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Guinart D, Fagiolini A, Fusar-Poli P, Giordano GM, Leucht S, Moreno C, Correll CU. On the Road to Individualizing Pharmacotherapy for Adolescents and Adults with Schizophrenia - Results from an Expert Consensus Following the Delphi Method. Neuropsychiatr Dis Treat 2024; 20:1139-1152. [PMID: 38812809 PMCID: PMC11133879 DOI: 10.2147/ndt.s456163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes. Methods A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population. Results There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient's diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment. Conclusion Individualized care can help provide effective, tailored treatments based on an individual's clinical characteristics, disease trajectory, family and social environment, and goals and preferences.
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Affiliation(s)
- Daniel Guinart
- Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain
- Hospital Del Mar Research Institute, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King’s College London, London, UK
- Outreach and Support in South-London (OASIS) Service, South London and Maudsley (Slam) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | | | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (LISGM), Madrid, Spain
- Centro de Investigación Biomedica en Red (CIBERSAM), ISCIII, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Christoph U Correll
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, New York, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitatsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
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Morena D, Lippi M, Di Fazio N, Delogu G, Rinaldi R, Frati P, Fineschi V. Capacity to Consent in Healthcare: A Systematic Review and Meta-Analysis Comparing Patients with Bipolar Disorders and Schizophrenia Spectrum Disorders. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:764. [PMID: 38792947 PMCID: PMC11123007 DOI: 10.3390/medicina60050764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Background: Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. Objective: This meta-analysis aimed to investigate potential differences in decision-making capacity within the healthcare context among groups of patients with bipolar disorders (BD) and schizophrenia spectrum disorders (SSD). Methods: A systematic search was conducted on Medline/Pubmed, and Scopus. Additionally, Google Scholar was manually inspected, and a manual search of emerging reviews and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving patients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges' g was used as a measure for outcomes. Results: Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better compared to patients with SSD, with the difference being statistically significant in the domain of Appreciation (ES = 0.23, 95% CI: 0.01 to 0.04, p = 0.037). There was no statistically significant difference between the two groups for Understanding (ES = 0.09, 95% CI:-0.10 to 0.27, p = 0.352), Reasoning (ES = 0.18, 95% CI: -0.12 to 0.47, p = 0.074), and Expression of a choice (ES = 0.23, 95% CI: -0.01 to 0.48, p = 0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES = 0.21, 95% CI: -0.04 to 0.46, p = 0.102). Conclusions: These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.
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Affiliation(s)
| | | | | | | | | | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (M.L.); (N.D.F.); (G.D.); (R.R.); (V.F.)
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Wullschleger A, Chatton A, Kuenzi N, Baeriswyl R, Kaiser S, Bartolomei J. Experience of violence and attitudes of staff members towards coercion in psychiatric settings: observational study. BJPsych Open 2024; 10:e80. [PMID: 38616714 PMCID: PMC11060063 DOI: 10.1192/bjo.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Among important dimensions related to the use of coercive measures, professionals' attitude towards coercion is of particular interest. Little is known about how experiences of violence in the workplace might influence these attitudes. AIMS The present study aimed to investigate potential correlates of attitudes towards coercion, especially experiences of violence in the workplace. METHOD Mental health professionals were contacted through an online survey to assess their attitudes towards coercion using the Staff Attitude to Coercion Scale (SACS). The three subscales of the SACS (critical, pragmatic and positive attitudes) were analysed in a multivariate multiple linear regression, using a set of covariates including experiences of violence in the workplace. We hypothesised that experience of violence in the workplace would correlate with less critical attitudes of staff members towards coercion. RESULTS A total of 423 professionals were included in the regression analysis. Age, professional category, feeling of insecurity, having witnessed or used coercion, and the emotional burden associated with coercive measures had a joint significant effect on the three SACS subscales. A feeling of insecurity, but not the experience of violence, was associated with a less critical, more positive appraisal of coercive measures. The emotional burden related to the use of coercion was associated with a more critical attitude. CONCLUSIONS The present results highlight the importance of considering staff members' training and well-being regarding their feelings of insecurity when addressing attitudes towards coercion. The experience of patients should be integrated into staff training and coercion reduction programmes.
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Affiliation(s)
| | - Anne Chatton
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Noémie Kuenzi
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rachel Baeriswyl
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Javier Bartolomei
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Dauriac-Le Masson V, El-Khoury Lesueur F, Lahaye J, Launay C, Christodoulou A, Boiteux C, Maman J, Bonnemaison X, Perquier F, Vacheron MN. Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group. Front Psychiatry 2024; 15:1296356. [PMID: 38445090 PMCID: PMC10913196 DOI: 10.3389/fpsyt.2024.1296356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.
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Affiliation(s)
| | - Fabienne El-Khoury Lesueur
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Sorbonne Universite, INSERM UMRS_1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Justine Lahaye
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Corinne Launay
- Pôle Psychiatrie Précarité, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | | | - Florence Perquier
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Lasalvia A, Patuzzo S, Braun E, Henderson C. Advance statements in mental healthcare: time to close the evidence to practice gap. Epidemiol Psychiatr Sci 2023; 32:e68. [PMID: 38053411 PMCID: PMC10803188 DOI: 10.1017/s2045796023000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023] Open
Abstract
This article discusses advance statements in mental health care, which allow individuals with mental disorders to express their preferences for treatment during mental health crises. Despite the evidence supporting their effectiveness, their implementation in clinical practice remains limited. This article explores variations among advance statements, such as psychiatric advance directives (PADs), joint crisis plans (JCPs) and self-binding directives (SBDs), highlighting their content, development process and legal status. We outline the benefits of advance statements, including empowerment, early intervention, improved therapeutic relationships and reduced compulsory admissions. We then draw attention to the challenges that may contribute to their lack of implementation, including legal complexities, communication issues, cultural factors, potential inequities, healthcare provider knowledge, changing preferences, resource constraints, crisis responses, data privacy, family involvement, and long-term evaluation. In conclusion, advance statements offer significant benefits but require addressing these critical aspects to ensure ethical and effective use. Bridging the evidence-to-practice gap is essential, with a focus on implementation science. Integrating these tools into routine clinical practice can significantly benefit individuals with severe mental disorders and mental health systems.
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Affiliation(s)
- Antonio Lasalvia
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Patuzzo
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Esther Braun
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
- Department of Philosophy, University of Oxford, Oxford, UK
| | - Claire Henderson
- Health Service and Population Research Department P029, David Goldberg Centre, King’s College London Institute of Psychiatry, London, UK
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Steinert T, Baumgardt J, Bechdolf A, Bühling-Schindowski F, Cole C, Flammer E, Jaeger S, Junghanss J, Kampmann M, Mahler L, Muche R, Sauter D, Vandamme A, Hirsch S. Implementation of guidelines on prevention of coercion and violence (PreVCo) in psychiatry: a multicentre randomised controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100770. [PMID: 38058297 PMCID: PMC10696231 DOI: 10.1016/j.lanepe.2023.100770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023]
Abstract
Background Interventions to prevent the use of coercion in psychiatric hospitals have been summarized in the 2018 German Association for Psychiatry, Psychotherapy, and Psychosomatic's comprehensive guidelines. Twelve recommendations for implementation of these guideline on psychiatric wards have been deducted and their feasibility has been tested in a pilot study, using external implementation consultants as facilitators. The objective of the PreVCo study was to test their effect in a randomised clinical trial. Methods Fifty-four psychiatric wards in Germany treating voluntary and involuntary patients were randomly allocated to either an intervention or to a waiting list condition. The intervention consisted of the implementation of three out of 12 suggested recommendations as selected by the ward teams, supported by external study workers. As the primary outcome measure, the number of coercive measures used per bed and month in the final 3 months of the intervention period was determined. Secondary outcomes were the cumulative duration of coercive measures used per bed and months and assaults per bed and month. Achieved guideline adherence was measured by a fidelity scale developed for this purpose during a pilot study for the PreVCo Rating Tool. After a 3-month baseline collection period under routine conditions, randomisation was done after matching wards pairwise according to frequency of coercive measures used and scores on the PreVCo Rating Tool at baseline. The duration of the intervention period was 12 months; control wards received only an initial workshop presentation of the study and completed their PreVCo ratings. We used the Wilcoxon signed rank test and the paired t-test and conducted sensitivity analyses for different periods of observation. Findings Neither the number of coercive measures used per month and bed nor their cumulative duration nor the number of assaults per bed and months differed significantly between the 27 intervention wards and the 27 control wards in the final 3 months of the intervention period. The median number of coercive measures used decreased by 45% (median 0.96 (IQR 1.34)-0.53 (IQR 0.59) from baseline until the end of the intervention period on the intervention wards and by 28% (median 0.98 (IQR 1.71)-0.71 (IQR 1.08) on waiting list wards. The PreVCo Rating Tool showed a significant improvement in intervention wards compared to control wards, indicating a successful implementation. Interpretation The study demonstrated that guideline adherence could be significantly improved by the intervention. However, there was no evidence for an effect on the frequency or duration of coercive measures used. Spill-over effects and the impact of the COVID-19 pandemic on in-patient care might have limited the effect of the intervention. Further research from robust randomised controlled trials are necessary to identify effective interventions to reduce the use of coercion in psychiatric hospitals. Funding The study was funded by the German Innovationsfonds beim Gemeinsamen Bundesausschuss (project no. 01VSF19037). The funder had no role in study design or data collection.
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Affiliation(s)
- Tilman Steinert
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | | | | | | | | | - Erich Flammer
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | - Susanne Jaeger
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | | | - Marie Kampmann
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | | | - Rainer Muche
- Ulm University, Institute of Epidemiology and Medical Biometry, Germany
| | | | | | - Sophie Hirsch
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
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Stephenson L, Gieselmann A, Gergel T, Owen G, Gather J, Scholten M. Self-binding directives in psychiatric practice: a systematic review of reasons. Lancet Psychiatry 2023; 10:887-895. [PMID: 37714174 DOI: 10.1016/s2215-0366(23)00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 09/17/2023]
Abstract
Self-binding directives (SBDs) are an ethically controversial type of advance decision making involving advance requests for involuntary treatment. This study systematically reviewed the academic literature on psychiatric SBDs to elucidate reasons for and against their use in psychiatric practice. Full-text articles were thematically analysed within the international, interdisciplinary authorship team to produce a hierarchy of reasons. We found 50 eligible articles. Reasons for SBD use were promoting service user autonomy, promoting wellbeing and reducing harm, improving relationships, justifying coercion, stakeholder support, and reducing coercion. Reasons against SBD use were diminishing service user autonomy, unmanageable implementation problems, difficulties with assessing mental capacity, challenging personal identity, legislative issues, and causing harm. A secondary finding was a clarified concept of capacity-sensitive SBDs. Future pilot implementation projects that operationalise the clarified definition of capacity-sensitive SBDs with safeguards around informed consent, capacity assessment, support for drafting, and independent review are required.
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Affiliation(s)
- Lucy Stephenson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Astrid Gieselmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tania Gergel
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gareth Owen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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Wullschleger A, Vandamme A, Mielau J, Heinz A, Bermpohl F, Mahler L, Montag C. Relationship between perceived coercion and perceived justification of coercive measures - secondary analysis of a randomized-controlled trial. BMC Psychiatry 2023; 23:712. [PMID: 37784077 PMCID: PMC10546675 DOI: 10.1186/s12888-023-05192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients' appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients' appraisal of the justification of coercive measures and their level of perceived coercion. METHODS This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants' appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. RESULTS 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). CONCLUSIONS Patients' perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.
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Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany.
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Ch. Du Petit-Bel-Air 2, Thônex, 1226, Switzerland.
| | - Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
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Cassivi C, Sergerie-Richard S, Saint-Pierre B, Goulet MH. Crisis plans in mental health: A scoping review. Int J Ment Health Nurs 2023; 32:1259-1273. [PMID: 37098744 DOI: 10.1111/inm.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.
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Affiliation(s)
- Christine Cassivi
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
| | - Sophie Sergerie-Richard
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Institut universitaire en santé mentale de Montréal (IUSMM), Québec, Montréal, Canada
| | - Benoît Saint-Pierre
- Centre intégré universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Québec, Montréal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
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10
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Saint-Julien Guizonne R, Le Gal C. [Role of the IPA in the empowerment of the patient with schizophrenia and use of incentive advance directives in psychiatry]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:22-25. [PMID: 37419596 DOI: 10.1016/j.soin.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
Interruption of treatment and lack of follow-up are the main causes of relapses and iterative emergency hospitalizations of people with schizophrenia. Recognition of mental illness, adherence to therapy and the ability to attribute psychotic phenomena to the pathology promote patient empowerment. In terms of APN's skills, it seems interesting to understand how the proactive supervision of people suffering from schizophrenia by this professional can meet the empowerment needs of this population.
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Affiliation(s)
| | - Christophe Le Gal
- Établissement public de santé mentale de la Guadeloupe, 1(er) Plateau, 97120 Saint-Claude, France
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11
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Sibeoni J. Lived experience of psychosis: challenges and perspectives for research and care. Curr Opin Psychiatry 2023; 36:194-199. [PMID: 36728595 DOI: 10.1097/yco.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW There is currently a recognition of the first-personal knowledge of people with lived experience of schizophrenia as an epistemic privilege that can influence and improve the quality of research and care. This review aims to identify and better understand the actual challenges and perspectives of this field. RECENT FINDINGS Two main themes are present in the recent literature: first, the direct involvement of persons with lived experience of psychosis both in research (first person accounts, lived experience and participatory research) and care with the development of new professional positions such as expert patients and peer workers ; second, the field of research on lived experience of psychosis based mostly on phenomenological psychiatry and qualitative research. SUMMARY Both involvement of persons with lived experience in care and research, and research on lived experience of psychosis have direct impact and outcomes such as leading to a better understanding of psychotic phenomena and to reduced stigma and providing more person-centered and holistic care and better social support. This review also highlights the conceptual and ethical challenges to overcome, especially the risk of tokenism.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil Cedex
- ECSTRRA Team, UMR-1153, Inserm, Université Paris Cité, Paris, France
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Loubière S, Loundou A, Auquier P, Tinland A. Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study). Epidemiol Psychiatr Sci 2023; 32:e27. [PMID: 37096868 PMCID: PMC10130836 DOI: 10.1017/s2045796023000197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
AIMS We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. METHODS In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results. RESULTS Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, -0.22; 95% confidence interval, [-0.33 to -0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, -€4,286 [-4,711 to -4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003-0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040-0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources. CONCLUSION PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.
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Affiliation(s)
- S Loubière
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
| | - A Loundou
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
| | - P Auquier
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
| | - A Tinland
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
- Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Lefebvre A, Pouchon A, Bioulac S, Mallet J, Polosan M, Dondé C. Management of schizophrenia in women during the perinatal period: a synthesis of international recommendations. Expert Opin Pharmacother 2022; 23:1337-1350. [PMID: 35835161 DOI: 10.1080/14656566.2022.2102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The perinatal period in schizophrenia is associated with high risk of psychotic relapse and pregnancy/child outcomes. The extent to which antipsychotics may potentially affect the fetus or the child development is unclear and debated. Even though guidelines have been developed, there is a lack of consensual recommendations regarding the optimal strategy to manage schizophrenia during the perinatal period. AREAS COVERED This systematic review describes the current state of evidence with respect to the impact of recommended interventions for schizophrenia during the perinatal period, including childbearing age, pregnancy and post-partum. It compares recent international treatment guidelines for this specific group of women. Last, this review presents a set of major points to be discussed with patients and relatives for shared-decision making and a summary of key recommendations from the international guidelines. EXPERT OPINION Although treatment guidelines may be of significant help, discrepancies exist across them regarding the management of antipsychotics for schizophrenia women during the perinatal period. Shared decision-making and advance directives represent useful patient-centered approaches during this specific period. Further cohort-based evidence is needed to better identify maternal and fetal risks associated to antipsychotic treatment exposure.
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Affiliation(s)
| | - Arnaud Pouchon
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Stéphanie Bioulac
- Laboratoire de Psychologie et Neurocognition (CNRS-UMR 5105), Université Grenoble Alpes; Service Psychiatrie de l'enfant et l'adolescent, CHU Grenoble Alpes, France
| | - Jasmina Mallet
- Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Clément Dondé
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France; Psychiatry Department, CH Alpes-Isère, F-38000 Saint-Egrève, France
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Stephenson LA, Gergel T, Ruck Keene A, Rifkin L, Owen G. Preparing for Mental Health Act reform: Pilot study of co-produced implementation strategies for Advance Choice Documents. Wellcome Open Res 2022; 7:182. [PMID: 36081756 PMCID: PMC9433915 DOI: 10.12688/wellcomeopenres.17947.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Advance Decision Making (ADM) is strongly supported by stakeholders but implementation remains challenging. In England and Wales, implementation strategies are urgently required to prepare for the introduction of mental health 'Advance Choice Documents' (ACDs) as part of Mental Health Act reforms. We report on a pilot project which aimed to co-produce and evaluate implementation strategies for ACDs with those who experience fluctuating mental capacity in the context of bipolar. Methods A co-produced prototype ACD template was piloted in 'Plan, Do, Study Act' (PDSA) cycles. Implementation strategies were co-produced with participants and mapped onto the Expert Recommendations for Implementing Change (ERIC) framework. Strategies were evaluated during thematically analysed qualitative interviews. Results We piloted the template with 17 service users during 5 successive PDSA cycles and conducted 75 in depth interviews with stakeholders. Key strategies identified as accessible, appropriate and feasible were: interactive assistance from an independent 'supporter', a structured template and active offers of involvement to service users and informal carers. Conclusions Mental health professionals and organisations must prepare for increased expectations around mental health ADM. We recommend further pilot projects and the establishment of 'ACD workshops'. Resource is essential to fund independent 'supporters', training, network building and embedding ADM in clinical pathways.
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Affiliation(s)
- Lucy A Stephenson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK
| | - Tania Gergel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK
| | - Alex Ruck Keene
- 39 Essex Chambers, 81 Chancery Lane, London, WC2A 1DD, UK.,Dickson Poon School of Law, Kings College London, London, WC2R 2LS, UK
| | - Larry Rifkin
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gareth Owen
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AB, UK
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