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O'Callaghan AK, Plunkett R, Kelly BD. What is the role of gender in perceived coercion during psychiatric admission? Ir J Psychol Med 2023:1-5. [PMID: 36803581 DOI: 10.1017/ipm.2023.6] [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: 02/22/2023]
Abstract
OBJECTIVES This paper explores factors linking gender with increased perceived coercion, perceived negative pressures and procedural injustice during psychiatric admission. METHODS We used validated tools to perform detailed assessments of 107 adult psychiatry inpatients admitted to acute psychiatry admission units at two general hospitals in Dublin, Ireland, between September 2017 and February 2020. RESULTS Among female inpatients (n = 48), perceived coercion on admission was associated with younger age and involuntary status; perceived negative pressures were associated with younger age, involuntary status, seclusion, and positive symptoms of schizophrenia; and procedural injustice was associated with younger age, involuntary status, fewer negative symptoms of schizophrenia, and cognitive impairment. Among females, restraint was not associated with perceived coercion on admission, perceived negative pressures, procedural injustice, or negative affective reactions to hospitalisation; seclusion was associated with negative pressures only. Among male inpatients (n = 59), not being born in Ireland appeared more relevant than age, and neither restraint nor seclusion were associated with perceived coercion on admission, perceived negative pressures, procedural injustice, or negative affective reactions to hospitalisation. CONCLUSIONS Factors other than formal coercive practices are primarily linked with perceived coercion. Among female inpatients, these include younger age, involuntary status, and positive symptoms. Among males, not being born in Ireland appears more relevant than age. Further research is needed on these correlations, along with gender-aware interventions to minimise coercive practices and their consequences among all patients.
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Affiliation(s)
- Aoife K O'Callaghan
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
| | - Róisín Plunkett
- Psychological Medicine Department, St James's Hospital, Dublin 8, Ireland
| | - Brendan D Kelly
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
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Shozi Z, Saloojee S, Mashaphu S. Experiences of coercion amongst involuntary mental health care users in KwaZulu-Natal, South Africa. Front Psychiatry 2023; 14:1113821. [PMID: 36960456 PMCID: PMC10027751 DOI: 10.3389/fpsyt.2023.1113821] [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: 12/01/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023] Open
Abstract
Background Involuntary admission is a common practice globally. Previous international studies reported that patients experienced high levels of coercion, threats and a range of negative emotions. Little is known about the patients' experience in South Africa. The aim of this study was to describe the patient's experiences of involuntary admission at two psychiatric hospitals in KwaZulu-Natal. Methods A cross-sectional descriptive quantitative study of patients admitted involuntarily was conducted. Demographic information was extracted from clinical records and interviews were conducted with consenting participants at discharge. The MacArthur Perceived Coercion Scale, the MacArthur Negative Pressures Scale, and the MacArthur Procedural Justice Scale, of the MacArthur Admission Experience Survey (short form) were utilized to describe participants' experiences. Results This study comprised 131 participants. The response rate was 95.6%. Most participants (n = 96; 73%) experienced high levels of coercion and threats (n = 110; 84%) on admission. About half (n = 61; 46.6%) reported that they felt unheard. Participants reported feeling sad (n = 68; 52%), angry (n = 54; 41.2%), and confused (n = 56; 42.7%). There was a significant association between good insight and a feeling of relief (p = 0.001), and between poor insight and feelings of anger (p = 0.041). Conclusion The findings of this study confirm that most patients who were admitted involuntarily experienced high levels of coercion, threats, and exclusion from the decision-making process. Patient involvement and control of the decision-making process must be facilitated to improve clinical and overall health outcomes. The need for involuntary admission must justify the means.
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Gowda GS, Kumar CN, Ray S, Das S, Nanjegowda RB, Math SB. Caregivers' Attitude and Perspective on Coercion and Restraint Practices on Psychiatric Inpatients from South India. J Neurosci Rural Pract 2019; 10:261-266. [PMID: 31001015 PMCID: PMC6454949 DOI: 10.4103/jnrp.jnrp_302_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Coercion and restraint practices in psychiatric care are common phenomena and often controversial and debatable ethical issue. Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients have received relatively less research attention till date. Aims: Caregivers’ attitude and perspective on coercion and restraint practices on psychiatric inpatients. Methodology: This is a hospital-based, a descriptive, cross-sectional study. A total of 200 (n = 200) consecutive patient and their caregivers were chosen between June 2013 and September 2014 through computer-generated random numbers sampling technique. We used a semi-structured interview questionnaire to capture caregivers’ attitude and perspective on coercion and restraint practices. Sociodemographic and coercion variable were analyzed using descriptive statistics. McNemar test was used to assess discrete variables. Results: The mean age was 43.8 (±14.9) years. About 67.5% of the caregivers were family members, 60.5% of them were male and 69.5% were from low-socioeconomic status. Caregivers used multiple methods were used to bring patients into the hospital. Threat (52.5%) was the most common method of coercion followed by persuasion (48.5%). Caregivers felt necessary and acceptable to use chemical restraint (82.5%), followed by physical restraint (71%) and electroconvulsive therapy (ECT) (56.5%) during acute and emergency psychiatric care to control imminent risk behavior of patients. Conclusion: Threat, persuasion and physical restraint were the common methods to bring patients to bring acutely disturbed patients to mental health care. Most patients caregivers felt the use of chemical restraint, physical restraint and ECT as necessary for acute and emergency care in patients with mental illness.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Sujoy Ray
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Soumitra Das
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Luo C, Chen H, Zhong S, Guo H, Li Q, Cai W, de Girolamo G, Zhou J, Wang X. Manic episode, aggressive behavior and poor insight are significantly associated with involuntary admission in patients with bipolar disorders. PeerJ 2019; 7:e7339. [PMID: 31355058 PMCID: PMC6644629 DOI: 10.7717/peerj.7339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/23/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives Serious mental illnesses, such as bipolar disorders and schizophrenia, are closely associated with involuntary admission. Many studies have focused on involuntary admission in people with schizophrenia, but little is known about the factors associated with involuntary admission in Chinese patients with bipolar disorders. This study aimed to investigate socio-demographic and clinical factors associated with involuntary admission in Chinese patients with bipolar disorders. Methods In this multi-center cross-sectional survey in China, a total of 155 newly admitted patients with bipolar disorders were consecutively recruited from 16 psychiatric institutions from 15 March to 14 April, 2013. Patients' socio-demographic and clinical data were collected from their medical records. The Modified Overt Aggression Scale and the Insight and Treatment Attitudes Questionnaire were used to measure patients' level of aggression and insight of current psychiatric illness. Results The prevalence of involuntary admission was 52% in this sample of Chinese inpatients with bipolar disorders. In multiple logistic regression, a high level of aggression (odds ratio (OR) = 2.48), diagnosis of manic episode (OR = 3.65), poor insight (OR = 7.52), and a low level of education (OR = 3.13) were significantly associated with involuntary admission. Conclusion Manic episode, aggressive behavior, and poor insight were the significant contributing factors to involuntary admission in Chinese patients with bipolar disorders.
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Affiliation(s)
- Chenyuli Luo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Hui Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Shaoling Zhong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Huijuan Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Qiguang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Weixiong Cai
- Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai, China
| | | | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.,National Technology Institute on Mental Disorders, Changsha, Hunan, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
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Abstract
Restraint use in mentally ill patients are regulated by Mental Healthcare Act 2017 in India. At times, persons with mental disorders become dangerous to self, others or towards the property, warranting an emergency intervention in the form of restraint. Restraint as a matter of policy, should be implemented after attempting alternatives, only under extreme circumstances as last resort and not as a punishment. It should be an intervention focused at managing the concerned behavior for a given point of time. Restraint should always result in safety and should ensure that the human rights of mental health care users are upheld. This guideline was developed towards Indian mental health services in conjunction with international evidence-based strategies following a decade of collaborative research work between Indian and European mental health professionals.
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Affiliation(s)
| | - Peter Lepping
- Wrexham Maelor Hospital, Wales, UK.,Betsi Cadwaladr University Health Board, Wales, UK.,Bangor University, Wales, UK.,Mysore Medical College and Research Institute, Mysore, Karnataka, India
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Gowda GS, Lepping P, Ray S, Noorthoorn E, Nanjegowda RB, Kumar CN, Math SB. Clinician attitude and perspective on the use of coercive measures in clinical practice from tertiary care mental health establishment - A cross-sectional study. Indian J Psychiatry 2019; 61:151-155. [PMID: 30992609 PMCID: PMC6425791 DOI: 10.4103/psychiatry.indianjpsychiatry_336_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Use of coercive measures in mental health care is an important issue for research. There are scarce data available on perception and attitudes toward coercion among Indian psychiatrists. AIMS This study aims to study psychiatrists' attitude and perspectives on the use of coercive measure in clinical practice against the background of family and patients' opinion. MATERIALS AND METHODS The study was conducted at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India. Psychiatrist in charge of the inpatients was asked about their general opinion on coercion and was administered Staff Attitude to Coercion Scale questionnaire. Findings were compared to previously published studies on patients' opinion and family opinion in the same sample. Data were analyzed using descriptive statistics. RESULTS Coercion proved to be a common measure applied in nearly 70% of the patients studied. The 189 psychiatrists participating in the study almost all perceived coercion as care, protection and safety, and as protection from dangerous situations. About 66% of psychiatrists perceived physical and chemical restraint (sedation) as necessary and acceptable in acute emergency care. One-third of the psychiatrists felt their patients lost autonomy, dignity, and the possibility of interpersonal contact. The same amount agreed that some patients could have been treated with less restriction and fewer coercive measures. CONCLUSION Psychiatrists felt that physical and chemical restraints are necessary and acceptable in acute emergencies. Most psychiatrists considered coercion as a caring protective and safety attitude but also acknowledged its potential negative impact on patient dignity and therapeutic relationships.
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Affiliation(s)
- Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Peter Lepping
- Bangor University, Centre for Mental Health and Society, Wales, United Kingdom
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysore, Karnataka, India
- Wrexham Maelor Hospital, Liaison Psychiatry, BCUHB, Wrexham, Wales, United Kingdom
| | - Sujoy Ray
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Eric Noorthoorn
- GGNet Community Mental Health Centre, Warnsveld, Netherlands
| | | | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Duffy RM, Kelly BD. India's Mental Healthcare Act, 2017: Content, context, controversy. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:169-178. [PMID: 30122262 DOI: 10.1016/j.ijlp.2018.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 05/13/2023]
Abstract
India's new mental health legislation, the Mental Healthcare Act, 2017, was commenced on 29 May 2018 and seeks explicitly to comply with the United Nations Convention on the Rights of Persons with Disabilities. It grants a legally binding right to mental healthcare to over 1.3 billion people, one sixth of the planet's population. Key measures include (a) new definitions of 'mental illness' and 'mental health establishment'; (b) revised consideration of 'capacity' in relation to mental healthcare (c) 'advance directives' to permit persons with mental illness to direct future care; (d) 'nominated representatives', who need not be family members; (e) the right to mental healthcare and broad social rights for the mentally ill; (f) establishment of governmental authorities to oversee services; (g) Mental Health Review Boards to review admissions and other matters; (h) revised procedures for 'independent admission' (voluntary admission), 'supported admission' (admission and treatment without patient consent), and 'admission of minor'; (i) revised rules governing treatment, restraint and research; and (j) de facto decriminalization of suicide. Key challenges relate to resourcing both mental health services and the new structures proposed in the legislation, the appropriateness of apparently increasingly legalized approaches to care (especially the implications of potentially lengthy judicial proceedings), and possible paradoxical effects resulting in barriers to care (e.g. revised licensing requirements for general hospital psychiatry units). There is ongoing controversy about specific measures (e.g. the ban on electro-convulsive therapy without muscle relaxants and anaesthesia), reflecting a need for continued engagement with stakeholders including patients, families, the Indian Psychiatric Society and non-governmental organisations. Despite these challenges, the new legislation offers substantial potential benefits not only to India but, by example, to other countries that seek to align their laws with the United Nations' Convention on the Rights of Persons with Disabilities and improve the position of the mentally ill.
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Affiliation(s)
- Richard M Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
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Gowda GS, Lepping P, Noorthoorn EO, Ali SF, Kumar CN, Raveesh BN, Math SB. Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. Asian J Psychiatr 2018; 36:10-16. [PMID: 29857265 DOI: 10.1016/j.ajp.2018.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND The Indian Mental Health Care Act 2017 (MHCA -2017) advocates the duty to provide treatment in the least coercive manner. Little data exists on how Indian patients perceive coercion in medical settings. AIMS To study the prevalence of restraint in a Indian psychiatric inpatient unit, and to examine the level of perceived coercion correlating to various forms of restraint. METHODOLOGY This is a hospital based prospective observational study. Two hundred patients were recruited through computer generated random number sampling. In eligible subjects, demographic and clinical data, restraints used and assessments related to perceived coercion were completed within 3 days of admission. Perceived coercion was reassessed at the time or within 3 days before discharge. RESULTS In 66.5% one or more restraint measures were used, physical restraints in 20%, chemical restraints in 58%, seclusion in 18%, and involuntary medication in 32%. ECT is associated with the lowest level of perceived coercion followed by isolation/seclusion, chemical restraint, involuntary medication and physical restraint. Male gender, being married, rural background, low socioeconomic status, having a mood disorder, and alcohol or drug dependence was associated with an increased risk of physical or chemical restraint. Having a mood disorder, being from a rural area and a lower socioeconomic status was associated with being subjected to more than one form of coercion. CONCLUSION Restraint measures are more prevalent in psychiatric hospital care in India than in Europe. Physical restraint is particularly associted with higher perceived coercion.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560029, India.
| | - Peter Lepping
- Centre for Mental Health and Society, Technology Park, Croesnewydd Road, Wrexham LL13 7TP, Wales, United Kingdom; Department of Psychiatry, Mysore Medical College and Research Institute (MMCRI), Mysore, India; Bangor University, Wrexham, Wales, United Kingdom
| | - Eric O Noorthoorn
- GGNet Community Mental Health Centre, PO Box 2003, 7230 GC Warnsveld, The Netherlands
| | - Syed Farooq Ali
- Department of Clinical Neuro Sciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560029, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, 560029, India
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Mielau J, Altunbay J, Lehmann A, Bermpohl F, Heinz A, Montag C. The influence of coercive measures on patients' stances towards psychiatric institutions. Int J Psychiatry Clin Pract 2018; 22:115-122. [PMID: 28978249 DOI: 10.1080/13651501.2017.1383437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the impact of coercive interventions (CI) on patients' evaluations of psychiatric hospitals as adversaries versus allies. METHODS Self-constructed interviews were conducted relating to quantitative and subjective aspects of coercion and the attitude towards psychiatry of 79 patients with psychotic and bipolar disorders. The Coercion Experience Scale (CES) and the Admission Experience Survey (AES) were used to establish the subjective impact of CI. Instruments measuring psychopathological symptoms and the Global Assessment of Functioning (GAF) were applied alongside the Schedule for the Assessment of Illness (SAI) and the Beck Cognitive Insight Scale (BCIS). Using a logistic regression approach, considered influencing factors such as number, type and patients' subjective experiences of CI, cognitive and clinical insight, psychopathological symptoms and patients' global perceptions of their hospitalisation were analysed for their predictive value of patients' attitudes towards psychiatry. RESULTS Binary logistic regression revealed that the subjective experience of CI and the perception of fairness and effectiveness during the treatment process predict patients' attitudes towards psychiatry to a greater extent than symptom-related measures or the quantity of CI. Patients presenting a higher degree of self-reflectiveness perceive psychiatric institutions more likely as allies. CONCLUSIONS The manner in which coercion is subjectively experienced has direct influence on patients' perceptions of psychiatry.
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Affiliation(s)
- Juliane Mielau
- a Department of Psychiatry, Psychotherapy and Psychosomatics , Alexianer Krankenhaus Hedwigshöhe , Berlin , Germany
| | - Jasmin Altunbay
- b Department of Psychiatry and Psychotherapy , Charité Universitätsmedizin , Berlin , Germany
| | - Anja Lehmann
- b Department of Psychiatry and Psychotherapy , Charité Universitätsmedizin , Berlin , Germany
| | - Felix Bermpohl
- b Department of Psychiatry and Psychotherapy , Charité Universitätsmedizin , Berlin , Germany
| | - Andreas Heinz
- b Department of Psychiatry and Psychotherapy , Charité Universitätsmedizin , Berlin , Germany
| | - Christiane Montag
- b Department of Psychiatry and Psychotherapy , Charité Universitätsmedizin , Berlin , Germany
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Gowda GS, Das S, Nanjegowda RB. Psychotropic implant can be a new hope in psychiatry. Asian J Psychiatr 2017; 30:214-217. [PMID: 28410867 DOI: 10.1016/j.ajp.2017.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/17/2022]
Abstract
Non-adherence to oral psychotropic medications is common in patients with severe mental illness (SMI). This substantially limits the effectiveness of treatment and results in higher rates of relapse, rehospitalization, suicide, early mortality and disability in SMI. This is a major concern for professionals, caregivers and policy makers. The pharmacological, psychological, psychosocial models and interventions have been there since last few decades to address non-adherence. These have not made major changes in treatment adherence and outcome of SMI. Hence new powerful, long acting and novel psychotropic implant can be developed and could soon revolutionize the treatment in psychiatry.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Soumitra Das
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Raveesh Bevinahalli Nanjegowda
- Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences (DIMHANS), Belgaum Road, Dharwad 580008, India
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Gowda GS, Kondapuram N, Kumar CN, Math SB. Involuntary admission and treatment experiences of persons with schizophrenia: Implication for the Mental Health Care Bill 2016. Asian J Psychiatr 2017; 29:3-7. [PMID: 29061422 DOI: 10.1016/j.ajp.2017.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Involuntary admission and treatment experiences may affect the attitude of patients toward subsequent treatment and further outcomes. This issue has received relatively less research attention in persons with schizophrenia from developing countries. METHODOLOGY In this hospital based prospective observational study, involuntary admission, treatment and coercion experiences among 76 persons with schizophrenia, admitted under special circumstances of Mental Health Act -1987 were studied. Demographic, clinical and assessments related to coercion experiences were completed within 3days of admission. In 67 subjects, a reassessment was done just before discharge. RESULTS Mean (SD) age was 33.1 (±11.5) years, 47.8% (n=32) were males and 32.8% (n=22) were married. 92.5% (n=62) had absent insight at admission. Mean CGI Severity score at admission was 6.27 (±0.53). Mean (SD) score on MacArthur Perceived Coercion Scale at admission was 4.04 (±1.61). This reduced to 2.43(±1.91) [p<0.001]. This reduction correlated significantly with improvements in global functioning (r=-0.40, p <0.001), insight level(r=0.26, p<0.001) and as well as symptom severity(r=0.36, p<0.001). At discharge, 70% (n=47) patients reported that their involuntary admission was justified. CONCLUSION Perceived coercion in schizophrenia though common clinical phenomena, it is a dynamic state which reduces over course of treatment. At Discharge, majority reported that their admission was justified, even though they were admitted involuntarily. The study underlines the need for a standardized rule of conduct based coercive practice in psychiatry.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India.
| | - Nithin Kondapuram
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, 560029, India
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