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Marcó-García S, Ribas-Muñoz N, Guilera G, Balsells-Mejía S, Huerta-Ramos E. RECAPACITA PROJECT: Impact of the New York Convention on capacity modification judgments in persons with severe mental disorders: A comparative study using mixed methodology. MEDICINE, SCIENCE, AND THE LAW 2023:258024231206863. [PMID: 37817639 DOI: 10.1177/00258024231206863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
In 2013, Spain aligned its capacity modification processes (CM) legislation with the UN Convention on the rights of persons with disabilities, specifically for individuals with severe mental disorders (SMD). The reforms replaced incapacity verdicts with support provision and introduced the term "CM". However, the social impact of these changes remains uncertain. The RECAPACITA project was initiated to generate knowledge on SMD and CM, and this study aims to investigate modifications in CM sentences and associated terminology. Using a qualitative-quantitative methodology, content analysis was conducted on 56 sentences from individuals with SMD. Terminology analysis utilized 19 sentences to achieve information saturation. A comparison was made between sentences prior to 2013 and those spanning 2014 to 2023, analyzing the data through ANOVA and Bonferroni tests (significance level: 0.05). The analysis revealed that psychiatric illness, its evolution, lack of self-governance, and economic management were frequently mentioned aspects in the sentences. However, no significant correlations were found. Qualitatively, mentions of self-governance were more prevalent in sentences before 2013. Conversely, after 2013, there was an increased focus on substances use, lack of insight and medical adherence, and the need for support in daily life. The term "incapable person" appeared in 100% of the sentences, indicating no differences in terminology. The study suggests that current CM sentences provide increasingly individualized information, addressing the specific support needs of individuals. To enhance future legal proceedings, incorporating neuroscience in studying SMD individuals and reconsidering terminology based on Convention guidelines is recommended.
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Affiliation(s)
- Silvia Marcó-García
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Sant Joan de Déu Research Institute, Sant Joan de Déu Foundation, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | | | - Georgina Guilera
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Group of Invariance Studies for the Measurement and Analysis of Change in the Social and Health Environments (GEIMAC), Institute of Neurosciences (UBNeuro), University of Barcelona, Barcelona, Spain
| | - Sol Balsells-Mejía
- Research Promotion and Management Department. Statistical Support, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Sant Joan de Déu Research Institute, Sant Joan de Déu Foundation, Barcelona, Spain
- Biomedical Research in the Mental Health Network (CIBERSAM), Carlos III Health Institute, Madrid, Spain
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2
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Murnion BP, Roberts DM. Responding to the rising number of suicides using barbiturates. Med J Aust 2022; 216:187-188. [PMID: 35122273 DOI: 10.5694/mja2.51409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Bridin P Murnion
- Western Sydney Local Health District, Sydney, NSW.,The University of Sydney, Sydney, NSW
| | - Darren M Roberts
- Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW.,Royal Prince Alfred Hospital, Sydney, NSW
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3
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Matson M, Nery-Hurwit M, Crosby S, Greene GJ, Macapagal K. Awareness and Knowledge of Pre-exposure Prophylaxis Among Sexual and Gender Minority Adolescents Assigned Male at Birth in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1701-1711. [PMID: 33982212 PMCID: PMC8919433 DOI: 10.1007/s10508-020-01904-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Sexual and gender minority (SGM) adolescents assigned male at birth are at increased risk for HIV infection. Pre-exposure prophylaxis (PrEP) is a daily pill taken to prevent HIV, which the United States Food and Drug Administration approved for minors under age 18 years weighing at least 77.5 lb in 2018. A lack of awareness and knowledge of PrEP are barriers to uptake among adults and adolescents, but SGM adolescents' awareness and knowledge about PrEP remain underexplored and no studies have assessed SGM adolescents' informational needs. We collected data on 59 SGM adolescents' (ages 14-18 years) awareness, knowledge, and questions about PrEP in an online survey and six online focus groups. Although a majority of SGM adolescents (83.1%) were aware of PrEP before the study, many wanted more information about side effects and how to navigate potential barriers to PrEP initiation. Findings can inform public health efforts to promote PrEP knowledge and uptake among SGM adolescents.
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Affiliation(s)
- Margaret Matson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Mara Nery-Hurwit
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Shariell Crosby
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Chicago, IL, 60611, USA
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
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4
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Smilan LE. The Revised Common Rule and Mental Illness: Enduring Gaps in Protections. AMERICAN JOURNAL OF LAW & MEDICINE 2020; 46:413-444. [PMID: 33413011 DOI: 10.1177/0098858820975532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa E Smilan
- Lisa E. Smilan, Visiting Scholar, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, VA; J.D., George Washington University Law School, Washington, D.C.; LL.M., specialization in health law, University of Maryland Francis King Carey School of Law, Baltimore, MD; Member, National Institutes of Health Intramural Institutional Review Board, Bethesda, MD. The opinions here expressed are those of the Author and completely independent of the National Institutes of Health. The Author thanks Ellen Wright Clayton for supporting this scholarship and for comments on earlier drafts. Thanks, also, to Leslie Meltzer Henry for her guidance and encouragement, and both Richard Bonnie and Xuemei Ding for their hospitality at the University of Virginia and for facilitating access to university libraries. Finally, thanks to the anonymous peer reviewers for their observations, probing questions, and helpful suggestions, and AJLM editors Jessa Boubker and Sharon Jaquez for their dedication and meticulous care in preparing this Article for publication
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5
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Toledo-Fernández A, Sánchez-Domínguez R, Villalobos-Gallegos L, Pérez-López A, Macías-Flores A, Marín-Navarrete R. Neuropsychological validation of a brief quiz to examine comprehension of consent information in observational studies of substance users. ETHICS & BEHAVIOR 2020. [DOI: 10.1080/10508422.2020.1822175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Ricardo Sánchez-Domínguez
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
| | | | - Alejandro Pérez-López
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
| | - Alan Macías-Flores
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
| | - Rodrigo Marín-Navarrete
- Unidad de Ensayos Clínicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
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Brezel ER, Powell T, Fox AD. An ethical analysis of medication treatment for opioid use disorder (MOUD) for persons who are incarcerated. Subst Abus 2019; 41:150-154. [PMID: 31800376 DOI: 10.1080/08897077.2019.1695706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Opioid use disorder (OUD) is highly prevalent among persons who are incarcerated. Medication treatment for opioid use disorder (MOUD), methadone, buprenorphine, and naltrexone, is widely used to treat OUD in the community. Despite MOUD's well-documented effectiveness in improving health and social outcomes, its use in American jails and prisons is limited.Several factors are used to justify limited access to MOUD in jails and prisons including: "uncertainty" of MOUD's effectiveness during incarceration, security concerns, risk of overdose from MOUD, lack of resources and institutional infrastructure, and the inability of people with OUD to provide informed consent. Stigma regarding MOUD also likely plays a role. While these factors are relevant to the creation and implementation of addiction treatment policies in incarcerated settings, their ethicality remains underexplored.Using ethical principles of beneficence/non-maleficence, justice, and autonomy, in addition to public health ethics, we evaluate the ethicality of the above list of factors. There is a two-fold ethical imperative to provide MOUD in jails and prisons. Firstly, persons who are incarcerated have the right to evidence-based medical care for OUD. Secondly, because jails and prisons are government institutions, they have an obligation to provide that evidence-based treatment. Additionally, jails and prisons must address the systematic barriers that prevent them from fulfilling that responsibility. According to widely accepted ethical principles, strong evidence supporting the health benefits of MOUD cannot be subordinated to stigma or inaccurate assessments of security, cost, and feasibility. We conclude that making MOUD inaccessible in jails and prisons is ethically impermissible.
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Affiliation(s)
- Emma R Brezel
- Department of Pediatrics, Montefiore Medical Center, New York, New York, USA
| | - Tia Powell
- Montefiore-Einstein Center for Bioethics, Montefiore Medical Center, New York, New York, USA
| | - Aaron D Fox
- Department of Internal Medicine, Montefiore Medical Center, New York, New York, USA
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7
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Quan P, Yu L, Yang Z, Lei P, Wan C, Chen Y. Development and validation of quality of life instruments for chronic diseases-Chronic gastritis version 2 (QLICD-CG V2.0). PLoS One 2018; 13:e0206280. [PMID: 30427879 PMCID: PMC6235280 DOI: 10.1371/journal.pone.0206280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/10/2018] [Indexed: 01/10/2023] Open
Abstract
Quality of life is an important outcome indicator to evaluate whether treatment is successful or not. Chronic gastritis leads to ongoing deterioration of subjectively perceived quality of life. There are several generic measures, but they are not developed particularly to assess chronic gastritis problems. The Quality of Life Instruments for Chronic Diseases-Chronic Gastritis (QLICD-CG V2.0) questionnaire is a 39-item, multi-dimensional, self-report instrument to assess chronic gastritis patients' perception of their health related quality of life in four domains. The instrument was developed in China. The current study aimed to evaluate the psychometric properties of the QLICD-CG V2.0. 194 patients with chronic gastritis were enrolled from 4 hospitals in China. The QLICD-CG V2.0 was administered to patients by trained research assistants. In addition, their demographic characteristics were also recorded. The psychometric testing included construct validity, convergent validity, discriminant validity, test-retest, and responsiveness. The results showed good internal consistency and acceptable floor and ceiling effects (Cronbach's alpha range from 0.80 to 0.93). CFA showed that the instrument structure has a reasonable fitness (RMSEA = 0.063, 95%CI = [0.057 0.079], CFI = 0.93, GFI = 0.95, SRMR = 0.028). The convergent validity was considered appropriate, with 38 of the 39 items correlated stronger with their assigned scale than a competing scale, except for GPS1. Known groups comparisons showed that the QLICD-CG V2.0 discriminated well between subgroups on the basis of gender, marriage status, and economy status, thus providing evidence of discriminative validity. Convergent validity testing revealed that the QLICD-CG V2.0 domain scores correlated significantly with SF-36 dimension scores, which ranged from 0.21 to 0.58. Test-retest coefficients were satisfactory. A majority of intraclass correlation coefficients were above 0.70, except the psychological domain (0.60) and the items of social support/security (0.61). Responsiveness was tested on 157 patients. Significant differences were found on all QLICD-CG V2.0 domains, between baseline responses and after a treatment, except for the items of appetite and sleep. Robust sensitivity to change was observed. The QLICD-CG V2.0 appears to be a valid and reliable instrument to measure QOL in chronic gastritis patients. Scores were reproducible.
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Affiliation(s)
- Peng Quan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, CHINA
| | - Lei Yu
- Huadu District, Guangzhou City People's Hospital, Guangzhou, CHINA
| | - Zheng Yang
- School of Public Health, Guangdong Medical University, Dongguan, CHINA
| | | | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, CHINA
- * E-mail:
| | - Ying Chen
- School of Public Health, Kunming Medical University, Kunming, CHINA
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8
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Abstract
In the current epidemic of opioid use disorders, there is both a scientific and ethical imperative to develop effective medical and behavioral treatments for opioid addiction. Research in subject populations with active and ongoing drug addictions bring unique ethical considerations and challenges. Sponsors, researchers, and institutional review board (IRB) members should be familiar with these unique ethical and medical issues as they design, review, and conduct research planned for this population. Issues include those of informed consent and decision-making capacity of research participants, compensation for participation and concerns about undue inducement, forces that threaten the voluntary nature of research participation including the scarcity of available drug treatment programs, and ensuring that participants are aware of and understand risks that may continue after research participation such as increased risk of overdose after research-mandated drug abstinence. This manuscript discusses the current thinking on these issues.
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Affiliation(s)
- Emily Anderson
- 1 Associate Professor, Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Lindsay McNair
- 2 Chief Medical Officer, WIRB-Copernicus Group, Princeton, NJ, USA
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9
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Rhenter P, Moreau D, Laval C, Mantovani J, Albisson A, Suderie G, Boucekine M, Tinland A, Loubière S, Greacen T, Auquier P, Girard V. Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29538346 PMCID: PMC5877065 DOI: 10.3390/ijerph15030520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded theory was used to construct an interview guide, conduct multiple interviews with 35 Housing First participants sampled for heterogeneity, and produce memos on their trajectories before and after entering the program based on interview information. Thematic analysis of a representative subsample (n = 13) of memos identified 12 objective factors and 6 subjective factors key to the recovery process. An in-depth re-analysis of the memos generated four recovery themes: (1) the need for secure space favorable to self-reflexivity; (2) a “honeymoon” effect; (3) the importance of even weak social ties; (4) support from and hope among peers. Three challenges to recovery were identified: (1) finding a balance between protection and risk; (2) breaking downward spirals; (3) bifurcating the trajectory. This study provides new insight into the recovery process, understood as a non-linear transformation of an experience—the relationship between objective life conditions and subjective perception of those conditions—which reinforces protective support over risk elements.
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Affiliation(s)
- Pauline Rhenter
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
| | - Delphine Moreau
- Research Laboratory, Maison Blanche Hospital, 75018 Paris, France.
| | - Christian Laval
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
| | - Jean Mantovani
- Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France.
| | - Amandine Albisson
- Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France.
| | - Guillaume Suderie
- Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France.
| | - Mohamed Boucekine
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Public Hospital of Marseille (AP-HM), 13005 Marseille, France.
| | - Aurelie Tinland
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Community Mental Health Outreach Team, MARS (Movement and Action for Social Recovery), Public Hospital of Marseille (AP-HM), 13005 Marseille, France.
| | - Sandrine Loubière
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Public Hospital of Marseille (AP-HM), 13005 Marseille, France.
| | - Tim Greacen
- Research Laboratory, Maison Blanche Hospital, 75018 Paris, France.
| | - Pascal Auquier
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- French Housing First Study Group, 13000 Marseille, France.
| | - Vincent Girard
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Regional Health Agency PACA (ARS), 13002 Marseille, France.
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10
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Abstract
The Mental Capacity Act 2005 provides a new legal framework within which health and social care professionals (as well as informal carers) must act when providing care and treatment for the estimated 2 million people in England, Wales and Northern Ireland who lack the capacity to make certain decisions for themselves. Although the Mental Capacity Act 2005 Code of Practice provides comprehensive advice on good practice in assessing capacity, it does not identify a specific process to be used. Good clinical practice depends on the exercise of clinical judgement within a valid and contestable process. This article outlines a flow chart (Fig. 1) that can be used to guide the process of capacity assessments in more complex cases, in line with the Mental Capacity Act 2005 and the Code of Practice.
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11
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Tinland A, Boyer L, Loubière S, Greacen T, Girard V, Boucekine M, Fond G, Auquier P. Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life. Neuropsychiatr Dis Treat 2018; 14:2269-2279. [PMID: 30233184 PMCID: PMC6129029 DOI: 10.2147/ndt.s161377] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to determine the following: 1) the proportion of women in the homeless population with schizophrenia (SZ) or bipolar disorder (BD), in addition to the trajectory of their homelessness (ie, homelessness history, number of nights spent without home during the 180 past nights) and the characteristics of their illnesses compared to men (ie, illness severity, suicide risk, physical health status, and quality of life [QoL]); 2) whether these women were victimized more frequently than similarly situated men; 3) the impact of victimization on these women in terms of illness severity, suicide risk, physical health status, and QoL; and lastly 4) the differences and overlap of homeless women with SZ and BD. METHODS This study employed data at baseline from a multicenter randomized controlled trial conducted in the following four large French cities: Lille, Marseille, Paris, and Toulouse. Mobile mental health outreach teams recruited SZ/BD homeless patients in the street, emergency shelters, hospitals, and jails from August 2011 to April 2014. Evaluations were performed during face-to-face interviews by psychiatrists and research assistants in the offices of mobile mental health outreach teams that were located in the downtown area of each city. The quantitative data were analyzed using descriptive analyses, chi-square and Student's t-tests, generalized estimating equation regression models, and path analysis. RESULTS A total of 703 patients were included in this study. The proportion of women in the SZ/BD homeless population was 123/703 (17.5%). In this population, women were more likely than men to declare that they were subjected to physical or sexual assault during the past 6 months, that they had been diagnosed with posttraumatic stress disorder (PTSD), and that they had experienced more severe depressive symptoms. Moreover, these women presented a higher suicide risk, worse physical health status, and lower QoL than similarly situated men. Homeless women with BD were more vulnerable than women with SZ. A path analysis revealed that PTSD and violent victimization might explain the higher levels of depression and suicide risk and the lower levels of physical health status and QoL in homeless women. CONCLUSION SZ/BD homeless women experience more PTSD and victimization than men, which are both associated with poor clinical outcomes. These results confirm the vulnerability of homeless women in this high need population and should be considered by public health policy.
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Affiliation(s)
- Aurelie Tinland
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - Laurent Boyer
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France,
| | - Sandrine Loubière
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France,
| | - Tim Greacen
- Research Unit, Public Health Institution Maison Blanche, Paris, France
| | - Vincent Girard
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - Mohamed Boucekine
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France,
| | - Guillaume Fond
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Jeanne d'Arc - private Hospital, Paris-East University, FondaMental Fundation, Paris, France
| | - Pascal Auquier
- EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France, .,Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France,
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12
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Tinland A, Zemmour K, Auquier P, Boucekine M, Girard V, Loubière S, Fond G, Boyer L. Homeless women with schizophrenia reported lower adherence to their medication than men: results from the French Housing First experience. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1113-1122. [PMID: 28656452 DOI: 10.1007/s00127-017-1411-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the factors associated with non-adherence to medication in a large multi-center sample of homeless schizophrenia (HSZ) patients. METHODS This multi-center study was conducted in four French cities: Lille, Marseille, Paris, and Toulouse. In addition to the Medication Adherence Rating Scale (MARS), sociodemographic information, history of homelessness, illness severity using the Modified Colorado Symptom Index (MCSI) and the Multnomah Community Integration Scale (MCAS), and drug information were collected. RESULTS In total, 218 HSZ patients (16.1% women, mean age 36.8 ± 9.3 years) were included in this study. In the multivariate analysis, being a woman and having higher illness severity (MCSI score) and lower "acceptance of illness" (MCAS score) were significantly associated with lower MARS index scores. Compared to men, women had lower MARS dimension 1 ('medication adherence behavior') and dimension 3 ('negative side effects and attitudes toward psychotropic medication') scores. First-generation antipsychotic use was also associated with lower MARS dimension 3 scores. CONCLUSION HSZ women reported lower adherence than men, mainly due to having more subjective negative side effects and worse attitudes toward psychotropic medication. Future longitudinal studies should confirm these findings and explore the applicability of specific pharmacological and non-pharmacological treatment strategies for HSZ women, including treatment dose adaptation and psychoeducation. Clinical trial number NCT01570712.
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Affiliation(s)
- A Tinland
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - K Zemmour
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - P Auquier
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
| | - M Boucekine
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
| | - V Girard
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - S Loubière
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
| | - G Fond
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
- Clinique Jeanne d'Arc-Hôpital Privé Parisien, 94160, Saint-Mandé, France
- CHU Carémeau, 30000, Nîmes, France
| | - Laurent Boyer
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France.
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13
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Lakeman R. Paradoxes of Personal Responsibility in Mental Health Care. Issues Ment Health Nurs 2016; 37:929-933. [PMID: 27858512 DOI: 10.1080/01612840.2016.1235637] [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] [Indexed: 10/20/2022]
Abstract
Personal responsibility is widely considered important in mental health recovery as well as in popular models of alcohol and drug treatment. Neo-liberal socio-political rhetoric around consumerism in health care often assumes that people are informed and responsible for their own choices and behaviour. In the mental health care context and especially in emergency or crisis settings, personal responsibility often raises particular paradoxes. People often present whose behaviour does not conform to the ideals of the responsible consumer; they may seek and/or be granted absolution from irresponsible behaviour. This paradox is explored and clinicians are urged to consider the context-bound nature of personal responsibility and how attributions of personal responsibility may conflict with policy and their own professional responsibilities to intervene to protect others.
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Affiliation(s)
- Richard Lakeman
- a Faculty of Health , University of Tasmania , Hobart , Australia
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Girard V, Tinland A, Boucekine M, Loubière S, Lancon C, Boyer L, Auquier P. Validity of a common quality of life measurement in homeless individuals with bipolar disorder and schizophrenia. J Affect Disord 2016; 204:131-7. [PMID: 27344622 DOI: 10.1016/j.jad.2016.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To provide new evidence regarding the validity, reliability, sensitivity to change and acceptability of a schizophrenia (SCZ) quality of life measurement (S-QoL 18) in homeless people with bipolar disorder (BPD). METHODS This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. In addition to the S-QoL 18, data on sociodemographic information, disease severity using the Modified Colorado Symptom Index (MCSI), recovery using the Recovery Assessment Scale (RAS) and QoL using the Short-Form Health Survey (SF-36) were collected. The S-QoL 18 was tested for construct validity, reliability, external validity, sensitivity to change and acceptability. RESULTS In total, 216 homeless patients with BPD participated in this study. The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA=0.058, CFI=0.98, TLI=0.966). The scalability was satisfactory, with INFIT statistics within an acceptable range (from 0.77 to 1.20). The internal consistency (from 0.43 to 0.76) and reliability coefficients (Cronbach's alpha from 0.65 to 0.86) were satisfactory for all dimensions. The external validity testing revealed that the S-QoL 18 dimension scores were significantly correlated with the MCSI, the RAS and the SF-36 scores. The percentage of missing data for the dimensions (<15%) and sensitivity to change were satisfactory. CONCLUSIONS These results demonstrate adequate acceptability and psychometric properties of the S-QoL 18 among homeless patients with BPD. The S-QoL 18 can be a common instrument for measuring QoL in homeless people with SCZ and BD.
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Affiliation(s)
- V Girard
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - A Tinland
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - M Boucekine
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - S Loubière
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - C Lancon
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - L Boyer
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France; Department of Public Health, University Hospital, Marseille, France.
| | - P Auquier
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France; Department of Public Health, University Hospital, Marseille, France
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Nunes EV, Lee JD, Sisti D, Segal A, Caplan A, Fishman M, Bailey G, Brigham G, Novo P, Farkas S, Rotrosen J. Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence. Contemp Clin Trials 2016; 51:34-43. [PMID: 27687743 PMCID: PMC5466164 DOI: 10.1016/j.cct.2016.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/12/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) known poor effectiveness of one possible, commonly used treatment as usual control condition-detoxification followed by counseling without medication; 2) the role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) differences between the optimal "usual treatment" clinical settings for different treatments making it challenging to design a fair comparison; 4) vested interest groups favoring different treatments exerting potential influence on the design process; 5) potentially vulnerable populations of substance users and prisoners; 6) potential therapeutic misconception in the implementation of safety procedures; and 7) high cost of a large trial limiting questions that could be addressed. We examine how the design features underlying these ethical issues are characteristic of effectiveness trials, which are often large trials that compare treatments with varying degrees of existing effectiveness data and familiarity to patients and clinicians, in community-based treatment settings, with minimal exclusion criteria that could involve vulnerable populations. Hence, investigators designing effectiveness trials may wish to remain alert to the possibility of similar ethical issues.
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Affiliation(s)
- Edward V Nunes
- Columbia University Medical Center, New York State Psychiatric Institute, United States.
| | - Joshua D Lee
- NYU School of Medicine, Department of Population Health, United States
| | - Dominic Sisti
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Andrea Segal
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Arthur Caplan
- NYU School of Medicine, Division of Medical Ethics, United States
| | - Marc Fishman
- Johns Hopkins University School of Medicine, Mountain Manor Treatment Program, United States
| | - Genie Bailey
- Warren Alpert Medical School of Brown University, Stanley Street Treatment and Resources, United States
| | | | - Patricia Novo
- NYU School of Medicine, Department of Psychiatry, United States
| | - Sarah Farkas
- NYU School of Medicine, Department of Psychiatry, United States
| | - John Rotrosen
- NYU School of Medicine, Department of Psychiatry, United States
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Zemmour K, Tinland A, Boucekine M, Girard V, Loubière S, Resseguier N, Fond G, Auquier P, Boyer L. Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia: Results from the French Housing First experience. Sci Rep 2016; 6:31598. [PMID: 27534796 PMCID: PMC4989491 DOI: 10.1038/srep31598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/26/2016] [Indexed: 01/08/2023] Open
Abstract
The Medication Adherence Rating Scale (MARS) is one of the most widely used measurements of adherence in schizophrenia (SZ), but there is no available data regarding its psychometric properties in homeless SZ patients (HSZ). The aim of this study was therefore to assess the psychometric properties of the MARS in a large multicenter sample of HSZ subjects. This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Three hundred and fifty-three patients were included. The 3-factor structure of the MARS was confirmed using confirmatory factor analysis: RMSEA = 0.045, CFI = 0.98, TLI = 0.97 and WRMR = 0.76. The unidimensionality of each factor was supported by the satisfactory INFIT statistics. Item internal consistencies were all higher than 0.20 and the Kuder–Richardson were higher than to 0.6, except for factor 2, which was closed to 0.5. Significant associations with symptoms, functioning and quality of life showed satisfactory external validity. The acceptability was satisfactory with missing data lower than 5% for each dimension. The MARS is a short self-administered instrument with acceptable psychometric properties in homeless SZ patients that yields interesting information about medication adherence.
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Affiliation(s)
- K Zemmour
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - A Tinland
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - M Boucekine
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - V Girard
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - S Loubière
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - N Resseguier
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France
| | - G Fond
- Université Paris-Est Créteil, Pôle de psychiatrie des hôpitaux universitaires H Mondor, INSERM U955, Eq Psychiatrie Génétique, Fondation FondaMental Fondation de coopération scientifique en santé mentale, Pole de Psychiatrie, Hôpital A. Chenevier, 40 rue de Mesly, Créteil, F-94010, France
| | - P Auquier
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Public Health, University Hospital, Marseille, France
| | - L Boyer
- Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.,Department of Public Health, University Hospital, Marseille, France
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Morán-Sánchez I, Luna A, Sánchez-Muñoz M, Aguilera-Alcaraz B, Pérez-Cárceles MD. Decision-making capacity for research participation among addicted people: a cross-sectional study. BMC Med Ethics 2016; 17:3. [PMID: 26759171 PMCID: PMC4710992 DOI: 10.1186/s12910-015-0086-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research. METHODS 53 subjects with DSM-5 diagnoses of a Substance Use Disorder (SUD) and 50 non psychiatric comparison subjects (NPCs) participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out at a community-based Outpatient Treatment Center and at an urban-located Health Centre in Spain. A binary judgment of capacity/incapacity was made guided by the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) and a clinical interview. Demographics and clinical characteristics were assessed by cases notes and the Mini-Mental State Examination, the Global Assessment Functional Scale and the Clinical Global Impression Scale. RESULTS NPCs performed the best on the MacCAT-CR, and patients with SUD had the worst performance, particularly on the Understanding and Appreciation subscales. 32.7% SUD people lacked research-related decisional capacity. There were no statistically significant differences between the groups in terms of capacity to consent to research. CONCLUSIONS The findings of our study provide evidence that a large proportion of individuals with SUD had decisional capacity for consent to research. It is therefore inappropriate to draw conclusions about capacity to make research decisions on the basis of a SUD diagnosis. In the absence of advanced cognitive impairment, acute withdrawal or intoxication, we should assume that addicted persons possess decision-making capacity. Thus, the view that people with SUD would ipso facto lose decision-making power for research consent is flawed and stigmatizing.
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Affiliation(s)
- Inés Morán-Sánchez
- Mental Health Centre (Health Service of Murcia), Real St 8, E-30201, Cartagena (Murcia), Spain.
| | - Aurelio Luna
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, (Murcia), Spain.
| | - Maria Sánchez-Muñoz
- Mental Health Centre (Health Service of Murcia), Real St 8, E-30201, Cartagena (Murcia), Spain.
| | - Beatriz Aguilera-Alcaraz
- Isaac Peral Health Centre (Health Service of Murcia), Ulloa St 6. E 30300, Cartagena (Murcia), Spain.
| | - Maria D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, (Murcia), Spain.
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Gergel T, Owen GS. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder - Self-binding directives and self-determination. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 40:92-101. [PMID: 25939286 PMCID: PMC4503819 DOI: 10.1016/j.ijlp.2015.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research.
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Affiliation(s)
- Tania Gergel
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, C/O Department of Classics, King's College London, Strand, London WC2R 2LS, UK.
| | - Gareth S Owen
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, UK
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Cavaiola AA, Dolan D. Considerations in civil commitment of individuals with substance use disorders. Subst Abus 2015; 37:181-7. [PMID: 25832824 DOI: 10.1080/08897077.2015.1029207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several states currently have enacted laws that allow for civil commitment for individuals diagnosed with severe substance use disorders. Civil commitment or involuntary commitment refers to the legal process by which individuals with mental illness are court-ordered into inpatient and/or outpatient treatment programs. Although initially civil commitment laws were intended for individuals with severe mental illness, these statutes have been extended to cover individuals with severe substance use disorders. Much of the recent legislation allowing for civil commitment of individuals with substance use disorders has come about in response to the heroin epidemic and is designed to provide an alternative to the unrelenting progression of opioid use disorders. Civil commitment also provides an opportunity for individuals with opioid use disorders to make informed decisions regarding ongoing or continued treatment. However, civil commitment also raises concerns regarding the potential violation of 14th Amendment rights, specifically pertaining to abuses of deprivation of liberty or freedom, which are guaranteed under the 14th Amendment to the United States Constitution. This commentary examines these issues while supporting the need for effective brief civil commitment legislation in all states.
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Affiliation(s)
- Alan A Cavaiola
- a Department of Psychological Counseling , Monmouth University , West Long Branch , New Jersey , USA
| | - David Dolan
- a Department of Psychological Counseling , Monmouth University , West Long Branch , New Jersey , USA
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Sisti D, Segal AG, Thase ME. Proceed with caution: off-label ketamine treatment for major depressive disorder. Curr Psychiatry Rep 2014; 16:527. [PMID: 25308395 DOI: 10.1007/s11920-014-0527-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ketamine offers a promising new option for the treatment of depression, but its increasing off-label use is ethically and clinically inappropriate at the moment.
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Affiliation(s)
- Dominic Sisti
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,
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Chenneville T, Machacek M, Tan R, Lujan-Zilberman J, Emmanuel P, Rodriguez C. Decisional capacity among youth with HIV: results from the MacArthur Competence Tool for Treatment. AIDS Patient Care STDS 2014; 28:425-32. [PMID: 24999924 DOI: 10.1089/apc.2013.0374] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed the decisional capacity (DC) of 72 youth with HIV, ages 13-24, using the MacArthur Competence Tool for Treatment, a structured interview that assesses DC along the following dimensions: understanding, appreciation, reasoning, and the ability to express a choice. Using previously established cutoff scores, results suggested 100% of youth were competent in the area of appreciation, but only 62% and 60% were competent in the areas of understanding and reasoning, respectively. Additional descriptive analyses reveal more detailed information regarding specific strengths and weaknesses within each of the dimensions of decisional capacity. These findings have important implications for health literacy initiatives, medical education, and treatment for youth with HIV, and support the need for adherence and secondary prevention interventions that include a decisional capacity component.
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Affiliation(s)
- Tiffany Chenneville
- Department of Psychology, University of South Florida St. Petersburg, St. Petersburg, Florida
| | - Marielle Machacek
- Department of Psychology, University of South Florida St. Petersburg, St. Petersburg, Florida
| | - Robin Tan
- Department of Psychology, University of South Florida Tampa, Tampa, Florida
| | | | - Patricia Emmanuel
- Department of Pediatrics, University of South Florida Tampa, Tampa, Florida
| | - Carina Rodriguez
- Department of Pediatrics, University of South Florida Tampa, Tampa, Florida
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Restifo S. A review of the concepts, terminologies and dilemmas in the assessment of decisional capacity: a focus on alcoholism. Australas Psychiatry 2013; 21:537-40. [PMID: 23884961 DOI: 10.1177/1039856213497812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The formal assessment of a person's capacity for making reasoned decisions is an infrequent and usually unappealing clinical task. The purpose of this paper is to dissect the task, consider the component parts, clarify those aspects that can be problematic and highlight those that remain so. METHOD The paper reviews the concepts, terminologies and dilemmas around alcoholism, insight, lack of insight, denial, judgement, will, decisional capacity and competence. CONCLUSION Assessments of patients suffering from alcoholism (or any other dyscontrol problem such as deliberate self-harm, problem gambling or eating disorders) are likely to evoke unease because of the interweaving of potentially disputable phenomenological, clinical, ethical, semantic and legal aspects. Familiarity with the concepts and terms around decisional capacity helps to orientate clinicians in their work. There remain some particular conceptual issues that are in need of further scholarly attention.
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Affiliation(s)
- Sam Restifo
- Psychiatrist, North Metropolitan Area Mental Health Service, Shenton Park, WA, Australia
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Auquier P, Tinland A, Fortanier C, Loundou A, Baumstarck K, Lancon C, Boyer L. Toward meeting the needs of homeless people with schizophrenia: the validity of quality of life measurement. PLoS One 2013; 8:e79677. [PMID: 24205390 PMCID: PMC3808288 DOI: 10.1371/journal.pone.0079677] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/06/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To provide new evidence regarding the suitability of using quality of life (QoL) measurements in homeless people with schizophrenia, we assess the acceptability and psychometric properties of a specific QoL instrument (S-QoL 18) in a population of homeless people with schizophrenia, and we compare their QoL levels with those observed in non-homeless people with schizophrenia. METHODS This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Two hundred and thirty-six homeless patients with schizophrenia were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, external validity and sensitivity to change. The QoL of the 236 homeless patients was compared with 236 French age- and sex-matched non-homeless patients with schizophrenia. RESULTS The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.035, CFI = 0.95, GFI = 0.99 and SRMR = 0.015). Internal consistency, reliability and sensitivity to change were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores and SF-36, symptomatology and recovery scores. The percentage of missing data did not exceed 5%. Finally, homeless patients had significantly lower QoL levels than non-homeless patients with schizophrenia. CONCLUSIONS These results demonstrate the satisfactory acceptability and psychometric properties of the S-QoL 18, suggesting the validity of QoL measurement among homeless patients with schizophrenia. Our study also reported that QoL levels in homeless patients with schizophrenia were dramatically low, highlighting the need for new policies to eradicate homelessness and tackle poverty.
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Affiliation(s)
- Pascal Auquier
- Aix-Marseille University, EA 3279 Research Unit, Marseille, France
- Department of Public Health, University Hospital, Marseille, France
| | - Aurelie Tinland
- Aix-Marseille University, EA 3279 Research Unit, Marseille, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - Cecile Fortanier
- Aix-Marseille University, EA 3279 Research Unit, Marseille, France
| | - Anderson Loundou
- Aix-Marseille University, EA 3279 Research Unit, Marseille, France
| | | | - Christophe Lancon
- Aix-Marseille University, EA 3279 Research Unit, Marseille, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 Research Unit, Marseille, France
- * E-mail:
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Tinland A, Fortanier C, Girard V, Laval C, Videau B, Rhenter P, Greacen T, Falissard B, Apostolidis T, Lançon C, Boyer L, Auquier P. Evaluation of the Housing First program in patients with severe mental disorders in France: study protocol for a randomized controlled trial. Trials 2013; 14:309. [PMID: 24063556 PMCID: PMC3850649 DOI: 10.1186/1745-6215-14-309] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 09/10/2013] [Indexed: 11/30/2022] Open
Abstract
Background Recent studies in North American contexts have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness. In the context of the highly generous French national health and social care system, which is easily accessible and does not require out-of-pocket payment, the French Health Ministry insists on rigorous techniques, including randomized protocols, to evaluate the impact of Housing First approaches in France. Method and design A prospective randomized trial was designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness, compared to Treatment-As-Usual. The study is being conducted in four cities in France: Lille, Marseille, Paris and Toulouse. The inclusion criteria are as follows: over 18 years of age, absolutely homeless or in precarious housing, and possessing a ‘high’ level of need: diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale (score ≤ 62) and at least one of the following three criteria: 1) having been hospitalized for mental illness two or more times in any one year during the preceding five years; 2) co-morbid alcohol or substance use; and 3) having been recently arrested or incarcerated. Participants will be randomized to receiving the Housing First intervention or Treatment-As-Usual. The Housing First intervention provides immediate access to independent housing and community care. The primary outcome criterion is the use of high-cost health services (that is,, number of hospital admissions and number of emergency department visits) during the 24-month follow-up period. Secondary outcome measures include health outcomes, social functioning, housing stability and contact with police services. An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted. A total of 300 individuals per group will be included. Discussion This is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France. It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context. Trial registration The current clinical trial number is NCT01570712
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Affiliation(s)
- Aurelie Tinland
- Aix-Marseille University, EA 3279 Research Unit, Marseille 13385, France.
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Aydin Er R, Sehiralti M, Aker AT. Preliminary Turkish study of psychiatric in-patients' competence to make treatment decisions. Asia Pac Psychiatry 2013; 5:E9-E18. [PMID: 23857795 DOI: 10.1111/appy.12000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 08/15/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases. METHODS This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). RESULTS The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups. DISCUSSION These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders.
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Affiliation(s)
- Rahime Aydin Er
- Vocational School of Health, Kocaeli University, Kocaeli, Turkey.
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The Neuroethics of Pleasure and Addiction in Public Health Strategies Moving Beyond Harm Reduction: Funding the Creation of Non-Addictive Drugs and Taxonomies of Pleasure. NEUROETHICS-NETH 2010. [DOI: 10.1007/s12152-010-9074-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The early experience of Old Age Psychiatrists in the application of the Mental Capacity Act 2005: a pilot study. Int Psychogeriatr 2010; 22:147-57. [PMID: 19552832 DOI: 10.1017/s1041610209990202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. METHODS A pilot questionnaire study examined the experience of consultants in Old Age Psychiatry in the early implementation of the MCA pertaining to local policy and training in the application of the MCA, the assessment of decision-making capacity, the determination of best interests, and the use of the least restrictive option and restraint. RESULTS Fifty-two (27%) of the 196 consultants in Old Age Psychiatry returned useable questionnaires. Seventy-five percent of them reported that local training on the application of the MCA was available, but less than 50% reported that training was mandatory. The vast majority of assessments of decision-making capacity were conducted by consultants in Old Age Psychiatry. Almost all of them reported using the four-fold specific test of decision-making capacity (DMC) described in the MCA. Restraint was reported to be rarely used. CONCLUSIONS Consultants in Old Age Psychiatry generally reported using the criteria for the assessment of DMC, the determination of best interests and restraint described in the MCA. The findings highlight concern about the workload of clinicians in implementing the MCA and this requires careful monitoring. Consideration should be given to statutory provision of training in the application of the MCA by all healthcare and social care providers for all their healthcare and social care staff.
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Fisher CB, Oransky M. Informed consent to psychotherapy: Protecting the dignity and respecting the autonomy of patients. J Clin Psychol 2008; 64:576-88. [DOI: 10.1002/jclp.20472] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Calton T, Ferriter M, Huband N, Spandler H. A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia. Schizophr Bull 2008; 34:181-92. [PMID: 17573357 PMCID: PMC2632384 DOI: 10.1093/schbul/sbm047] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The "Soteria paradigm" attempts to support people diagnosed with schizophrenia spectrum disorders using a minimal medication approach. Interest in this approach is growing in the United Kingdom, several European countries, North America, and Australasia. AIMS To summarize the findings from all controlled trials that have assessed the efficacy of the Soteria paradigm for the treatment of people diagnosed with schizophrenia spectrum disorders. METHODS A systematic search strategy was used to identify controlled studies (randomized, pseudorandomized, and nonrandomized) employing the Soteria paradigm to treat adults and adolescents meeting the criteria for schizophrenia spectrum disorders according to International Classification of Diseases and Diagnostic and Statistical Manual for Mental Disorders criteria. RESULTS We identified 3 controlled trials involving a total of 223 participants diagnosed with first- or second-episode schizophrenia spectrum disorders. There were few major significant differences between the experimental and control groups in any of the trials across a range of outcome measures at 2-year follow-up, though there were some benefits in specific areas. CONCLUSIONS The studies included in this review suggest that the Soteria paradigm yields equal, and in certain specific areas, better results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (achieving this with considerably lower use of medication) when compared with conventional, medication-based approaches. Further research is urgently required to evaluate this approach more rigorously because it may offer an alternative treatment for people diagnosed with schizophrenia spectrum disorders.
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Affiliation(s)
- Tim Calton
- Division of Psychiatry, University of Nottingham, Nottingham, UK NG3 5AA.
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Saks ER, Jeste DV. Capacity to consent to or refuse treatment and/or research: theoretical considerations. BEHAVIORAL SCIENCES & THE LAW 2006; 24:411-29. [PMID: 16883609 DOI: 10.1002/bsl.708] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This article discusses theoretical dimensions of competency to consent to or refuse treatment and/or research. We will consider a number of issues. Our first subject is the nature of assessments of competency-their empirical, normative, and conceptual aspects. We then discuss how we should divide up the components of capacity-understanding, appreciation, reasoning, and evidencing a choice; how we should understand these different components; and whether all are indeed necessary. We discuss where to draw the line between capacity and incapacity on each of the four elements of capacity. We ask whether we should have a variable competency standard, either in general or in different contexts (e.g. treatment versus research). Finally we consider the role of mental illness in competency assessments.
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Affiliation(s)
- Elyn R Saks
- University of Southern California Gould School of Law, USA.
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