Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries.

BACKGROUND: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

The epithelium and the pharmacology of guinea-pig tracheal tone in vitro.

1. Epithelium removal did not influence the development of spontaneous tone in guinea-pig tracheal smooth muscle mounted as open ring preparations with two adjoining cartilaginous rings in vitro. 2. Epithelium removal did not change the potency of carbachol but tended to reduce the maximal contraction. In the presence of epithelium the EC50 of carbachol was not different in tracheal open ring compared with intact tube preparations (comprising four cartilaginous rings), suggesting that the size of continuous epithelium in vitro was not critical for the potency of carbachol. 3. Substance P produced the same response in intact and rubbed tracheae. The enkephalinase inhibitor thiorphan (0.1 mM) by itself contracted the trachea and appeared to potentiate the substance P response five times more in the absence than in the presence of epithelium. Capsaicin (1 microM)-induced contractions did not differ between intact and rubbed preparations. 4. Arachidonic acid, 22 microM, variably produced small relaxations and contractions in intact as well as in rubbed tracheae. The mean effects of arachidonic acid were not significantly altered by epithelium removal. 5. Adenosine produced small contractions and dose-dependent relaxations in the presence and absence of epithelium. 6. Epithelium removal had no effect on the potency of the relaxant agonists theophylline and enprofylline. The isoprenaline curve was shifted 2 fold to the left and the terbutaline curve 1.5 fold to the right. The maximal relaxations were generally reduced in epithelium-free tissue. The reduction reached statistical significance with theophylline. 7. The present results suggest that epithelium removal is of little consequence for the pharmacology of the guinea-pig tracheal open ring preparation in vitro.