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Carrà G, Bartoli F, Moretti F, Villa O, Camera P, Crocamo C. Influence of prior contact with community mental health services on first inpatient psychiatric admission for ethnic minorities: Findings from the NOMIAC study. Int J Soc Psychiatry 2024; 70:1495-1504. [PMID: 39082115 DOI: 10.1177/00207640241267802] [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] [Indexed: 11/01/2024]
Abstract
BACKGROUND Research has extensively documented inequalities in inpatient psychiatric care provided to people of minoritized ethnic groups. Nonetheless, the role of their previous engagement with community mental health care has been little studied. AIMS We aimed at exploring whether previous clinical care can influence key domains of subsequent psychiatric inpatient care for people of ethnic minorities. METHODS We identified patients with a first hospital admission between 2016 and 2022, from a representative, highly diverse, catchment area of Northern Italy, using electronic health data of the NOMIAC study. We aimed at testing the impact of clinical care prior to admission on indicators of poor inpatient care, as identified by a participatory expert panel, that is, compulsory admission, insufficient length of stay, administration of Long-Acting Antipsychotics (LAI) during the last 7 days before discharge. Multiple regression models, predicted and counterfactual proportions and path analyses from generalized structural equations modeling were used to explore the association between belonging to ethnic minorities and these indicators. RESULTS Among 1,524 participants, 18% were from minoritized ethnic groups. While these were more likely to experience an involuntary admission, regardless of previous care received, they were offered appropriate length of stay if had previous engagement with community mental health care. Both belonging to ethnic minorities and mental health care prior-to-admission were independently associated with early LAI administration. CONCLUSIONS Several ethnic inequalities in inpatient care continue despite previous community mental health care provided. Future research should examine how these disparities translate into clinical outcomes. Nonetheless, there is the need to actively promote equity, improving the quality of inpatient care of minoritized ethnic groups.
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Affiliation(s)
- Giuseppe Carrà
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Bartoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Federico Moretti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Oliviero Villa
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Camera
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristina Crocamo
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Fischer R, Moritz S, Scheunemann J, Nagel M, Osthues C, Schöttle D, Luedecke D. Treatment Preferences in Acute Psychosis: A Comparison of Patient and Staff Perspectives on Symptom Prioritization and Biopsychosocial Interventions. Psychiatr Q 2024:10.1007/s11126-024-10099-2. [PMID: 39467937 DOI: 10.1007/s11126-024-10099-2] [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] [Accepted: 10/13/2024] [Indexed: 10/30/2024]
Abstract
Patients with acute psychosis are often confronted with the prejudice that they refuse all treatment due to lack of insight. This study examined and compared the aims and preferences for treatment of patients with acute psychosis and of psychiatric inpatient staff. A total of 142 inpatients being treated for a psychotic disorder on either a locked or an open ward indicated which of a range of symptoms they want to be treated and which of various biopsychosocial treatment options they would like to receive. Staff members from the same wards reported which psychiatric symptoms they deemed relevant in the treatment of psychosis and which treatment options should be offered. Patients assigned the highest treatment need to neurocognitive symptoms, followed by affective and positive symptoms. In contrast, staff assigned the highest treatment need to positive symptoms, followed by neurocognitive and affective symptoms. Patients and staff on open wards expressed more treatment needs overall than did patients and staff on locked wards. Patients' desire for treatment differed across treatment types. In comparing patients on locked versus open wards, patients on open wards expressed higher approval of medication than patients on locked wards. Even patients with highly acute psychosis being treated on locked psychiatric wards endorsed treatment. Treatment preferences of this group deviated markedly in some instances from staffs' preferences. Considering their specific needs may contribute to increasing patient self-efficacy, and improving adherence to treatment.
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Affiliation(s)
- Rabea Fischer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
- Clinic for Psychiatry and Psychotherapy, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Charlotte Osthues
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Harburg, Hamburg, Germany
| | - Daniel Luedecke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Moell A, Lyle MS, Rozental A, Långström N. Rates and risk factors of coercive measure use in inpatient child and adolescent mental health services: a systematic review and narrative synthesis. Lancet Psychiatry 2024; 11:839-852. [PMID: 39121879 DOI: 10.1016/s2215-0366(24)00204-9] [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] [Received: 05/03/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 08/12/2024]
Abstract
Reducing the use of coercive measures in inpatient child and adolescent mental health services (CAMHS) requires an understanding of current rates and associated factors. We conducted a systematic review of research published between Jan 1, 2010, and Jan 10, 2024, addressing rates and risk factors for mechanical, physical, or pharmacological restraint, seclusion, or forced tube feeding in inpatient CAMHS. We identified 30 studies (including 39 027 patients or admissions) with low risk of bias. Median prevalence was 17·5% for any coercive measure, 27·7% for any restraint, and 6·0% for seclusion. Younger age, male sex, ethnicity or race other than White, longer stay, and repeated admissions were frequently linked to coercive measure use. Variable rates and conflicting risk factors suggest that patient traits alone are unlikely to determine coercive measure use. More research, especially in the form of nationwide studies, is needed to elucidate the impact of care and staff factors. Finally, we propose reporting guidelines to improve comparisons over time and settings.
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Affiliation(s)
- Astrid Moell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Maria Smitmanis Lyle
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Dossa A, Hein M, Bikrani O, Wacquier B, Point C. Impact of Comorbid Personality Disorder on the Risk of Involuntary Hospitalization in Patients Referred for Urgent Forensic Assessment: A Cross-Sectional Study. Brain Sci 2024; 14:961. [PMID: 39451974 PMCID: PMC11505764 DOI: 10.3390/brainsci14100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES In Belgium, involuntary psychiatric hospitalization is authorized in the presence of certain criteria governed by the law relating to the protection of the mentally ill. The number of involuntary hospitalizations has been increasing continuously in recent years. Since personality disorders are frequent comorbidities in involuntarily hospitalized patients, the aim of this study was to investigate the potential role played by comorbid personality disorders in the decisions about involuntary hospitalization made during urgent forensic assessment. METHODS A total of 565 individuals were retrospectively recruited from the database of urgent forensic assessment carried out in the Psychiatric Emergency Department. Logistic regression analyses were performed to investigate the risk of involuntary hospitalization associated with comorbid personality disorders in patients referred for urgent forensic assessment. RESULTS 66.7% of urgent forensic assessments resulted in involuntary hospitalization. In addition, comorbid personality disorders (especially borderline personality disorder) were associated with a lower risk of involuntary hospitalization in patients referred for urgent forensic assessment. CONCLUSIONS In this study, we demonstrated that urgent forensic assessments frequently result in involuntary hospitalizations. Furthermore, this study highlighted that comorbid personality disorders (especially borderline personality disorder) appeared to have a major impact on the decision not to involuntarily hospitalize patients referred for urgent forensic assessment. These elements therefore justify the establishment of adequate clinical reflection to avoid the stigmatization related to these frequent comorbidities in patients at risk of involuntary hospitalization.
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Affiliation(s)
- Axel Dossa
- Faculté de Médecine, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; (A.D.); (O.B.)
| | - Matthieu Hein
- Service de Psychiatrie et Laboratoire du Sommeil, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; (B.W.); (C.P.)
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles (ULB), 1020 Bruxelles, Belgium
| | - Oussama Bikrani
- Faculté de Médecine, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; (A.D.); (O.B.)
| | - Benjamin Wacquier
- Service de Psychiatrie et Laboratoire du Sommeil, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; (B.W.); (C.P.)
| | - Camille Point
- Service de Psychiatrie et Laboratoire du Sommeil, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium; (B.W.); (C.P.)
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Kellett S, Gaskell C, Keslake A, Seneviratne M, Simmonds-Buckley M. Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design. Behav Cogn Psychother 2024; 52:508-521. [PMID: 38695154 DOI: 10.1017/s1352465824000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
BACKGROUND Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity. AIMS To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self. METHOD This was a four-phase ABC plus community follow-up (D) mixed methods n=1 single case experimental design. Four idiographic measures were collected daily across four phases; the baseline (A) was during PICU admission, the first treatment phase (B) was behavioural on the PICU, the second treatment phase (C) was cognitive on an acute ward and the follow-up phase (D) was conducted in the community. Four nomothetic measures were taken on admission, on discharge from the PICU, discharge from the acute ward and then at 4-week follow-up. The participant was also interviewed at follow-up using the Change Interview. RESULTS Compared with baseline, the behavioural and the cognitive interventions appeared effective in terms of improving calmness, optimism and rumination, but the effects on sociability were poor. There was evidence across idiographic and nomothetic outcomes of a relapse during the follow-up phase in the community. Eleven idiographic changes were reported in the interview and these tended to be unexpected, related to the therapy and personally important. DISCUSSION Single case methods can be responsive to tracking the progress of patients moving through in-patient pathways and differing modules of evidence-based interventions. There is a real need to implement robust outcome methodologies on PICUs to better evaluate the psychological aspects of care in this context.
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Affiliation(s)
- Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
- University of Sheffield, Sheffield, UK
| | - Chris Gaskell
- North Staffordshire Combined NHS Foundation Trust, UK
| | - Andy Keslake
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | | | - Melanie Simmonds-Buckley
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
- University of Sheffield, Sheffield, UK
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Minchin M, Christiansen C, Maconick L, Johnson S. Area-level factors associated with variation in involuntary psychiatric hospitalisation across England: a cross-sectional, ecological study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02748-5. [PMID: 39190053 DOI: 10.1007/s00127-024-02748-5] [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: 04/10/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Involuntary hospitalisations for mental health care are rising in many high income countries, including England. Looking at variation between areas can help us understand why rates are rising and how this might be reversed. This cross-sectional, ecological study aimed to better understand variation in involuntary hospitalisations across England. METHOD The unit of analysis was Clinical Commissioning Groups (CCGs), NHS bodies responsible for delivering healthcare to local areas in England. 205 CCGs were included in the analysis. Demographic, clinical, and socioeconomic variables at CCG-level were extracted from national, open access data bases. The outcome variable was the rate of involuntary hospitalisation for psychiatric care under the 1983 Mental Health Act in 2021/22. RESULTS There was a four-fold difference between the CCGs with the highest and lowest involuntary hospitalisations. In an adjusted analysis, CCGs with a higher percentage of severe mental illness in the population, higher percentage of male population, and higher community and outpatient mental health care use showed a higher rate of involuntary hospitalisation. Depression, urbanicity, deprivation, ethnicity, and age were not strongly associated with involuntary hospitalisation after adjustment. These variables explained 10.68% of the variation in involuntary hospitalisations across CCGs. CONCLUSION Some demographic and clinical variables explained variation in involuntary hospitalisation between areas in England, however, most of the variance was unexplained. Complex relationships between urbanicity, deprivation, age, and ethnicity need to be further explored. The role of other influences, such as variation in service organisation or clinical practice, also need to be better understood.
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Affiliation(s)
- Matilda Minchin
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | | | - Lucy Maconick
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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Aluh DO, Diaz-Milanes D, Pedrosa B, Silva M, Grigaitė U, Almeida CR, de Almeida Mousinho MF, Vieira M, Cardoso G, Caldas-de-Almeida JM. Coercion in psychiatry: psychometric validation of the Portuguese Staff Attitudes to Coercion Scale (SACS). DISCOVER MENTAL HEALTH 2024; 4:27. [PMID: 39141248 PMCID: PMC11324637 DOI: 10.1007/s44192-024-00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND There is a growing recognition that staff attitudes toward coercion in mental health care may influence its application. This study presents the psychometric properties of the Portuguese version of the Staff Attitudes towards Coercion Scale (SACS) and describes mental health professionals' attitudes towards coercion in Portugal. METHODS Mental health professionals working in five Portuguese mental health services in urban and rural regions of Portugal were invited to complete a questionnaire comprising the SACS and a socio-demographic form. Psychometric analyses including construct validity and internal consistency were carried out using R software. RESULTS A total of 91 out of 119 questionnaires completed were valid for analysis. Fifty-seven (62.64%) respondents were female, with an age range of 24 to 69 years (M = 39.33; SD = 11.09). More than half of them were nurses (52.75%, n = 48), and a third were psychiatrists (36.26%, n = 33). A three-factor structure was confirmed and showed the best fit compared to previously proposed models with a cumulative explained variance of 59%. The Portuguese SACS exhibited adequate internal consistency for both the full-scale and subscales. The highest mean score was in the pragmatic attitude domain (20.60; SD = 3.37). A negative correlation was observed between the critical attitude domain and both age and years of experience (p < 0.05). CONCLUSION A three-factor structure was confirmed and showed the best fit compared to previously proposed models. The Portuguese SACS showed excellent psychometric properties and is acceptable for assessing staff attitudes towards coercion.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Nigeria.
| | - Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalusia, Seville, Spain
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Manuela Silva
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Carolina Rocha Almeida
- Serviço de Psiquiatria E Saúde Mental de Adultos, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Margarida Vieira
- Centro Hospitalar De Vila Nova De Gaia/Espinho, E.P.E.| V. N. Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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Blæhr EE, Gallo Cordoba B, Skipper N, Søgaard R. Variation in Psychiatric Hospitalisations: A Multiple-Membership Multiple-Classification Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:973. [PMID: 39200584 PMCID: PMC11353323 DOI: 10.3390/ijerph21080973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 09/02/2024]
Abstract
The complexity of variation in healthcare, particularly in mental health, remains poorly understood. However, addressing this issue presents an opportunity to opti-mise the allocation of scarce healthcare resources. To explore this, we investigated the variation in psychiatric care measured as the number of psychiatric hospitalisations. We estimated multiple-membership multiple-classification models utilising Danish register data for 64,694 individuals and their healthcare providers, including 2101 general practitioners, 146 community-based care institutions, 46 hospital departments, and 98 municipalities. This approach recognised that data are not strictly hierarchical. We found that, among individuals attending a single healthcare provider, 67.4% of the total variance in the number of hospitalisations corresponds to differences between individuals, 22.6% to differences between healthcare providers' geographical location, 7.02% to differences between healthcare providers, and 3% to differences between the geographical locations of the individuals. Adding characteristics to the model ex-plained 68.5% of the variance at the healthcare provider geographical level, but almost no explanation of the variation was found on the three other levels despite the nu-merous characteristics considered. This suggests that medical practice may vary un-warrantedly between healthcare providers, indicating potential for optimisation. Streamlining medical practices, such as adhering to clinical guidelines, could lead to more efficient supply of mental health resources. In conclusion, understanding and addressing variation in psychiatric care may impact resource allocation and patient outcomes, ultimately leading to a more effective healthcare system.
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Affiliation(s)
- Emely Ek Blæhr
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark;
| | - Beatriz Gallo Cordoba
- Faculty of Education, Monash University, Clayton, VIC 3800, Australia;
- Centre for International Research on Education Systems, Mitchell Institute, Victoria University, Melbourne, VIC 8001, Australia
| | - Niels Skipper
- Department of Economics and Business Economics, Aarhus University, 8000 Aarhus, Denmark;
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
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Storman D, Jemioło P, Sawiec Z, Swierz MJ, Antonowicz E, Bala MM, Prokop-Dorner A. Needs Expressed in Peer-to-Peer Web-Based Interactions Among People With Depression and Anxiety Disorders Hospitalized in a Mental Health Facility: Mixed Methods Study. J Med Internet Res 2024; 26:e51506. [PMID: 38996331 DOI: 10.2196/51506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 04/03/2024] [Accepted: 05/06/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery. OBJECTIVE Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers. METHODS We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson χ2 test, and φ coefficient was used to evaluate the posts. RESULTS The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization. CONCLUSIONS Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support.
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Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | | | - Zuzanna Sawiec
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Jan Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Antonowicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
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Bartl G, Stuart R, Ahmed N, Saunders K, Loizou S, Brady G, Gray H, Grundy A, Jeynes T, Nyikavaranda P, Persaud K, Raad A, Foye U, Simpson A, Johnson S, Lloyd-Evans B. A qualitative meta-synthesis of service users' and carers' experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update. BMC Psychiatry 2024; 24:476. [PMID: 38937705 PMCID: PMC11209989 DOI: 10.1186/s12888-024-05914-w] [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] [Received: 02/29/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. METHODS We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. RESULTS Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. CONCLUSIONS Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. PROTOCOL REGISTRATION The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).
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Affiliation(s)
- Gergely Bartl
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Katherine Saunders
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sofia Loizou
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grainne Brady
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Hannah Gray
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Andrew Grundy
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Tamar Jeynes
- Lived Experience Working Group, University College London, London, UK
| | - Patrick Nyikavaranda
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Karen Persaud
- Lived Experience Working Group, University College London, London, UK
| | - Ari Raad
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Una Foye
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alan Simpson
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Johnson
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Camden and Islington National Health Service Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK.
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Peters SJ, Schmitz-Buhl M, Zielasek J, Gouzoulis-Mayfrank E. Involuntary psychiatric hospitalisation - differences and similarities between patients detained under the mental health act and according to the legal guardianship legislation. BMC Psychiatry 2024; 24:442. [PMID: 38872132 DOI: 10.1186/s12888-024-05892-z] [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: 09/20/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Involuntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL. METHODS We conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care. RESULTS Cases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low. CONCLUSION We found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.
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Affiliation(s)
- Sönke Johann Peters
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
| | - Mario Schmitz-Buhl
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
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12
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Jäger M, Klimczyk J. [Involuntary Psychiatric Hospital Admissions According to Public Law - A Retrospective Analysis]. PSYCHIATRISCHE PRAXIS 2024; 51:122-128. [PMID: 37984357 DOI: 10.1055/a-2191-4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE We provide an empirical survey of the current practice on involuntary psychiatric hospital admission. METHODS Bases on clinical case records, we performed a retrospective analysis of 346 cases with an involuntary hospital admission according to public law in 2020 (21.0% of all inpatient admissions in this period). RESULTS Announcement of suicide was the most frequent cause for involuntary hospital admission (45.1%). Most common diagnoses were substance-related disorders (30.1%), stress-related disorders (19.9%), and schizophrenic psychoses (18.8%). Only 12.7% of the involuntary admissions resulted in a further involuntary hospitalization, whereas 44.5% of all episodes were followed by a discharge within 24 hours. CONCLUSION In many cases, involuntary hospital admissions are reactions to suicidal crises. It will be interesting to see, if the introduction of alternative low-threshold services can help to reduce the frequency of such admissions.
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Affiliation(s)
- Markus Jäger
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus(BKH) Kempten
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13
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Corderoy A, Large MM, Ryan C, Sara G. Factors associated with involuntary mental healthcare in New South Wales, Australia. BJPsych Open 2024; 10:e59. [PMID: 38433586 PMCID: PMC10951846 DOI: 10.1192/bjo.2023.628] [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: 05/29/2022] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry. AIMS To explore variables associated with involuntary care in the largest database of involuntary admissions published. METHOD We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression. RESULTS A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61-5.38), and psychosis (odds ratio 4.48, 95% CI 4.31-4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85-5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56-2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99-2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57-1.74); unmarried status (odds ratio 1.62, 95% CI 1.49-1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35-1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24-1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62-0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87-0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86-0.93). CONCLUSIONS This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.
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Affiliation(s)
- Amy Corderoy
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Matthew Michael Large
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Christopher Ryan
- Discipline of Psychiatry, Centre for Values, Ethics, and the Law in Medicine, University of Sydney, Australia
| | - Grant Sara
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; and InforMH, System Information and Analytics Branch, New South Wales Ministry of Health, St Leonards, New South Wales, Australia
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14
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Coleman CH. Holding the Guardrails on Involuntary Commitment. Hastings Cent Rep 2024; 54:8-11. [PMID: 38639168 DOI: 10.1002/hast.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
In response to the increasing number of mentally ill people experiencing homelessness, some policy-makers have called for the expanded use of involuntary commitment, even for individuals who are not engaging in behaviors that are immediately life-threatening. Yet there is no evidence that involuntary commitment offers long-term benefits, and significant reasons to believe that expanding the practice will cause harm. In addition, these proposals ignore research showing that most people with mental illness have the capacity to make medical decisions for themselves. Rather than expanding the use of involuntary commitment, policy-makers should support approaches proven to decrease the prevalence of homelessness, such as supportive housing. In addition, states should reevaluate their commitment standards for persons who pose no risk of harm to others. One promising approach is Northern Ireland's Mental Health Capacity Act of 2016, which establishes a uniform standard for imposing nonconsensual health care interventions, without any distinction between mental illnesses and other conditions in which capacity might be compromised.
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Johnson S, Birken M, Nyikavaranda P, Kular A, Gafoor R, Parkinson J, Hutchings-Hay C, Gant T, Molai J, Rivera J, Fenwick J, Bendall C, Blakley L, Bacarese-Hamilton T, White VC, Holden MK, Seale J, Hardy J, Fraser KL, Mitchell L, Lay B, Mbeah-Bankas H, McCrone P, Freemantle N, Wood L, Lobban F, Lloyd-Evans B. A crisis planning and monitoring intervention to reduce compulsory hospital readmissions (FINCH study): protocol for a randomised controlled feasibility study. Pilot Feasibility Stud 2024; 10:35. [PMID: 38378694 PMCID: PMC10877855 DOI: 10.1186/s40814-024-01453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Rates of compulsory (also known as involuntary) detention under mental health legislation have been rising over several decades in countries including England. Avoiding such detentions should be a high priority given their potentially traumatic nature and departure from usual ethical principles of consent and collaboration. Those who have been detained previously are at high risk of being detained again, and thus a priority group for preventive interventions. In a very sparse literature, interventions based on crisis planning emerge as having more supporting evidence than other approaches to preventing compulsory detention. METHOD We have adapted and manualised an intervention previously trialled in Zürich Switzerland, aimed at reducing future compulsory detentions among people being discharged following a psychiatric admission that has included a period of compulsory detention. A co-production group including people with relevant lived and clinical experience has co-designed the adaptations to the intervention, drawing on evidence on crisis planning and self-management and on qualitative interviews with service users and clinicians. We will conduct a randomised controlled feasibility trial of the intervention, randomising 80 participants to either the intervention in addition to usual care, or usual care only. Feasibility and acceptability of the intervention and trial procedures will be assessed through process evaluation (including rates of randomisation, recruitment, and retention) and qualitative interviews. We will also assess and report on planned trial outcomes. The planned primary outcome for a full trial is repeat compulsory detention within one year of randomisation, and secondary outcomes include compulsory detention within 2 years, and symptoms, service satisfaction, self-rated recovery, self-management confidence, and service engagement. A health economic evaluation is also included. DISCUSSION This feasibility study, and any subsequent full trial, will add to a currently limited literature on interventions to prevent involuntary detention, a goal valued highly by service users, carers, clinicians, and policymakers. There are significant potential impediments to recruiting and retaining this group, whose experiences of mental health care have often been negative and traumatising, and who are at high risk of disengagement. TRIAL REGISTRATION ISRCTN, ISRCTN11627644. Registered 25th May 2022, https://www.isrctn.com/ISRCTN11627644 .
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Affiliation(s)
- Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
| | - Mary Birken
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Patrick Nyikavaranda
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Ariana Kular
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Rafael Gafoor
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | - Chloe Hutchings-Hay
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas Gant
- North East London NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jazmin Molai
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - James Fenwick
- Camden and Islington NHS Foundation Trust, London, UK
| | | | | | - Theresa Bacarese-Hamilton
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Valerie Christina White
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Mark Keith Holden
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Janet Seale
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jackie Hardy
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kathleen Lindsay Fraser
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Lizzie Mitchell
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | | | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lisa Wood
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
- North East London NHS Foundation Trust, London, UK
| | - Fiona Lobban
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
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Laureano CD, Laranjeira C, Querido A, Dixe MA, Rego F. Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review. Healthcare (Basel) 2024; 12:445. [PMID: 38391820 PMCID: PMC10888148 DOI: 10.3390/healthcare12040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.
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Affiliation(s)
- Cláudio Domingos Laureano
- Psychiatric and Mental Health Service, Local Health Unit of the Leiria Region-Hospital of Santo André, Rua das Olhalvas, 2410-197 Leiria, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Xu L, Zhu T, Tang Y, Tang X, Qian Z, Wei Y, Cui H, Hu Y, Zhang D, Wang Y, Zhu J, Li H, Liu X, Zhang T, Hong X, Wang J. Impaired insight and error-monitoring deficits among outpatients with attenuated psychosis syndrome and first-episode psychosis. J Psychiatr Res 2024; 170:33-41. [PMID: 38101208 DOI: 10.1016/j.jpsychires.2023.12.007] [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: 07/11/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
We aimed to determine the relationship between electrophysiological signatures of error monitoring and clinical insight among outpatients with attenuated psychosis syndrome (APS) and first-episode psychosis (FEP). Error-related negativity (ERN), error positivity (Pe), and correct response negativity (CRN) were recorded during a modified flanker task for patients with FEP (n = 32), APS individuals (n = 58), and healthy controls (HC, n = 49). Clinical insight was measured using the Schedule of Assessment of Insight (SAI) and included awareness of illness (SAI-illness), relabeling of specific symptoms (SAI-symptoms), and treatment compliance (SAI-treatment). Compared with HC, patients with FEP showed smaller ERN (p < 0.001) and Pe (p = 0.011) amplitudes and individuals with APS showed smaller ERN amplitude (p = 0.009). No significant difference in CRN amplitude was observed among the groups. A smaller negative amplitude of ERN correlated with a lower score on SAI-symptoms (b = -0.032, 95% CI: 0.062 to -0.002, p = 0.035) and a decreased total score of SAI (b = -0.096, 95% CI: 0.182 to -0.010, p = 0.029). This links were adjusted for age, education, and diagnosis (a dummy variable with FEP = 1 and APS = 0), and was independent of positive symptoms. SAI-illness was predominantly influenced by diagnosis, whereas SAI-treatment was additionally affected by disorganized communications. Neither Pe nor CRN amplitude exhibited an association with clinical insight. Unconscious error detection, as indicated by ERN, may aid individuals at the preliminary stage of psychosis in recognizing the unusual symptoms.
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Affiliation(s)
- LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - TianYuan Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - ZhenYing Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Dan Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - YingChan Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - JunJuan Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Hui Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - XiaoHua Liu
- Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China; Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China.
| | - XiangFei Hong
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China.
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, 201203, PR China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, 200030, PR China.
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18
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Schölin L, Tucker Z, Chopra A, Borschmann R, McKay C. Detention of children and adolescents under mental health legislation: a scoping review of prevalence, risk factors, and legal frameworks. BMC Pediatr 2024; 24:12. [PMID: 38178014 PMCID: PMC10765764 DOI: 10.1186/s12887-023-04464-6] [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: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND For individuals with severe mental illness, involuntary assessment and/or treatment (hereafter detention) can be a necessary intervention to support recovery and may even be lifesaving. Despite this, little is known about how often these interventions are used for children and adolescents. METHODS This global scoping review set out to: (1) map the current evidence around mental health detentions of children and adolescents (< 18 years); (2) identify the clinical, sociodemographic, and behavioural factors associated with detention; and (3) document the views of professionals and young people on the implementation of mental health legislation. RESULTS After searching databases of peer-reviewed literature and citation chaining, 42 articles from 15 jurisdictions were included. About one fifth of psychiatric admissions in national register data were detentions, however trends were only available for a few high-income Western countries. The circumstances justifying detention and the criteria authorising detention varied between studies, with a mix of clinical factors and observed behaviours reported as the reason(s) warranting/precipitating a detention. Particular groups were more likely to experience detention, such as children and adolescents from minority ethnic communities and those with a documented history of abuse. There was a notable absence of qualitative research exploring the views of professionals or children and adolescents on detention. CONCLUSION Further research is needed to explore the impact of detention on those aged < 18 years, including national register-based studies and qualitative studies. This is particularly relevant in nations currently undergoing legislative reform.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK.
| | - Zack Tucker
- Masters student at University of Edinburgh, Edinburgh, UK
| | - Arun Chopra
- Mental Welfare Commission for Scotland, Edinburgh, UK
| | - Rohan Borschmann
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Colin McKay
- Centre for Mental Health and Capacity Law, Edinburgh Napier University, Edinburgh, UK
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Berardelli I, Aguglia A, Amerio A, Sarubbi S, Rogante E, Trocchia MA, Zelletta D, Longhini L, Erbuto D, Pastorino F, Lamis DA, Innamorati M, Serafini G, Pompili M. Characterization of Psychiatric Inpatients: The Role of Gender Differences in Clinical and Pharmacological Patterns. J Psychiatr Pract 2024; 30:2-12. [PMID: 38227722 DOI: 10.1097/pra.0000000000000756] [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: 01/18/2024]
Abstract
BACKGROUND Severe mental disorders that require hospitalization are disabling conditions that contribute to the burden of mental diseases. They pose increased clinical challenges and highlight the need to thoroughly explore variables emerging from daily clinical practice. In this study, we assessed to what extent gender differences may characterize a large population of psychiatric inpatients. METHODS We conducted a cross-sectional study in 2 Italian teaching medical centers, which included 2358 patients who were consecutively admitted to the psychiatric emergency units. We explored and characterized gender differences for variables such as prevalence of psychiatric diagnosis, presence of suicidal ideation, suicide attempts, age at onset of psychiatric illness, presence of substance or alcohol abuse, length of stay, number of hospitalizations, presence of involuntary admission, type of discharge from the hospital, and pharmacological treatment at discharge. RESULTS Female patients were primarily diagnosed with bipolar disorder or personality disorders. Female patients had a significantly higher prevalence of lifetime suicide attempts (23.1% vs. 16.5%, P<0.001) and a longer length of hospitalization (11.43±10.73 d vs. 10.52±10.37 d, t=-2.099, gl=2356, P=0.036) compared with male patients. Male patients had more involuntary admissions (25.1% vs. 19.7%, χ2=9.616, gl=1, P=0.002), more use of illicit substances (34.1% vs. 20.9%, χ2=51.084, gl=1, P<0.001), and higher rates of alcohol abuse (21.3% vs. 14.7%, χ2=17.182, gl=1, P<0.001) compared with female patients. Finally, antidepressants and lithium were prescribed more frequently to the female patients, whereas other mood stabilizers were more often prescribed to the male patients. CONCLUSIONS Our real-world results highlighted gender differences among patients with severe mental disorders admitted to psychiatric units, and suggest further investigations that may help in understanding trajectories accompanying disabling clinical conditions.
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Di Lorenzo R, Reami M, Dragone D, Morgante M, Panini G, Rovesti S, Filippini T, Ferrari S, Ferri P. Involuntary Hospitalizations in an Italian Acute Psychiatric Ward: A 6-Year Retrospective Analysis. Patient Prefer Adherence 2023; 17:3403-3420. [PMID: 38111689 PMCID: PMC10726769 DOI: 10.2147/ppa.s437116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose We evaluated the differences between demographic (age, sex, nationality, employment, housing, schooling, support administrator), clinical (hospitalization reason, aggressive behaviour, length of hospitalization, psychiatric diagnosis and comorbidities, psychiatric medications, discharge destination, "revolving door" hospitalizations) and environmental (pre-and pandemic period) variables in voluntary (VHs) and involuntary hospitalizations (IHs) in an acute psychiatric ward during a 6-year period. Patients and Methods We retrospectively collected the selected variables concerning the hospitalizations of subjects over 18 years of age in the Service for Psychiatric Diagnosis and Care of Mental Health and Drug Abuse Department in Modena from 01/01/2017 to 31/12/2022. Results We observed a progressive and sharp reduction in the number of VHs (n = 1800; 61.41%) during the pandemic and a stability of IHs (n = 1131; 38.59%), which in 2022 became prevalent. We highlighted the following differences between VHs and IHs: an increase in hospitalization length in IHs (14.25 mean days ± 15.89 SD) in comparison with VHs (8.78 mean days ± 13.88 SD), which increased more during the pandemic; an increase in aggressive behavior in IHs, especially during the pandemic (Pearson Chi2 = 90.80; p = 0.000); a prevalence of schizophrenia and bipolar disorders (Pearson Chi2 = 283.63; p = 0.000) and more frequent maladaptive social conditions among subjects in IHs. Conclusion During the 6-year observation period, we underscored a trend of increasingly reduced recourse to VHs, whereas IHs increased even in the pandemic. Our results suggest that IHs in Psychiatry represented an extreme measure for treating the most severe psychopathological situations such as schizophrenia and bipolar disorders, characterized by aggressive behaviour and precarious social conditions, which needed longer stay than VHs, especially during the pandemic.
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Affiliation(s)
| | - Matteo Reami
- School of Medicine & Surgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Diego Dragone
- Mental Health Department and Drug Abuse, AUSL-Modena, Modena, Italy
| | - Martina Morgante
- Mental Health Department and Drug Abuse, AUSL-Modena, Modena, Italy
| | - Giulia Panini
- Mental Health Department and Drug Abuse, AUSL-Modena, Modena, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Mental Health Department and Drug Abuse, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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21
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Paradis-Gagné E, Holmes D, Bernheim E, Cader M. The Judiciarization of People Living with Mental Illness: A Grounded Theory on the Perceptions of Persons Involuntary Admitted in Psychiatric Institution. Issues Ment Health Nurs 2023; 44:1200-1208. [PMID: 37913502 DOI: 10.1080/01612840.2023.2265468] [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: 11/03/2023]
Abstract
The involvement of people living with mental illness in the judicial process, whether in civil or criminal justice system, is a growing phenomenon that can be defined as judiciarization. Such over-representation of people with mental illness in the justice system is related to several issues, including stigma, experienced coercion, loss of autonomy and social isolation. To explore this understudied phenomenon in nursing research, we conducted a study to better understand how judiciarization affects people living with mental illness. The specific objectives were: 1) to understand how insertion into a judicial process affects people living with mental illness; 2) to explore the perception of these people and their lived experience within the judicial trajectory. For the methodology, grounded theory was used as a research model. The theoretical framework of the total institution, proposed by Erwin Goffman, was used conceptually. Participants were recruited from a university-affiliated hospital. Hospitalized persons who had been involved in the justice system were interviewed (n = 10). Three conceptualizing categories were identified through the analyzed data: 1) Diversity of Judicial Trajectories; 2) Involuntary Psychiatric Admission Process; 3) Judiciarization Lived as a Complex Experience. The results of this research can be used to better inform nurses, clinicians, and policy makers about the impacts of the judiciarization of mental illness, and how clinical practices can be better adapted to populations with very complex health needs.
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Affiliation(s)
| | - Dave Holmes
- School of Nursing, University of Ottawa, Ontario, Canada
| | | | - Myriam Cader
- Faculty of Nursing, Université de Montréal, Québec, Canada
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22
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Amare AT, Thalamuthu A, Schubert KO, Fullerton JM, Ahmed M, Hartmann S, Papiol S, Heilbronner U, Degenhardt F, Tekola-Ayele F, Hou L, Hsu YH, Shekhtman T, Adli M, Akula N, Akiyama K, Ardau R, Arias B, Aubry JM, Hasler R, Richard-Lepouriel H, Perroud N, Backlund L, Bhattacharjee AK, Bellivier F, Benabarre A, Bengesser S, Biernacka JM, Birner A, Marie-Claire C, Cervantes P, Chen HC, Chillotti C, Cichon S, Cruceanu C, Czerski PM, Dalkner N, Del Zompo M, DePaulo JR, Étain B, Jamain S, Falkai P, Forstner AJ, Frisen L, Frye MA, Gard S, Garnham JS, Goes FS, Grigoroiu-Serbanescu M, Fallgatter AJ, Stegmaier S, Ethofer T, Biere S, Petrova K, Schuster C, Adorjan K, Budde M, Heilbronner M, Kalman JL, Kohshour MO, Reich-Erkelenz D, Schaupp SK, Schulte EC, Senner F, Vogl T, Anghelescu IG, Arolt V, Dannlowski U, Dietrich D, Figge C, Jäger M, Lang FU, Juckel G, Konrad C, Reimer J, Schmauß M, Schmitt A, Spitzer C, von Hagen M, Wiltfang J, Zimmermann J, Andlauer TFM, Fischer A, Bermpohl F, Ritter P, Matura S, Gryaznova A, Falkenberg I, Yildiz C, Kircher T, Schmidt J, Koch M, Gade K, Trost S, Haussleiter IS, Lambert M, Rohenkohl AC, Kraft V, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Jiménez E, Kahn JP, Kassem L, Kuo PH, Kato T, Kelsoe J, Kittel-Schneider S, Ferensztajn-Rochowiak E, König B, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Tortorella A, Manchia M, Martinsson L, McCarthy MJ, McElroy S, Colom F, Millischer V, Mitjans M, Mondimore FM, Monteleone P, Nievergelt CM, Nöthen MM, Novák T, O'Donovan C, Ozaki N, Pfennig A, Pisanu C, Potash JB, Reif A, Reininghaus E, Rouleau GA, Rybakowski JK, Schalling M, Schofield PR, Schweizer BW, Severino G, Shilling PD, Shimoda K, Simhandl C, Slaney CM, Squassina A, Stamm T, Stopkova P, Maj M, Turecki G, Vieta E, Veeh J, Witt SH, Wright A, Zandi PP, Mitchell PB, Bauer M, Alda M, Rietschel M, McMahon FJ, Schulze TG, Clark SR, Baune BT. Association of polygenic score and the involvement of cholinergic and glutamatergic pathways with lithium treatment response in patients with bipolar disorder. Mol Psychiatry 2023; 28:5251-5261. [PMID: 37433967 DOI: 10.1038/s41380-023-02149-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental health disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar patients, it is essential to identify prediction biomarkers such as polygenic scores. In this study, we developed a polygenic score for lithium treatment response (Li+PGS) in patients with BD. To gain further insights into lithium's possible molecular mechanism of action, we performed a genome-wide gene-based analysis. Using polygenic score modeling, via methods incorporating Bayesian regression and continuous shrinkage priors, Li+PGS was developed in the International Consortium of Lithium Genetics cohort (ConLi+Gen: N = 2367) and replicated in the combined PsyCourse (N = 89) and BipoLife (N = 102) studies. The associations of Li+PGS and lithium treatment response - defined in a continuous ALDA scale and a categorical outcome (good response vs. poor response) were tested using regression models, each adjusted for the covariates: age, sex, and the first four genetic principal components. Statistical significance was determined at P < 0.05. Li+PGS was positively associated with lithium treatment response in the ConLi+Gen cohort, in both the categorical (P = 9.8 × 10-12, R2 = 1.9%) and continuous (P = 6.4 × 10-9, R2 = 2.6%) outcomes. Compared to bipolar patients in the 1st decile of the risk distribution, individuals in the 10th decile had 3.47-fold (95%CI: 2.22-5.47) higher odds of responding favorably to lithium. The results were replicated in the independent cohorts for the categorical treatment outcome (P = 3.9 × 10-4, R2 = 0.9%), but not for the continuous outcome (P = 0.13). Gene-based analyses revealed 36 candidate genes that are enriched in biological pathways controlled by glutamate and acetylcholine. Li+PGS may be useful in the development of pharmacogenomic testing strategies by enabling a classification of bipolar patients according to their response to treatment.
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Affiliation(s)
- Azmeraw T Amare
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia.
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine & Health, University of New South Wales, Sydney, Australia
| | - Klaus Oliver Schubert
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Mental Health Services, Adelaide, SA, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Muktar Ahmed
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Simon Hartmann
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Klinikum Essen, University of Duisburg-Essen, Rheinische Kliniken, Essen, Germany
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Liping Hou
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Yi-Hsiang Hsu
- HSL Institute for Aging Research, Harvard Medical School, Boston, MA, USA
- Program for Quantitative Genomics, Harvard School of Public Health, Boston, MA, USA
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Nirmala Akula
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Bárbara Arias
- Unitat de Zoologia i Antropologia Biològica (Dpt. Biologia Evolutiva, Ecologia i Ciències Ambientals), Facultat de Biologia and Institut de Biomedicina (IBUB), University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Jean-Michel Aubry
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Roland Hasler
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Lena Backlund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Frank Bellivier
- INSERM UMR-S 1144, Université Paris Cité, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Antonio Benabarre
- Bipolar and Depressive Disorders Program,, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Joanna M Biernacka
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Cynthia Marie-Claire
- INSERM UMR-S 1144, Université Paris Cité, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
- Université Paris Cité, Inserm, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006, Paris, France
| | - Pablo Cervantes
- The Neuromodulation Unit, McGill University Health Centre, Montreal, Canada
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Sven Cichon
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Piotr M Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Maria Del Zompo
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bruno Étain
- INSERM UMR-S 1144, Université Paris Cité, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Stephane Jamain
- Inserm U955, Translational Psychiatry laboratory, Fondation FondaMental, Créteil, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Louise Frisen
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Sébastien Gard
- Pôle de Psychiatrie Générale Universitaire, Hôpital Charles Perrens, Bordeaux, France
| | - Julie S Garnham
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Andreas J Fallgatter
- University Department of Psychiatry and Psychotherapy Tuebingen, University of Tübingen, Tuebingen, Germany
| | - Sophia Stegmaier
- Department of General Psychiatry, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ethofer
- Department of General Psychiatry, University of Tuebingen, Tuebingen, Germany
- Department of Biomedical Resonance, University of Tuebingen, Tuebingen, Germany
| | - Silvia Biere
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Kristiyana Petrova
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Ceylan Schuster
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Maria Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Mojtaba Oraki Kohshour
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Thomas Vogl
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Ion-George Anghelescu
- Department of Psychiatry and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Detlef Dietrich
- AMEOS Clinical Center Hildesheim, Hildesheim, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg, 26160, Germany
| | - Markus Jäger
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Health North Hospital Group, Bremen, Germany
| | - Max Schmauß
- Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Martin von Hagen
- Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, Eschwege, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Till F M Andlauer
- Department of Neurology, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andre Fischer
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Silke Matura
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Anna Gryaznova
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Cüneyt Yildiz
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Julia Schmidt
- Institute for Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Marius Koch
- Institute for Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Sarah Trost
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Ida S Haussleiter
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja C Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ontario, Canada
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
| | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Herms
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Esther Jiménez
- Bipolar and Depressive Disorders Program,, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy - Université de Lorraine, Nancy, France
| | - Layla Kassem
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Po-Hsiu Kuo
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
| | - John Kelsoe
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Wurzburg, Germany
| | | | - Barbara König
- Department of Psychiatry and Psychotherapeutic Medicine, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Gonzalo Laje
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Mikael Landén
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Leboyer
- Inserm U955, Translational Psychiatry laboratory, Université Paris-Est-Créteil, Department of Psychiatry and Addictology of Mondor University Hospital, AP-HP, Fondation FondaMental, Créteil, France
| | - Susan G Leckband
- Office of Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Lina Martinsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA
| | - Susan McElroy
- Department of Psychiatry, Lindner Center of Hope / University of Cincinnati, Mason, OH, USA
| | - Francesc Colom
- Mental Health Research Group, IMIM-Hospital del Mar, Barcelona, Catalonia, Spain
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Vincent Millischer
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marina Mitjans
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
- Centro de Investigación Biomédica en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Francis M Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Palmiero Monteleone
- Neurosciences Section, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Tomas Novák
- National Institute of Mental Health, Klecany, Czech Republic
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norio Ozaki
- Department of Psychiatry & Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Claudia Pisanu
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - James B Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Barbara W Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Giovanni Severino
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Katzutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Christian Simhandl
- Bipolar Center Wiener Neustadt, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Claire M Slaney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessio Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School, Brandenburg, Germany
| | - Pavla Stopkova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Eduard Vieta
- Bipolar and Depressive Disorders Program,, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Adam Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Francis J McMahon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Norton College of Medicine, Syracuse, NY, USA
| | - Scott R Clark
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
- Department of Psychiatry, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Papadopoulou V, Arvaniti A, Kalamara E, Georgaca E, Stylianidis S, Peppou LE, Samakouri M. Outcome of Involuntary Mental Health Assessment in a Psychiatric Department in Greece. Healthcare (Basel) 2023; 11:2977. [PMID: 37998469 PMCID: PMC10671104 DOI: 10.3390/healthcare11222977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with "F20-29 schizophrenia, schizotypal and delusional disorders" were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor's Office of regions that are located far from the psychiatric department of UGHA (Fisher's exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an "F20-29 schizophrenia, schizotypal and delusional disorders" diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures.
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Affiliation(s)
- Vasiliki Papadopoulou
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
| | - Aikaterini Arvaniti
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
- University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Eleni Kalamara
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
- European Asylum Support Office (EASO), 1917 Valletta MRS, Malta
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stelios Stylianidis
- Department of Psychology, Panteion University of Social Sciences, 17671 Athens, Greece; (S.S.); (L.E.P.)
| | - Lily E. Peppou
- Department of Psychology, Panteion University of Social Sciences, 17671 Athens, Greece; (S.S.); (L.E.P.)
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
- University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
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Rojas-García A, Dalton-Locke C, Sheridan Rains L, Dare C, Ginestet C, Foye U, Kelly K, Landau S, Lynch C, McCrone P, Nairi S, Newbigging K, Nyikavaranda P, Osborn D, Persaud K, Sevdalis N, Stefan M, Stuart R, Simpson A, Johnson S, Lloyd-Evans B. Investigating the association between characteristics of local crisis care systems and service use in an English national survey. BJPsych Open 2023; 9:e209. [PMID: 37920101 PMCID: PMC10753954 DOI: 10.1192/bjo.2023.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. AIMS To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. METHOD Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data. RESULTS No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate. CONCLUSIONS The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.
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Affiliation(s)
- Antonio Rojas-García
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Department of Psychiatry, University of Granada, Spain
| | | | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Ceri Dare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Cedric Ginestet
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Sabine Landau
- NIHR Mental Health Policy Research Unit, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Chris Lynch
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Paul McCrone
- NIHR Mental Health Policy Research Unit, Institute for Lifecourse Development, University of Greenwich, UK
| | - Shilpa Nairi
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Department of Primary Care and Public Health, Brighton & Sussex Medical School, University of Sussex, UK
| | - David Osborn
- Department of Psychiatry, University of Granada, Spain; and Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; and NUS Centre for Behavioural & Implementation Science Interventions, Singapore
| | - Martin Stefan
- Mental Health Addictions and Intellectual Disability Directorate, Te Whatu Ora (Southern), Dunedin, New Zealand
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
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Hotzy F, Spiess M, Ruflin R, Schneeberger A, Traber R, Morandi S, Jaeger M, Theodoridou A. Association between perceived coercion and perceived level of information in involuntarily admitted patients: Results from a multicenter observational study in Switzerland. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101934. [PMID: 37738688 DOI: 10.1016/j.ijlp.2023.101934] [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: 06/12/2023] [Revised: 09/02/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Involuntary admissions (IA) to psychiatric hospitals are controversial because they interfere with people's autonomy. In some situations, however, they appear to be unavoidable. Interestingly, not all patients perceive the same degree of coercion during IA. The aim of this study was to assess whether the level of knowledge about one's own IA is associated with perceived coercion. METHODS This multicenter observational study was conducted on n = 224 involuntarily admitted patients. Interviews were conducted at five study centers from April 2021 to November 2021. The Macarthur Admission Experience Survey was administered to assess perceived coercion. Knowledge of involuntary admission, perceptions of information received, and attitudes towards legal aspects of involuntary admission were also assessed. RESULTS We found that higher levels of knowledge about IA were negatively associated with perceived coercion at admission. Perceived coercion did not differ between study sites. Only half of the patients felt well informed about their IA, and about a quarter found the information they received difficult to understand. DISCUSSION Legislation in Switzerland requires that patients with IA be informed about the procedure. Strategies to improve patients' understanding of the information given to them about IA might be helpful to reduce perceived coercion, which is known to be associated with negative attitudes towards psychiatry, a disturbed therapeutic relationship, avoidance of psychiatry, and the risk of further coercion.
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Affiliation(s)
- Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
| | | | | | | | | | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland; Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Lausanne, Switzerland
| | - Matthias Jaeger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Psychiatrie Baselland, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Psychiatrie Baselland, Switzerland
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Păun RM, Pavel AN, Matei VP, Tudose C. Risk factors for involuntary admission in a Romanian patient sample. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101938. [PMID: 37956559 DOI: 10.1016/j.ijlp.2023.101938] [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: 10/30/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Involuntary admission is widely used in psychiatry, usually requiring that the patient present an imminent danger to himself or others. Previous studies have established several predictors for involuntary admission, but they have been almost exclusively conducted in Western European or North American countries. By contrast, data on this topic from Eastern European countries is virtually absent. Historically, involuntary admission has been often used as a tool for political repression in Romania before the fall of the communist regime. While there have been significant changes in the legal framework in the last 30 years, there is still no real-world data to build upon. METHODS We analyzed a sample of 177 patients admitted to the "Alexandru Obregia" psychiatric hospital in Bucharest between November 2022 and January 2023, of which 49.7% (88) were involuntary hospitalizations. We collected socio-demographic and clinical data by both by direct interview, and by consulting patient records, attending physicians and relatives. RESULTS Socio-demographic factors predictive for involuntary admission were unemployment, lower income, and urban living. Of the clinical variables analyzed, diagnosis of psychosis or mania on admission carried increased risk of involuntary hospitalization, as did nonadherence to treatment, higher disease severity and aggression. Hospital presentation by police or ambulance carried significant additional risk compared to self-referral. CONCLUSION Certain categories of patients are considerably more likely to be involuntarily hospitalized and there appears to be considerable interrelatedness between the identified risk factors.
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Affiliation(s)
- Radu-Mihai Păun
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania; "Prof. Dr. Alexandru Obregia" Clinical Psychiatric Hospital, 10-12 Berceni Str, Bucharest, Romania
| | - Alexandru Neculai Pavel
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania
| | - Valentin Petre Matei
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania; "Prof. Dr. Alexandru Obregia" Clinical Psychiatric Hospital, 10-12 Berceni Str, Bucharest, Romania.
| | - Cătălina Tudose
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania
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Whittington R, Aluh DO, Caldas-de-Almeida JM. Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World. Healthcare (Basel) 2023; 11:2834. [PMID: 37957978 PMCID: PMC10650021 DOI: 10.3390/healthcare11212834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.
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Affiliation(s)
- Richard Whittington
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, Forensic Department Østmarka, St. Olav’s Hospital, 7030 Trondheim, Norway
- Department of Mental Health, Norwegian University of Science & Technology (NTNU), 7034 Trondheim, Norway
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool L69 3BX, UK
| | - Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, 1169-056 Lisbon, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Jose-Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, 1169-056 Lisbon, Portugal
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28
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Heffernan J, Pennay A, Hughes E, Gray R. The Association between the Police, Ambulance, Clinician Early Response (PACER) Model and Involuntary Detentions of People Living with Mental Illness: A Protocol for a Retrospective Observational Study. NURSING REPORTS 2023; 13:1452-1467. [PMID: 37873829 PMCID: PMC10594445 DOI: 10.3390/nursrep13040122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
Emergency services are frequently called to attend mental health incidents and are looking for innovative ways to improve their responses and reduce the burden on services. Involuntary detention of people living with mental illness is considered more frequent than necessary, leading to increased pressure on emergency departments, and is often a traumatic experience for patients. The Police, Ambulance, Clinician Early Response (PACER) model was developed in 2019 in Canberra, Australia, and seeks to reduce involuntary detentions by embedding a mental health clinician into emergency services as a mobile mental health crisis response intervention. This protocol details a retrospective cohort study that will examine the association between PACER and involuntary detentions using medical and police records and compare the results to standard ambulance and police responses. We will use relative risk and odds ratio calculations to determine the probability of being involuntarily detained or diverted from hospital; and we will describe the patient characteristics and outcomes in the PACER cohort. Results will be reported using the STROBE checklist for reporting cohort studies. This study was not registered on a publicly accessible registry.
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Affiliation(s)
- Julia Heffernan
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Melbourne, VIC 3068, Australia;
| | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
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29
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Ware OD, Strickland JC, Smith KE, Blakey SM, Dunn KE. Factors Associated with High-Risk Substance Use in Persons Receiving Psychiatric Treatment for a Primary Trauma- and Stressor-Related Disorder Diagnosis. J Dual Diagn 2023; 19:199-208. [PMID: 37796639 PMCID: PMC10645162 DOI: 10.1080/15504263.2023.2260340] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Although mental health disorders and high-risk substance use frequently co-occur, they are typically investigated independently. Clinical trials focused on treatment for individuals with trauma- and stressor-related disorders often exclude individuals with high-risk substance use. Little is also known about the role of gender in the relationship between trauma- and stressor-related disorders and high-risk substance use. We examined the relationship between trauma- and stressor-related disorders, high-risk substance use, and gender. METHODS Using the Mental Health Client-Level Data dataset, we examined 15,772 adults receiving treatment in psychiatric hospitals in the United States from 2013 to 2019. RESULTS A logistic regression model showed that for men, relative to women, having multiple mental health diagnoses and having a serious mental illness or serious emotional disturbance was associated with greater odds of high-risk substance use. CONCLUSIONS This study underscores the value of comprehensive gender-centered treatment for people with trauma- and stressor-related disorders engaging in high-risk substance use.
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Affiliation(s)
- Orrin D. Ware
- University of North Carolina at Chapel Hill School of Social Work, 325 Pittsboro Street, Chapel Hill, NC 27599
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Kirsten E. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Shannon M. Blakey
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709
| | - Kelly E. Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Clough AR, Evans A, Graham V, Catterall J, Lakeman R, Gilroy J, Pratt G, Petrucci J, Orda U, Sehdev R, Thornton N, Das S, Yearsley G, Stone R. Emergency examination authorities in Queensland, Australia. Emerg Med Australas 2023; 35:731-738. [PMID: 36951038 DOI: 10.1111/1742-6723.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters. METHODS Queensland's Public Health Act (2005), amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience sample of 942 EEAs including: (i) patient age, sex, address; (ii) free text descriptions by QPS and QAS officers of the person's behaviour and any serious risk of harm requiring urgent care; (iii) time examination period commenced; and (iv) outcome upon examination. RESULTS Of 942 EEA forms, 640 (68%) were retrieved at three 'larger central' hospitals and 302 (32%) at two 'smaller regional' hospitals in non-metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes (<1%), aged from 9 to 85 years (median 29 years, 17% aged <18 years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by 'drug and/or alcohol issues' (53%), 'self-harm' (40%), 'patient aggression' (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n = 419/534) required no inpatient admission. CONCLUSIONS EEAs furnish unique records for evaluating the impacts of Queensland's novel legislative reforms.
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Affiliation(s)
- Alan R Clough
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Angela Evans
- Queensland Police Service, Far Northern Region, Cairns, Queensland, Australia
| | - Veronica Graham
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Janet Catterall
- Library and Information Services, Division of Student Life, James Cook University, Cairns, Queensland, Australia
| | - Richard Lakeman
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - John Gilroy
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory Pratt
- Aboriginal and Torres Strait Islander Health, The University of Sydney, Sydney, New South Wales, Australia
- Aboriginal and Torres Strait Islander Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Joe Petrucci
- QLD and NT Neami National Cairns, Cairns, Queensland, Australia
| | - Ulrich Orda
- Emergency Medicine, North West Hospital and Health Service, Mount Isa, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Rajesh Sehdev
- Emergency Medicine, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Neale Thornton
- Emergency Medicine, Mackay Hospital and Health Service, Mackay, Queensland, Australia
| | - Sourav Das
- Statistics and Data Science, College of Science and Engineering, James Cook University, Cairns, Queensland, Australia
| | - Gillian Yearsley
- Northern Territory Primary Health Network, Darwin, Northern Territory, Australia
| | - Richard Stone
- Emergency Medicine, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Aluh DO, Santos-Dias M, Silva M, Pedrosa B, Grigaitė U, Silva RC, de Almeida Mousinho MF, Antunes JP, Remelhe M, Cardoso G, Caldas-de-Almeida JM. Contextual factors influencing the use of coercive measures in Portuguese mental health care. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 90:101918. [PMID: 37541138 DOI: 10.1016/j.ijlp.2023.101918] [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: 06/16/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
The use of coercive measures in mental health care is an important indicator of the quality of care being provided, and non-patient-related factors are increasingly recognized to contribute to their use. The study aimed to explore the perspectives of mental health care professionals who have first-hand experience with the use of coercion on the contextual factors that influence the use of coercion in the Portuguese mental health care. Five focus group discussions were conducted among 23 doctors and 17 nurses from five psychiatric departments in urban and rural regions of Portugal. Discussions were audio recorded, transcribed, and analyzed with the aid of MAXQDA. Four broad themes related to insufficient resources, staff-related factors, inefficient services, and socio-legal factors were derived. Participants highlighted how inadequate structures, staff shortages, staff attitudes, a lack of training, restrictive ward rules, an inefficient organization of services, the mental health legislation, and public attitudes contributed to the use of coercive measures. The COVID-19 pandemic complicated existing shortfalls in the system and increased the use of coercive measures. The study confirms that the use of coercive measures in mental health care is influenced by factors that are independent of patient characteristics. Addressing existing systemic problems is crucial for the successful implementation of interventions to reduce coercion in mental health care.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Margarida Santos-Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Manuela Silva
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ricardo Caetano Silva
- Serviço de Psiquiatria e Saúde Mental de Adultos, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Nova Medical School, Lisbon, Portugal
| | | | - João Paulo Antunes
- Unidade de Internamento do Serviço de Psiquiatria e Saúde Mental de Adultos - Departamento de Saúde Mental do Hospital Professor Doutor Fernando Fonseca
| | - Mariana Remelhe
- Centro Hospitalar De Vila Nova De Gaia/Espinho, E.P.E.| V. N. Gaia/Espinho Hospital Centre
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal; Comprehensive Health Research Centre (chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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Elhosary MY, Merranko JA, Goldstein TR, Hafeman DM, Goldstein BI, Gill MK, Hower H, Axelson DA, Hunt JI, Yen S, Diler RS, Ryan ND, Keller MB, Weinstock LM, Strober M, Birmaher B. Examining Factors Associated With Medication Adherence in Youth With Bipolar Disorder. JAACAP OPEN 2023; 1:105-115. [PMID: 39381188 PMCID: PMC11460791 DOI: 10.1016/j.jaacop.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Objective To assess medication adherence and factors associated with poor adherence in youth with bipolar disorder (BD) followed from adolescence through young adulthood. Method Participants with BD recruited through the Course and Outcome of Bipolar Youth (COBY) study were included in this study if they were prescribed psychotropic medications and had at least 3 follow-up assessments of medication adherence (N= 179, ages 12-36). Medication adherence had been evaluated for a median of 8 years using a questionnaire derived from the Coronary Artery Risk Development in Young Adults (CARDIA) study. For the longitudinal evaluation, adherence was measured as the percentage of follow-up assessments in which the participants did not endorse any of the nonadherence items included in the questionnaire. Concurrent and future predictors of poor adherence were assessed using both univariate and multivariate longitudinal analyses. Results Among the participants, 51% reported poor adherence in more than 50% of their follow-up assessments. Younger age, family conflicts, polypharmacy, lower functioning, greater severity of mood symptoms, and comorbid disorders were associated with poor adherence in the univariate analyses. In the multivariate analyses, comorbid ADHD was the single most influential factor associated with concurrent and future poor adherence in all age groups. Participants' most reported reasons for poor adherence were forgetfulness (56%), negative attitudes toward medication treatment (10.5%), and disturbed daily routine (7%). Conclusions Poor medication adherence is a significant problem in youth with BD with the most influential factor being the presence of comorbid ADHD. Thus, it is important to identify and appropriately treat comorbid ADHD to improve medication adherence and patients' prognosis. Providers should also recommend tools to enhance consistent medication intake and address patients' concerns and negative beliefs about their illness and treatment.
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Affiliation(s)
- Mohamed Y Elhosary
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John A Merranko
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tina R Goldstein
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Danella M Hafeman
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Mary Kay Gill
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather Hower
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David A Axelson
- Nationwide Children's Hospital, and The Ohio State College of Medicine, Columbus, Ohio
| | - Jeffrey I Hunt
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Shirley Yen
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rasim Somer Diler
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neal D Ryan
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Martin B Keller
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Miller School of Medicine at the University of Miami, Miami, FL
| | - Lauren M Weinstock
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Strober
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Boris Birmaher
- UPMC Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
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Connolly M, Schölin L, Robertson GS, Chopra A. Length and associated characteristics of short-term detentions: an analysis of detentions under the Mental Health Act in Scotland, 2006-2018. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1343-1352. [PMID: 36997745 PMCID: PMC10423135 DOI: 10.1007/s00127-023-02459-3] [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: 06/13/2022] [Accepted: 02/27/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE The Mental Health Act in Scotland is under review. Previous iterations increased patients' rights but the maximum time for short-term detentions remains unchanged, despite evolving psychiatric treatment models. We explored length, mode of ending and factors of influence on the application of short-term detention certificates (STDCs), which can last up to 28 days, across Scotland between 2006 and 2018. METHODS Data on age, gender, ethnicity, date of commencement and ending of the STDC and detention site from all 42,493 STDCs issued to 30,464 patients over 12 years were extracted from the national repository for detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 and analysed using mixed models. RESULTS One in five STDCs lapsed on day 28. Two in five were revoked and the remainder extended to a treatment order. STDCs that were not extended averaged 19 days, and revoked STDCs 14 days. The probability of a detention lapsing varied across hospitals and increased with patient age. The odds of a detention lapsing on day 28 were 62% lower and revoked detentions 10% shorter in 2018 relative to 2006. The odds of a detention extending decreased significantly from 2012 to 2018. Extended STDCs were associated with increased patient age, male gender, and ethnicity other than White Scottish. There was little initiation of or active revocation of STDCs on weekend days. CONCLUSION The length of STDCs reduced over time, fewer detentions lapsed, and weekday patterning was evident in each year. These data can inform legislative and service reviews.
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Affiliation(s)
- Moira Connolly
- Mental Welfare Commission for Scotland, Edinburgh, Scotland.
| | - Lisa Schölin
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Gail S Robertson
- School of Mathematics, University of Edinburgh, Edinburgh, Scotland
| | - Arun Chopra
- Mental Welfare Commission for Scotland, Edinburgh, Scotland
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Aluh DO, Aigbogun O, Ukoha-Kalu BO, Silva M, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care. Healthcare (Basel) 2023; 11:1986. [PMID: 37510426 PMCID: PMC10379438 DOI: 10.3390/healthcare11141986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Osaro Aigbogun
- Department of Management, Marketing and Digital Business, Curtin University, Miri 98009, Malaysia
| | | | - Manuela Silva
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Margarida Santos-Dias
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
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Goldsmith LP, Anderson K, Clarke G, Crowe C, Jarman H, Johnson S, Lomani J, McDaid D, Park AL, Smith JG, Gillard S. Service use preceding and following first referral for psychiatric emergency care at a short-stay crisis unit: A cohort study across three cities and one rural area in England. Int J Soc Psychiatry 2023; 69:928-941. [PMID: 36527189 PMCID: PMC10248300 DOI: 10.1177/00207640221142530] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Internationally, hospital-based short-stay crisis units have been introduced to provide a safe space for stabilisation and further assessment for those in psychiatric crisis. The units typically aim to reduce inpatient admissions and psychiatric presentations to emergency departments. AIMS To assess changes to service use following a service user's first visit to a unit, characterise the population accessing these units and examine equality of access to the units. METHODS A prospective cohort study design (ISCTRN registered; 53431343) compared service use for the 9 months preceding and following a first visit to a short-stay crisis unit at three cities and one rural area in England. Included individuals first visited a unit in the 6 months between 01/September/2020 and 28/February/2021. RESULTS The prospective cohort included 1189 individuals aged 36 years on average, significantly younger (by 5-13 years) than the population of local service users (<.001). Seventy percent were White British and most were without a psychiatric diagnosis (55%-82% across sites). The emergency department provided the largest single source of referrals to the unit (42%), followed by the Crisis and Home Treatment Team (20%). The use of most mental health services, including all types of admission and community mental health services was increased post discharge. Social-distancing measures due to the COVID-19 pandemic were in place for slightly over 50% of the follow-up period. Comparison to a pre-COVID cohort of 934 individuals suggested that the pandemic had no effect on the majority of service use variables. CONCLUSIONS Short-stay crisis units are typically accessed by a young population, including those who previously were unknown to mental health services, who proceed to access a broader range of mental health services following discharge.
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Affiliation(s)
| | | | | | - Chloe Crowe
- North East London NHS Foundation Trust,
Goodmayes Hospital, Ilford, UK
| | - Heather Jarman
- Population Health Research Institute,
St George’s, University of London, UK
- St George’s University Hospitals NHS
Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research
Unit, Division of Psychiatry, University College London – Bloomsbury, UK
| | - Jo Lomani
- NHS England and NHS Improvement,
London, UK
| | - David McDaid
- Care Policy and Evaluation Centre,
Department of Health Policy, London School of Economics and Political Science,
UK
| | - A-La Park
- Care Policy and Evaluation Centre,
Department of Health Policy, London School of Economics and Political Science,
UK
| | - Jared G Smith
- Population Health Research Institute,
St George’s, University of London, UK
| | - Steven Gillard
- School of Health and Psychological
Sciences, City, University of London, London, UK
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Allerby K, Gremyr A, Ali L, Waern M, Goulding A. Increasing person-centeredness in psychosis inpatient care: care consumption before and after a person-centered care intervention. Nord J Psychiatry 2023:1-8. [PMID: 37083029 DOI: 10.1080/08039488.2023.2199726] [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] [Indexed: 04/22/2023]
Abstract
BACKGROUND Patients with psychotic disorders often need hospitalization with long stays. Person-centered care (PCC) has been shown to improve care quality and decrease the length of hospital stay in non-psychiatric settings. We carried out an educational intervention for inpatient staff, aiming to increase person-centeredness at a major Swedish psychosis clinic. The aim of this study was to test if the intervention could be associated with decreased length of hospital stay (LoS), involuntary stay (LoIS), and reduction in rapid readmissions. METHODS Data from the clinic's administrative registry were compared for patients with a discharge diagnosis within the schizophrenia-spectrum treated during the one-year periods before and after the PCC intervention. RESULTS Contrary to our hypotheses, a quantile regression estimated longer LoS post-intervention, median difference 10.4 d (CI 4.73-16.10). Neither age, sex nor diagnostic category were associated with LoS. Of all inpatient days, ∼80% were involuntary. While LoIS was numerically longer post-intervention, the difference did not reach significance in the final regression model (median difference 7.95 d, CI -1.40 to 17.31). Proportions with readmission within 2 weeks of discharge did not differ (7.7% vs 5.2%, n.s.). CONCLUSIONS Increased length of inpatient care was observed after the PCPC intervention. This could reflect an increased focus on the unmet needs of persons with serious psychotic conditions, but it needs to be explored in future research using a more rigorous study design. TRIAL REGISTRATION This study is part of a larger evaluation of Person-Centered Psychosis Care (PCPC), registered during data collection (after the study start, before analysis) at clinicaltrials.gov, identifier NCT03182283.
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Affiliation(s)
- Katarina Allerby
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Psychosis Department, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Psychosis Department, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health Care Sciences, Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Psychosis Department, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Goulding
- Psychosis Department, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Loyal JP, Lavergne MR, Shirmaleki M, Fischer B, Kaoser R, Makolewksi J, Small W. Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:257-268. [PMID: 36200433 PMCID: PMC10037746 DOI: 10.1177/07067437221128477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Involuntary psychiatric hospitalization occurs when someone with a serious mental disorder requires treatment without their consent. Trends vary globally, and currently, there is limited data on involuntary hospitalization in Canada. We examine involuntary hospitalization trends in British Columbia, Canada, and describe the social and clinical characteristics of people ages 15 and older who were involuntarily hospitalized between 2008/2009 and 2017/2018. METHOD We used population-based linked administrative data to examine and compare trends in involuntary and voluntary hospitalizations for mental and substance use disorders. We described patient characteristics (sex/gender, age, health authority, income, urbanity/rurality, and primary diagnosis) and tracked the count of involuntarily hospitalized people over time by diagnosis. Finally, we examined population-based prevalence over time by age and sex/gender. RESULTS Involuntary hospitalizations among British Columbians ages 15 and older rose from 14,195 to 23,531 (65.7%) between 2008/2009 and 2017/2018. Apprehensions involving police increased from 3,502 to 8,009 (128.7%). Meanwhile, voluntary admissions remained relatively stable, with a minimal increase from 17,651 in 2008/2009 to 17,751 in 2017/2018 (0.5%). The most common diagnosis for involuntary patients in 2017/2018 was mood disorders (25.1%), followed by schizophrenia (22.3%), and substance use disorders (18.8%). From 2008/2009 to 2017/2018, the greatest increase was observed for substance use disorders (139%). Over time, population-based prevalence increased most rapidly among women ages 15-24 (162%) and men ages 15-34 (81%) and 85 and older (106%). CONCLUSION Findings highlight the need to strengthen the voluntary care system for mental health and substance use, especially for younger adults, and people who use substances. They also signal a need for closer examination of the use of involuntary treatment for substance use disorders, as well as further research exploring forces driving police involvement and its implications.
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Affiliation(s)
- Jackson P Loyal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia
| | - M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mehdi Shirmaleki
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Ridhwana Kaoser
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jack Makolewksi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia
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38
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Werkmeister C, Cunningham R, Freeland A, Stanley J, Every-Palmer S, Kuehl S. Missed presentations, missed opportunities: A cross-sectional study of mental health presentation undercounting in the emergency department. Emerg Med Australas 2023; 35:276-282. [PMID: 36574586 DOI: 10.1111/1742-6723.14114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The burden of mental illness is increasing across developed countries. EDs are often used as access points by people experiencing mental health crises, with such rising demand in Australasia. Accurate data is critical to track and address this need, but research suggests that current data collection methods undercount mental health presentations to the EDs. The present study aimed to quantify and characterise ED mental health presentations that were not identified by usual clinical coding processes. METHODS From almost 50 000 presentations to a large regional ED over 12 months, 1988 were mental health-related as identified via discharge diagnoses and ICD-10 codes. For a further 384 presentations, it was ambiguous whether they were mental health-related. For these, free-text clinical notes were reviewed to identify mental health-related presentation missed by clinical coding practices. Demographic information, time of presentation, recent use of secondary mental health services and disposition from ED were extracted and analysed. RESULTS An additional 91 mental health presentations were found by review of clinical notes; 4.6% (95% confidence interval 3.7-5.6) more presentations than identified via screening of discharge codes. In these 'missed' cases, clinicians had documented clear mental health symptoms but without coding the corresponding diagnosis. Existing clinical coding practices were less accurate for patients who were not current or recent users of mental health services, and for those who were discharged directly from ED. CONCLUSIONS The present study demonstrates that ED mental health presentations may be underestimated by nearly 5%, revealing greater mental health demand than current figures suggest.
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Affiliation(s)
- Catherine Werkmeister
- Mental Health, Addiction and Intellectual Disability Service, Wellington, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Abigail Freeland
- Department of Public Health, University of Otago, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - James Stanley
- Biostatistics Group, University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Silke Kuehl
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Bakola M, Peritogiannis V, Stuckler D, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Who is coercively admitted to psychiatric wards? Epidemiological analysis of inpatient records of involuntary psychiatric admissions to a University General Hospital in Greece for the years 2008-2017. Int J Soc Psychiatry 2023; 69:267-276. [PMID: 35232289 DOI: 10.1177/00207640221081793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Involuntary psychiatric admissions are a widely used practice despite ethical concerns about coercion. There are particular concerns that vulnerable groups, such as single, unemployed or racial minorities, may be more subjected to such practices. AIM We aimed to investigate the social patterns of involuntary psychiatric admissions from 2008 to 2017 at University General Hospital in Ioannina, Greece. METHOD We retrospectively assessed inpatient records from 2008 to 2017 of patients admitted to the Department of Psychiatry of the Ioannina University General Hospital, Northwestern Greece. Alternative patients of alternative years were selected for inclusion; this yielded 332 patients involuntarily admitted, corresponding to 28.5% of total involuntary psychiatric admissions. RESULTS Over the 10-year period, the overall numbers of annual involuntary psychiatric admissions remained relatively stable, as did the length of hospital stay (mean = 23.8 days). The most common disorder upon admission was schizophrenia spectrum disorders, accounting for approximately two-thirds of all admissions, followed by mood disorders (about 20%). There was evidence that people who lacked social support or experienced financial hardship were more greatly represented among those admitted: 70.2% of admitted patients were single and 64.8% were unemployed. Most patients had been admitted to the psychiatric ward in the past (64.2%). CONCLUSION Our study indicates potentially worrisome evidence that patients who are in vulnerable positions are at elevated likelihood of being involuntarily admitted to psychiatric wards. Future research is needed to evaluate the socio-demographic patterning of involuntary admissions in other European countries.
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Affiliation(s)
- Maria Bakola
- Postgraduate Program of Public Health, Medical School, University of Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - David Stuckler
- Department of Social and Political Sciences, University of Bocconi, Milan, Italy
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Greece
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Elisa DF, Claudio B, Vincenzo V, Paola R. Compulsory admission: are there differences between migrants and natives? Data from a psychiatric emergency service of an Italian metropolitan area. Heliyon 2023; 9:e14406. [PMID: 36938435 PMCID: PMC10018564 DOI: 10.1016/j.heliyon.2023.e14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Background As compared to natives, higher rates of involuntary admission were found among migrants in most European countries. A possible strategy to reduce this phenomenon is to develop preventive strategies targeting risk and protective factors of compulsory admission specific to the migrant population. Aims The first aim of the present study was to evaluate compulsory admission rates in the migrant population as compared to natives admitted for an acute mental disorder. The second aim was investigate whether sociodemographic, clinical, and care-related variables associated with compulsory admission differed between migrants and natives. Moreover, in the whole sample we assessed whether migrant status affected the risk of compulsory admission. Methods Retrospective single-center study on patients hospitalized in the period between January 1, 2018 and December 31, 2020 in a large metropolitan academic hospital. We compared sociodemographic, clinical, and care-related variables between migrants and natives, voluntary or compulsory admitted. We investigated the association between compulsory admission and the variables collected in the whole sample and in the migrants' and natives' groups with a correlation analysis followed by hierarchical logistic regression models. Results The sample included 185 migrant patients and 933 native patients. The prevalence of compulsory admission was significantly higher in the migrants' group. Male gender, lower education, non-comprehension of the local language, a diagnosis of a schizophrenia spectrum disorder, and aggressive behavior were associated with compulsory admission in the migrants' sample, partially differing from the natives. Conclusion Our study highlighted how migrant status is associated with a higher risk for compulsory admission. Inclusion policies or the presence of cultural mediators in emergency settings might be preventive strategies in this context.
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Affiliation(s)
- Del Favero Elisa
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, Turin, Italy
- Corresponding author.
| | - Brasso Claudio
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, Turin, Italy
| | - Villari Vincenzo
- Dipartimento di Neuroscienze e Salute Mentale-, A.O.U. Città della Salute e della Scienza, Via Cherasco 11, Turin, Italy
| | - Rocca Paola
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale-, A.O.U. Città della Salute e della Scienza, Via Cherasco 11, Turin, Italy
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Nyttingnes O, Benth JŠ, Hofstad T, Rugkåsa J. The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway. BMC Psychiatry 2023; 23:112. [PMID: 36803444 PMCID: PMC9942375 DOI: 10.1186/s12888-023-04584-4] [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: 09/20/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects. AIM To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others. METHODS Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014-2017 predicted an increase in the standardized suicide ratios in 2014-2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287). RESULTS We found no adverse effects on patients' health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care. CONCLUSIONS Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.
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Affiliation(s)
- Olav Nyttingnes
- Health Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway. .,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Jūratė Šaltytė Benth
- grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore Hofstad
- grid.412008.f0000 0000 9753 1393Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.5510.10000 0004 1936 8921Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Jorun Rugkåsa
- grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway ,grid.463530.70000 0004 7417 509XCentre for Care Research, University of South-Eastern Norway, Notodden, Norway
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Amare A, Thalamuthu A, Schubert KO, Fullerton J, Ahmed M, Hartmann S, Papiol S, Heilbronner U, Degenhardt F, Tekola-Ayele F, Hou L, Hsu YH, Shekhtman T, Adli M, Akula N, Akiyama K, Ardau R, Arias B, Aubry JM, Backlund L, Bhattacharjee AK, Bellivier F, Benabarre A, Bengesser S, Biernacka J, Birner A, Marie-Claire C, Cervantes P, Chen HC, Chillotti C, Cichon S, Cruceanu C, Czerski P, Dalkner N, Del Zompo M, DePaulo JR, Etain B, Jamain S, Falkai P, Forstner AJ, Frisén L, Frye M, Gard S, Garnham J, Goes F, Grigoroiu-Serbanescu M, Fallgatter A, Stegmaier S, Ethofer T, Biere S, Petrova K, Schuster C, Adorjan K, Budde M, Heilbronner M, Kalman J, Oraki Kohshour M, Reich-Erkelenz D, Schaupp S, Schulte E, Senner F, Vogl T, Anghelescu IG, Arolt V, Dannlowski U, Dietrich DE, Figge C, Jäger M, Lang F, Juckel G, Spitzer C, Reimer J, Schmauß M, Schmitt A, Konrad C, von Hagen M, Wiltfang J, Zimmermann J, Andlauer T, Fischer A, Bermpohl F, Kraft V, Matura S, Gryaznova A, Falkenberg I, Yildiz C, Kircher T, Schmidt J, Koch M, Gade K, Trost S, Haußleiter I, Lambert M, Rohenkohl AC, Kraft V, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Jiménez E, Kahn JP, Kassem L, Kuo PH, Kato T, Kelsoe J, Kittel-Schneider S, Ferensztajn-Rochowiak E, König B, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Tortorella A, Manchia M, Martinsson L, McCarthy M, McElroy SL, Colom F, Mitjans M, Mondimore F, Monteleone P, Nievergelt C, Nöthen M, Novak T, O'Donovan C, Ozaki N, Pfennig A, Pisanu C, Potash J, Reif A, Reininghaus E, Rouleau G, Rybakowski JK, Schalling M, Schofield P, Schweizer BW, Severino G, Shilling PD, Shimoda K, Simhandl C, Slaney C, Squassina A, Stamm T, Stopkova P, Maj M, Turecki G, Vieta E, Veeh J, Witt S, Wright A, Zandi P, Mitchell P, Bauer M, Alda M, Rietschel M, McMahon F, Schulze TG, Millischer V, Clark S, Baune B. Association of Polygenic Score and the involvement of Cholinergic and Glutamatergic Pathways with Lithium Treatment Response in Patients with Bipolar Disorder. RESEARCH SQUARE 2023:rs.3.rs-2580252. [PMID: 36824922 PMCID: PMC9949170 DOI: 10.21203/rs.3.rs-2580252/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar patients, it is essential to identify prediction biomarkers such as polygenic scores. In this study, we developed a polygenic score for lithium treatment response (Li+PGS) in patients with BD. To gain further insights into lithium's possible molecular mechanism of action, we performed a genome-wide gene-based analysis. Using polygenic score modeling, via methods incorporating Bayesian regression and continuous shrinkage priors, Li+PGS was developed in the International Consortium of Lithium Genetics cohort (ConLi+Gen: N=2,367) and replicated in the combined PsyCourse (N=89) and BipoLife (N=102) studies. The associations of Li+PGS and lithium treatment response - defined in a continuous ALDA scale and a categorical outcome (good response vs. poor response) were tested using regression models, each adjusted for the covariates: age, sex, and the first four genetic principal components. Statistical significance was determined at P<����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mazda Adli
- Charité - Universitätsmedizin Berlin, Campus Charité Mitte
| | | | | | | | - Bárbara Arias
- Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, CIBERSAM
| | | | | | | | - Frank Bellivier
- Pôle de Psychiatrie, AP-HP, Groupe Hospitalier Lariboisière-F. Widal
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Louise Frisén
- Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Till Andlauer
- Technical University of Munich, Klinikum rechts der Isar
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Esther Jiménez
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jean-Pierre Kahn
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Layla Kassem
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marina Mitjans
- Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thomas Stamm
- Charité - Universitätsmedizin Berlin, Campus Charité Mitte
| | | | - Mario Maj
- University of Campania "Luigi Vanvitelli", Naples
| | | | | | | | | | | | - Peter Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | | | | | | | | | - Francis McMahon
- National Institute of Mental Health Intramural Research Program; National Institutes of Health
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Freitas DF, Walker S, Nyikavaranda P, Downs J, Patel R, Khondoker M, Bhui K, Hayes RD. Ethnic inequalities in involuntary admission under the Mental Health Act: an exploration of mediation effects of clinical care prior to the first admission. Br J Psychiatry 2023; 222:27-36. [PMID: 36281471 PMCID: PMC10250681 DOI: 10.1192/bjp.2022.141] [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: 06/13/2022] [Revised: 07/26/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies show ethnic inequalities in rates of involuntary admission and types of clinical care (such as psychological therapies). However, few studies have investigated if there is a relationship between clinical care practices and ethnic inequalities in involuntary admission. AIMS This study investigated the impact of ethnicity and clinical care on involuntary admission and the potential mediation effects of prior clinical care. METHOD In this retrospective cohort study, we used data from the electronic records of the South London and Maudsley NHS Foundation Trust and identified patients with a first hospital admission between January 2008 and May 2021. Logistic regression and mediation analyses were used to investigate the association between ethnicity and involuntary admission, and whether clinical care, in the 12 months preceding admission, mediates the association. RESULTS Compared with White British people, higher odds of involuntary admission were observed among 10 of 14 minority ethnic groups; with more than twice the odds observed among people of Asian Chinese, of Asian Bangladeshi and of any Black background. There were some ethnic differences in clinical care prior to admission, but these had a minimal impact on the inequalities in involuntary admission. More out-patient appointments and home treatment were associated with higher odds of involuntary admission, whereas psychological therapies and having a care plan were associated with reduced odds of involuntary admission. CONCLUSIONS Ethnic inequalities in involuntary admission persist after accounting for potential mediating effects of several types and frequencies of clinical care. Promoting access to psychological therapies and ensuring that care plans are in place may reduce involuntary admissions.
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Affiliation(s)
- Daniela Fonseca Freitas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry, University of Oxford, UK
| | - Susan Walker
- Division of Psychiatry, University College London, UK and Great Ormond Street Institute of Child Health, University College London, UK
| | - Patrick Nyikavaranda
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and South London and Maudsley NHS Foundation Trust, UK
| | - Rashmi Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and South London and Maudsley NHS Foundation Trust, UK
| | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, UK and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Richard D. Hayes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Heffernan J, McDonald E, Hughes E, Gray R. Tri-Response Police, Ambulance, Mental Health Crisis Models in Reducing Involuntary Detentions of Mentally Ill People: A Systematic Review. NURSING REPORTS 2022; 12:1004-1013. [PMID: 36548169 PMCID: PMC9785608 DOI: 10.3390/nursrep12040096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Police, ambulance, and mental health tri-response services are a relatively new model of responding to people experiencing mental health crisis in the community, though limited evidence exists examining their efficacy. Reducing unnecessary involuntary detentions and emergency department presentations is believed to be a benefit of this model. A systematic review was performed to review the evidence base around the relationship between the police, ambulance, mental health tri-response models in reducing involuntary detentions of people experiencing mental health crisis. We searched key health databases for clinical studies and grey literature as per a previously published protocol. Two researchers completed title and abstract screening and full text screening. Our search identified 239 citations. No studies or grey literature met the inclusion criteria. We report an empty review. It is recommended that further investigation of the tri-response mental health crisis model be undertaken to determine its effectiveness and value as a health and emergency service initiative.
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Affiliation(s)
- Julia Heffernan
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
| | - Ewan McDonald
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
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Hofstad T, Husum TL, Rugkåsa J, Hofmann BM. Geographical variation in compulsory hospitalisation - ethical challenges. BMC Health Serv Res 2022; 22:1507. [PMID: 36496384 PMCID: PMC9737766 DOI: 10.1186/s12913-022-08798-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Compulsory hospitalisation in mental health care restricts patients' liberty and is experienced as harmful by many. Such hospitalisations continue to be used due to their assumed benefit, despite limited scientific evidence. Observed geographical variation in compulsory hospitalisation raises concern that rates are higher and lower than necessary in some areas. METHODS/DISCUSSION We present a specific normative ethical analysis of how geographical variation in compulsory hospitalisation challenges four core principles of health care ethics. We then consider the theoretical possibility of a "right", or appropriate, level of compulsory hospitalisation, as a general norm for assessing the moral divergence, i.e., too little, or too much. Finally, we discuss implications of our analysis and how they can inform the future direction of mental health services.
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Affiliation(s)
- Tore Hofstad
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.
| | - Tonje Lossius Husum
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Bjørn Morten Hofmann
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
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Schneider M, Back M, Krückl JS, Moeller J, Lang UE, Huber CG. Compulsory psychiatric admissions in the canton of Basel-Stadt between September 2013 and April 2022: Analysis of the cantonal database of the Health Department of Basel-Stadt. Int J Soc Psychiatry 2022:207640221141020. [PMID: 36453089 DOI: 10.1177/00207640221141020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND According to federal and cantonal law, persons with an acute mental illness can be admitted to a psychiatric hospital or another suitable institution against their will, when other therapeutic options are not available or have been exhausted. In the canton of Basel-Stadt, this is the responsibility of public health officers employed by the division of Social Medicine of the cantonal Health Department. AIMS This study aims to elucidate which factors influence the decision-making of public health officers regarding compulsory admissions over the period from September 2013 to April 2022 in the canton of Basel-Stadt. METHOD Leveraging comprehensive clinical data from the health department of the canton Basel-Stadt (N = 5,'550), we estimated a mixed effects logistic regression model to identify factors contributing to the decision of public-health officers to compulsorily admit patients, while controlling for potential clustering effects among public health officers. RESULTS The risk for compulsory admissions was most strongly predicted by the presence of potential self-harm. In comparison, while being a strong predictor, potential harm to others played a considerably lesser role. Furthermore, psychiatric syndrome, previous compulsory admissions, and the specific context of evaluation were significant predictors. Finally, we found no meaningful personal bias among public health officers. CONCLUSION The results suggest that public health officers' decision-making regarding compulsory admissions focuses on preventing self-harm and, to a lesser degree, harm to others. This indicates that such measures are only used as a measure of last resort, which is in line with current evidence regarding the detrimental effects of compulsory measures on treatment outcomes in psychiatry. Our findings suggest that all relevant stakeholders, including the police, share this perspective. Decision-making regarding compulsory admissions was mostly free of personal biases, suggesting adherence to shared professional standards by public health officers.
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Affiliation(s)
- Michael Schneider
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Moritz Back
- Health Department of Basel-Stadt, Cantonal Medical Service, Social Medicine, Basel, Switzerland
| | - Jana S Krückl
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
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Mac Donald B, Bulik CM, Petersen LV, Clausen L. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 2022; 27:3157-3172. [PMID: 35864298 PMCID: PMC9805523 DOI: 10.1007/s40519-022-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. METHODS This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). RESULTS Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. CONCLUSIONS Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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Shea T, Dotson S, Tyree G, Ogbu-Nwobodo L, Beck S, Shtasel D. Racial and Ethnic Inequities in Inpatient Psychiatric Civil Commitment. Psychiatr Serv 2022; 73:1322-1329. [PMID: 35959533 DOI: 10.1176/appi.ps.202100342] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Involuntary psychiatric treatment may parallel ethnoracial inequities present in the larger society. Prior studies have focused on restraint and seclusion, but less attention has been paid to the civil commitment system because of its diversity across jurisdictions. Using a generalizable framework, this study investigated inequities in psychiatric commitment. METHODS A prospective cohort was assembled of all patients admitted to an inpatient psychiatric unit over 6 years (2012-2018). Patients were followed longitudinally throughout their admission; raters recorded legal status each day. Sociodemographic and clinical data were collected to adjust for confounding variables by using multivariate logistic regression. RESULTS Of the 4,393 patients with an initial admission during the study period, 73% self-identified as White, 11% as Black, 10% as primarily Hispanic or Latinx, 4% as Asian, and 3% as another race or multiracial. In the sample, 28% were involuntarily admitted, and court commitment petitions were filed for 7%. Compared with White patients, all non-White groups were more likely to be involuntarily admitted, and Black and Asian patients were more likely to have court commitment petitions filed. After adjustment for confounding variables, Black patients remained more likely than White patients to be admitted involuntarily (adjusted odds ratio [aOR]=1.57, 95% confidence interval [CI]=1.26-1.95), as were patients who identified as other race or multiracial (aOR=2.12, 95% CI=1.44-3.11). CONCLUSIONS Patients of color were significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, and Black patients and patients who identified as other race or multiracial were particularly vulnerable, even after adjustment for confounding variables.
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Affiliation(s)
- Timothy Shea
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Samuel Dotson
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Griffin Tyree
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Lucy Ogbu-Nwobodo
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Stuart Beck
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Derri Shtasel
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
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Draghetti S, Alberti S, Borgiani G, Panariello F, De Ronchi D, Atti AR. Compulsory and voluntary admissions in comparison: A 9-year long observational study. Int J Soc Psychiatry 2022; 68:1716-1726. [PMID: 34927496 DOI: 10.1177/00207640211057731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies, so far, have been specifically designed to highlight the features related to Compulsory Admissions (CA) and Voluntary Admissions (VA) in Italian psychiatric emergency wards. AIMS The main purpose of this observational study was to compare the sociodemographic and clinical characteristics of VA and CA and to explore possible predictors of re-admissions. METHODS During a 6-month Index Period (February, the 1st-July, the 31st 2008) all psychiatric admissions were documented and then followed-up through all available informatic systems for the next 9 years. RESULTS Out of 390 hospitalizations, 101 (25.9%) were compulsory (CA rate was 2.79 per 10,000 inhabitants per year, mean duration of hospitalizations of 7.33 ± 7.84 days). Diagnoses were recorded for the 325 patients who had been hospitalized during index period: schizophrenic psychoses ([p = .042], in particular schizophrenia [p = .027]), manic episode (p = .044), and delusional disorders (p = .009) were associated with CA; conversely, the diagnosis of unipolar major depression (p = .005) and personality disorders (p = .048) were significantly more frequent in VA. The 325 admitted patients were followed up for 1,801 person-years. No significant differences were found in terms of drop-outs, transferring, and discharge rates, and mortality rates due to both natural causes and suicides. Factors associated with at least one compulsory readmission were younger age and having had a previous CA (p = .011); conversely having been engaged with psychiatric services for over 1 year prior to index hospitalization was protective for a subsequent CA (p = .013). CONCLUSIONS After a 40-year old political reform, the current study shows that, in a context of integrated outpatient and inpatient services, engagement with outpatient care may be protective for compulsory rehospitalization.
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Affiliation(s)
- Stefano Draghetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Siegfried Alberti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Gianluca Borgiani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Fabio Panariello
- Servizio Psichiatrico di Diagnosi e Cura "P. Ottonello" - Azienda Sanitaria Locale di Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Aluh DO, Ayilara O, Onu JU, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Experiences and perceptions of coercive practices in mental health care among service users in Nigeria: a qualitative study. Int J Ment Health Syst 2022; 16:54. [PMID: 36424651 PMCID: PMC9694572 DOI: 10.1186/s13033-022-00565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND People with mental health problems are more vulnerable to a broad range of coercive practices and human rights abuses. There is a global campaign to eliminate, or at the very least decrease, the use of coercion in mental health care. The use of coercion in psychiatric hospitals in developing countries is poorly documented. The primary aim of this study was to explore service users' perceptions and experiences of coercion in psychiatric hospitals in Nigeria. METHODS Four focus group discussions were carried out among 30 service users on admission in two major psychiatric hospitals in Nigeria. The audio recordings were transcribed verbatim and then analyzed thematically with the aid of MAXQDA software. RESULTS The Focus group participants included 19 males and 11 females with a mean age of 34.67 ± 9.54. Schizophrenia was the most common diagnosis (40%, n = 12) and had a secondary school education (60%, n = 18). The focus group participants perceived coercion to be a necessary evil in severe cases but anti-therapeutic to their own recovery, an extension of stigma and a vicious cycle of abuse. The experience of involuntary admission revolved mainly around deception, maltreatment, and disdain. Participants in both study sites narrated experiences of being flogged for refusing medication. Mechanical restraint with chains was a common experience for reasons including refusing medications, to prevent absconding and in other cases, punitively. The use of chains was viewed by participants as dehumanizing and excruciatingly painful. CONCLUSION The experiences of coercion by participants in this study confirm that human rights violations occur in large psychiatric hospitals and underscore the need for mental health services reform. The use of coercion in this context reflects agelong underinvestment in the mental health care system in the country and obsolete mental health legislation that does not protect the rights of people with mental health problems. The study findings highlight an urgent need to address issues of human rights violations in psychiatric hospitals in the country.
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Affiliation(s)
- Deborah Oyine Aluh
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal.
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Enugu State, Nigeria.
| | - Olaniyi Ayilara
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Uselu, Edo State, Nigeria
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Anambra State, Nigeria
| | - Ugnė Grigaitė
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Barbara Pedrosa
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Margarida Santos-Dias
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
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