two arguments in support of the use of futility within the care of individuals experiencing SPMI: that some SPMI can be considered a terminal illness, and that the risk-benefit ratio is a dynamic entity such that futility can help describe what Gillett calls the ‘risk of unacceptable badness’ when it comes to considering how an intervention might impact a patient’s quality of life. We posit that capacity should not pose an obstacle to declaring futility when caring for individuals experiencing SPMI and explain how futility is not antithetical to recovery in mental health. Finally, we describe how using futility within psychiatric practice can allow for a reorientation of care by signalling the need to shift to a palliative approach.

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