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1.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31592608

RESUMO

BACKGROUND: Since 2016, all health regions have been instructed to provide drug-free psychiatric treatment options. The evidence base for such treatment has been called for. At Jæren District Psychiatric Centre we therefore identified the patients' wishes for drug-free treatment. MATERIAL AND METHOD: One hundred patients were sequentially asked upon admission whether they would want a drug-free treatment programme, given that it was available. The patients' age, sex, diagnosis and medical history were recorded, as well as their experience with the use of psychoactive drugs and counselling. RESULTS: Altogether 52 out of the 100 patients would want a drug-free treatment programme if this were available. The largest proportion was registered among patients who had been coercively sectioned (10 out of 13 patients) and among those who experienced least benefit from their drugs (17 out of 25). Even among those who reported to benefit well from their drugs, a considerable proportion wanted a drug-free option (24 out of 58). The majority of the patients had long illness trajectories and a high consumption of psychoactive drugs. INTERPRETATION: The observation that a large proportion of the patients would want a drug-free treatment programme if this were available can be seen as a reflection of frustration caused by persistent symptoms, adverse effects and a large burden of suffering despite the use of medication. An alternative interpretation is that the patients had an insufficient understanding of their need for preventive treatment or for their need for treatment at all.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/psicologia , Preferência do Paciente , Adolescente , Adulto , Idoso , Internação Compulsória de Doente Mental , Feminino , Humanos , Tratamento Psiquiátrico Involuntário , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Adulto Jovem
3.
Arq. bras. psicol. (Rio J. 2003) ; 71(2): 84-98, mai.-ago 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1010387

RESUMO

Este ensaio trata de uma discussão teórico-crítica sobre o dispositivo de internação compulsória, especificamente nos casos relacionados ao uso de crack. A construção teórica partirá de algumas reflexões sobre o olhar do outro como parte integrante desse fenômeno, através de uma analogia com o mito da Medusa. A análise terá como base a perspectiva existencialista de Jean-Paul Sartre, trazendo para a discussão o contexto neoliberalista, liberdade, campo dos possíveis, má-fé, estigma e o ser-para-outro. Dessa discussão, emerge o questionamento da internação compulsória como medida de tratamento para pessoas que fazem uso de crack. Essas pessoas, sob o olhar do outro, já têm suas possibilidades barradas em função do uso da substância, sendo que a imposição desse tratamento culmina em seu assujeitamento e objetificação


This essay is about a theoretical-critical discussion about the compulsory hospitalization device, specifically in cases related to the use of crack. The theoretical development will start from some thoughts about the gaze of the other as an integrating part of this phenomena, through the analogy with the Medusa myth. The analysis will have as a basis the existentialist perspective of Jean-Paul Sartre, bringing to the discussion the neoliberalist context, freedom, possible fields, bad faith, stigma and being-for-others. From this discussion, the debate of compulsory hospitalization as an action of treatment for people who use crack emerges. These people, under the gaze of the other, already have their opportunities restrained as a result of the use of the substance, since the imposition of this treatment culminates in their antipersonification and objectification


Este ensayo trata de una discusión teórico-crítica sobre el dispositivo de internación obligatoria, específicamente en los casos relacionados con el uso de crack. La construcción teórica partirá de algunas reflexiones sobre la mirada del otro como parte integrante de ese fenómeno, a través de una analogía con el mito de la Medusa. El análisis tendrá como base la perspectiva existencialista de Jean-Paul Sartre, trayendo para la discusión el contexto neoliberalista, libertad, campo de los posibles, mala fe, estigma y el ser-para-otro. De esta discusión, emerge el cuestionamiento de la internación obligatoria como medida de tratamiento para personas que hacen uso de crack. Esas personas, bajo la mirada del otro, ya tienen sus posibilidades barradas en función del uso de la sustancia, siendo que la imposición de ese tratamiento culmina en su sometimiento y objetivación.


Assuntos
Humanos , Cocaína Crack , Existencialismo , Estigma Social , Tratamento Psiquiátrico Involuntário , Mitologia/psicologia
4.
East Asian Arch Psychiatry ; 29(2): 63-65, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237248

RESUMO

On 25 to 26 August 2017, the 'Compulsory Mental Health Treatment in Hong Kong: Which Way Forward?' conference was held in Hong Kong. Academics and practitioners from the United Kingdom, United States, New Zealand, and Hong Kong came together to discuss such important topics as the philosophical justifications for compulsory treatment, constitutional and human rights, and how compulsory powers are and should be used in practice. Speakers and conference participants then engaged in roundtable discussions on various issues that arose, in particular how reform of the law regulating compulsory mental health treatment in Hong Kong should proceed.


Assuntos
Tratamento Psiquiátrico Involuntário , Transtornos Mentais/terapia , Congressos como Assunto , Hong Kong , Humanos , Tratamento Psiquiátrico Involuntário/ética , Tratamento Psiquiátrico Involuntário/métodos , Saúde Mental/ética , Saúde Mental/normas
6.
BMC Psychiatry ; 19(1): 127, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035963

RESUMO

BACKGROUND: The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment. METHODS: We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID). RESULTS: Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered. CONCLUSIONS: We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.


Assuntos
Internação Compulsória de Doente Mental , Registros Eletrônicos de Saúde , Hospitais Psiquiátricos , Tratamento Psiquiátrico Involuntário/métodos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Adulto , Árvores de Decisões , Feminino , Alemanha/epidemiologia , Hospitalização , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco
7.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 316-322, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31044673

RESUMO

Voluntariness in Outpatient Psychotherapy with Children and Adolescents Voluntariness is no selective construct in psychotherapy with children and adolescents. Generally psychotherapy is utilized under external pressure, at least partially. At any rate it is crucial to painstakingly analyze the motivation for change and possible obstacles to motivation. On that basis different strategies to foster motivation for change can be applied. Problems regarding the efficiency of voluntary or involuntary utilization of outpatient psychotherapy for children and adolescents should be subjects to further research.


Assuntos
Motivação , Pacientes Ambulatoriais/psicologia , Cooperação do Paciente/psicologia , Psicologia do Adolescente/métodos , Psicologia da Criança/métodos , Psicoterapia/métodos , Adolescente , Criança , Humanos , Tratamento Psiquiátrico Involuntário/ética , Psicologia do Adolescente/ética , Psicologia do Adolescente/normas , Psicologia da Criança/ética , Psicologia da Criança/normas , Psicoterapia/ética , Psicoterapia/normas
9.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 286-304, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31044678

RESUMO

Working with Involuntary Clients - When Control Becomes an Element of Counselling Counselling involuntary clients is an ambitious as well as contested job, which sometimes causes professionals to distance themselves from this work or even to reject it. This might be one of the reasons why the task to exercise control within a counselling context is assigned to the child protection agency (Jugendamt) while Psychological and Social Help Centers are tasked to provide "only" support services to involuntary clients. Hence, the two jobs of exercising control and providing help are split between the institutions. The arrangement allows professionals to get rid of an unattractive job. In child protection work such a division of responsibility is neither wise nor possible, even if this does not mean that there is no need to distinguish between the tasks and duties of the involved professionals. This article will first of all illustrate why it is necessary to discuss "involuntary clients" within child protection work and why this kind of counselling always implicates some kind of control. In the second part of the article, some results from serious case reviews will be presented. They demonstrate the kind of challenges and difficulties which the work with parents and children in child protection can create.


Assuntos
Psiquiatria Infantil/métodos , Aconselhamento/métodos , Tratamento Psiquiátrico Involuntário/métodos , Psicologia da Criança/métodos , Criança , Humanos , Pais/psicologia
10.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 253-270, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31044679

RESUMO

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.


Assuntos
Coerção , Centros Comunitários de Saúde Mental , Terapia Familiar/métodos , Tratamento Psiquiátrico Involuntário/métodos , Transtornos Mentais/terapia , Pais/psicologia , Psicoterapia/métodos , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Ansiedade de Separação , Criança , Filho de Pais Incapacitados/psicologia , Terapia Familiar/ética , Humanos , Tratamento Psiquiátrico Involuntário/ética , Transtornos Mentais/psicologia , Cooperação do Paciente/psicologia , Psicoterapia/ética
11.
Issues Ment Health Nurs ; 40(7): 626-631, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050565

RESUMO

Little is understood about restrictive practices (seclusion, physical restraint, mechanical restraint) for those admitted to mental health services from prison. This study aimed to determine restrictive practices use on males admitted involuntarily from prison compared to those admitted from the community. A retrospective cross-sectional, comparative research design was used. Those admitted from prison were no more likely to experience restrictive practices; but were more likely to have a co-existing diagnosis of alcohol/substance use or personality disorder, in addition to a primary diagnosis of psychotic illness. The proportionate use of restrictive practices despite such complex presentations is potentially indicative of the clinical use of effective alternative management strategies.


Assuntos
Tratamento Psiquiátrico Involuntário , Transtornos Mentais/terapia , Serviços de Saúde Mental , Isolamento de Pacientes , Prisioneiros , Restrição Física , Adulto , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
J Appl Res Intellect Disabil ; 32(4): 932-941, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950144

RESUMO

BACKGROUND: The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how "moving on" is defined and perceived. METHODS: The study reports on an ethnographic study using the field-notes and the 26 semi-structured interviews with detained women and staff on three wards. RESULTS: We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. CONCLUSION: The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.


Assuntos
Institucionalização , Deficiência Intelectual/psicologia , Deficiência Intelectual/reabilitação , Tratamento Psiquiátrico Involuntário , Pessoas com Deficiência Mental/psicologia , Pessoas com Deficiência Mental/reabilitação , Adulto , Inglaterra , Feminino , Humanos , Legislação como Assunto , Programas Nacionais de Saúde , Autonomia Pessoal , Pesquisa Qualitativa
14.
Lancet Psychiatry ; 6(4): 305-317, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30846354

RESUMO

BACKGROUND: Evidence suggests that black, Asian and minority ethnic (BAME) groups have an increased risk of involuntary psychiatric care. However, to our knowledge, there is no published meta-analysis that brings together both international and UK literature and allows for comparison of the two. This study examined compulsory detention in BAME and migrant groups in the UK and internationally, and aimed to expand upon existing systematic reviews and meta-analyses of the rates of detention for BAME populations. METHODS: For this systematic review and meta-analysis, we searched five databases (PsychINFO, MEDLINE, Cochrane Controlled Register of Trials, Embase, and CINAHL) for quantitative studies comparing involuntary admission, readmission, and inpatient bed days between BAME or migrant groups and majority or native groups, published between inception and Dec 3, 2018. We extracted data on study characteristics, patient-level data on diagnosis, age, sex, ethnicity, marital status, and occupational status, and our outcomes of interest (involuntary admission to hospital, readmission to hospital, and inpatient bed days) for meta-analysis. We used a random-effects model to compare disparate outcome measures. We assessed explanations offered for the differences between minority and majority groups for the strength of the evidence supporting them. This study is prospectively registered with PROSPERO, number CRD42017078137. FINDINGS: Our search identified 9511 studies for title and abstract screening, from which we identified 296 potentially relevant full-text articles. Of these, 67 met the inclusion criteria and were reviewed in depth. We added four studies after reference and citation searches, meaning 71 studies in total were included. 1 953 135 participants were included in the studies. Black Caribbean patients were significantly more likely to be compulsorily admitted to hospital compared with those in white ethnic groups (odds ratio 2·53, 95% CI 2·03-3·16, p<0·0001). Black African patients also had significantly increased odds of being compulsorily admitted to hospital compared with white ethnic groups (2·27, 1·62-3·19, p<0·0001), as did, to a lesser extent, south Asian patients (1·33, 1·07-1·65, p=0·0091). Black Caribbean patients were also significantly more likely to be readmitted to hospital compared with white ethnic groups (2·30, 1·22-4·34, p=0·0102). Migrant groups were significantly more likely to be compulsorily admitted to hospital compared with native groups (1·50, 1·21-1·87, p=0·0003). The most common explanations for the increased risk of detainment in BAME populations included increased prevalence of psychosis, increased perceived risk of violence, increased police contact, absence of or mistrust of general practitioners, and ethnic disadvantages. INTERPRETATION: BAME and migrant groups are at a greater risk of psychiatric detention than are majority groups, although there is variation across ethnic groups. Attempts to explain increased detention in ethnic groups should avoid amalgamation and instead carry out culturally-specific, hypothesis-driven studies to examine the numerous contributors to varying rates of detention. FUNDING: University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre, NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, and NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust.


Assuntos
Política de Saúde , Disparidades em Assistência à Saúde/etnologia , Tratamento Psiquiátrico Involuntário/legislação & jurisprudência , Saúde Mental/etnologia , Grupos Étnicos , Humanos , Internacionalidade , Reino Unido
20.
BMC Psychiatry ; 19(1): 37, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674292

RESUMO

BACKGROUND: Cardiometabolic health significantly impacts on the mortality of people with severe mental illness. Clozapine has the greatest efficacy for Treatment Resistant Schizophrenia (TRS) but the greatest negative impact on cardiometabolic health. Balancing the risks and benefits of treatment, dignity, autonomy, liberty, mental and physical health can be challenging, particularly when imposing interventions with potentially life threatening adverse events, such as clozapine. We describe the successful administration of clozapine in the face of myocardial infarction, pulmonary embolism and hyperlipidaemia resulting in the termination of long-term seclusion for a gentleman with TRS in high secure psychiatric services. CASE PRESENTATION: The impact of clozapine on a 44-year-old gentleman with TRS, extreme violence requiring physical restraint and long-term segregation, and numerous other significant physical health complications is described. He had metabolic syndrome; a poor diet, sedentary lifestyle, Body Mass Index (BMI) of 31.5, poorly controlled lipids and had smoked heavily since childhood. During preparations to initiate clozapine, he suffered a myocardial infarction and pulmonary embolism. His compliance with secondary prevention medications was poor due to paranoid persecutory and somatic delusions. Despite these concerns, nasogastric administration of clozapine was approved and prescribed within nine months of his myocardial infarction and a month from his pulmonary embolism but was ultimately not required. Accepting oral medication, his mental state made a rapid and dramatic improvement. After spending 1046 days in seclusion, this was terminated 94 days after clozapine initiation. He has been compliant with all medications for 24 months, had no incidents of violence or seclusion, and has been transferred to medium secure services. His physical health stabilised despite continuing to lead a sedentary lifestyle and remaining obese (BMI of 35). He developed hypertension, Type II Diabetes Mellitus and his triglycerides rose to 22.2 mmol/L in the same month after clozapine initiation. However, with pharmacological intervention, 24 months later these are controlled, and he has had no further thromboembolic events. CONCLUSIONS: We highlight that despite significant physical health concerns, clozapine can be successfully initiated and safely prescribed with a significantly positive effect on both the psychiatric and holistic care of patients with treatment resistant schizophrenia.


Assuntos
Clozapina/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Tratamento Psiquiátrico Involuntário , Infarto do Miocárdio/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/diagnóstico , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/tratamento farmacológico , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Esquizofrenia/complicações , Esquizofrenia/diagnóstico
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