scholarly journals What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

2021 ◽  
Vol 2 (2) ◽  
pp. 127-144
Author(s):  
Enric Vicens Pons ◽  
Alfredo Calcedo Barba ◽  
Jacinta Hastings ◽  
Miia Männikkö ◽  
Silvia Paz Ruiz
Keyword(s):  
Decision Making ◽  
Bipolar Disorder ◽  
Mental Illness ◽  
European Federation ◽  
Decisional Capacity ◽  
Global Alliance ◽  
Acute Symptom ◽  
Autonomous Decision ◽  
Advocacy Network ◽  
Barriers And Opportunities

Background: Research on the decisional capacity of schizophrenia and bipolar disorder patients mostly reflects the hospital context. Aim: To describe the views of patients, psychiatrists, and caregivers on the capacity of individuals with schizophrenia and bipolar disorder to make everyday decisions on their care related to their illness. Methods: A survey was conducted among schizophrenia and bipolar disorder patients, psychiatrists, and caregivers (June 2019 to January 2020; seven countries). A questionnaire was emailed to members of the Global Alliance of Mental Illness of Advocacy Network—Europe (GAMIAN; patients) and the European Federation of Families of People with Mental Illness (EUFAMI; caregivers) and to psychiatrists who voluntarily agreed to participate. Questions referred to patients’ involvement and capacity for healthcare decision making, and to barriers to and opportunities for autonomous decision making. Frequency, agreement, and importance were rated on Likert scales. Descriptive statistics were conducted. Results: 21 schizophrenia or bipolar disorder patients (52.3% female; mean age (years) ± SD: 50.71 ± 12.02), 11 psychiatrists (18.2% female), and 15 caregivers (86.6% female; 100% family related) participated in the survey. In total, 86% of patients felt frequently involved in decisions about everyday care and medications, and 91% of psychiatrists and 40% of caregivers perceived the same; 38% of patients felt frequently involved in decisions about the use of acute symptom medications, and 57% on care planning, and 55% and 82% of psychiatrists, and 40% and 53% of caregivers, respectively, believed the same; and 86% of patients, 91% of psychiatrists, and 47% of caregivers agreed on the capacity of schizophrenia or bipolar disorder patients to value the implications of taking medicines to prevent acute psychotic crises. Poor understanding and training are barriers, while advocacy and increasing interest in patients’ needs are opportunities for increasing autonomous decision making. Conclusions: Stakeholders concur that schizophrenia and bipolar disorder patients have the capacity to make everyday decisions around their care related to their illness, including acute symptom management. Barriers and opportunities exist to foster autonomous decisions among mental illness individuals.

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

Ethics and Depression

2017 ◽  
Author(s):  
Richard Ashcroft
Keyword(s):  
Decision Making ◽  
Medical Ethics ◽  
Personal Perspective ◽  
Depression Treatment ◽  
Ethical Obligation ◽  
Autonomous Decision

This chapter discusses the ethics of depression from a personal perspective. The author, an academic who has worked in the field of medical ethics or bioethics, has suffered episodes of depression throughout his life, some lasting several months. Here he shares a few quite informal things about how these two facts about him are connected. He first considers the paradigm of autonomy and autonomous decision-making, as well as the problem with functional accounts of autonomy with regard to depression. He then reflects on an approach to ethics and depression that involves thinking about the ethics of being depressed. He also highlights two aspects of the ‘ethics of depression’: treatment and the ethical obligation to talk about it.

What Patients With Severe Mental Illness Transitioning From Hospital to Community Have to Say About Care and Shared Decision-Making

2016 ◽  
Vol 37 (6) ◽  
pp. 400-405 ◽  
Author(s):  
Dawn I. Velligan ◽  
David L. Roberts ◽  
Cynthia Sierra ◽  
Megan M. Fredrick ◽  
Mary Jo Roach
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Shared Decision Making ◽  
Shared Decision

scholarly journals Overview of CAPICE—Childhood and Adolescence Psychopathology: unravelling the complex etiology by a large Interdisciplinary Collaboration in Europe—an EU Marie Skłodowska-Curie International Training Network

2021 ◽  
Author(s):  
Hema Sekhar Reddy Rajula ◽  
Mirko Manchia ◽  
Kratika Agarwal ◽  
Wonuola A. Akingbuwa ◽  
Andrea G. Allegrini ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Problems ◽  
Interdisciplinary Collaboration ◽  
Adolescent Psychopathology ◽  
Childhood And Adolescence ◽  
Global Alliance ◽  
Dissemination Strategy ◽  
Health And Wellbeing ◽  
Hyperactivity Disorder

AbstractThe Roadmap for Mental Health and Wellbeing Research in Europe (ROAMER) identified child and adolescent mental illness as a priority area for research. CAPICE (Childhood and Adolescence Psychopathology: unravelling the complex etiology by a large Interdisciplinary Collaboration in Europe) is a European Union (EU) funded training network aimed at investigating the causes of individual differences in common childhood and adolescent psychopathology, especially depression, anxiety, and attention deficit hyperactivity disorder. CAPICE brings together eight birth and childhood cohorts as well as other cohorts from the EArly Genetics and Life course Epidemiology (EAGLE) consortium, including twin cohorts, with unique longitudinal data on environmental exposures and mental health problems, and genetic data on participants. Here we describe the objectives, summarize the methodological approaches and initial results, and present the dissemination strategy of the CAPICE network. Besides identifying genetic and epigenetic variants associated with these phenotypes, analyses have been performed to shed light on the role of genetic factors and the interplay with the environment in influencing the persistence of symptoms across the lifespan. Data harmonization and building an advanced data catalogue are also part of the work plan. Findings will be disseminated to non-academic parties, in close collaboration with the Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe).

Relationships Between Reward-Based Decision Making and Activation in a Frontal-Striatal Network in Schizophrenia vs. Bipolar Disorder

2021 ◽  
Vol 89 (9) ◽  
pp. S176-S177
Author(s):  
Jason Smucny ◽  
Timothy Hanks ◽  
Tyler Lesh ◽  
Randall O'Reilly ◽  
Cameron Carter
Keyword(s):  
Decision Making ◽  
Bipolar Disorder

scholarly journals Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Emily B. H. Treichler ◽  
Borsika A. Rabin ◽  
William D. Spaulding ◽  
Michael L. Thomas ◽  
Michelle P. Salyers ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Service Delivery ◽  
Serious Mental Illness ◽  
Qualitative Interviews ◽  
Skills Training ◽  
Mental Illnesses ◽  
Open Trial ◽  
Collaborative Decision Making ◽  
Collaborative Decision

Abstract Background Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs. Trial registration ClinicalTrials.gov Identifier: NCT04324944

scholarly journals Autonomous Decision-Making While Drilling

Energies ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 969
Author(s):  
Eric Cayeux ◽  
Benoît Daireaux ◽  
Adrian Ambrus ◽  
Rodica Mihai ◽  
Liv Carlsen
Keyword(s):  
Decision Making ◽  
Internal State ◽  
Drilling Process ◽  
Autonomous Decision ◽  
Internal States ◽  
Markov Decision ◽  
Drilling Operations ◽  
Drilling System ◽  
Drilling Conditions ◽  
Erratic Behavior

The drilling process is complex because unexpected situations may occur at any time. Furthermore, the drilling system is extremely long and slender, therefore prone to vibrations and often being dominated by long transient periods. Adding the fact that measurements are not well distributed along the drilling system, with the majority of real-time measurements only available at the top side and having only access to very sparse data from downhole, the drilling process is poorly observed therefore making it difficult to use standard control methods. Therefore, to achieve completely autonomous drilling operations, it is necessary to utilize a method that is capable of estimating the internal state of the drilling system from parsimonious information while being able to make decisions that will keep the operation safe but effective. A solution enabling autonomous decision-making while drilling has been developed. It relies on an optimization of the time to reach the section total depth (TD). The estimated time to reach the section TD is decomposed into the effective time spent in conducting the drilling operation and the likely time lost to solve unexpected drilling events. This optimization problem is solved by using a Markov decision process method. Several example scenarios have been run in a virtual rig environment to test the validity of the concept. It is found that the system is capable to adapt itself to various drilling conditions, as for example being aggressive when the operation runs smoothly and the estimated uncertainty of the internal states is low, but also more cautious when the downhole drilling conditions deteriorate or when observations tend to indicate more erratic behavior, which is often observed prior to a drilling event.

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