The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review.

BACKGROUND AND AIM: Having decision making capacity is central to the exercise of autonomy in mental health care. The objective of this scoping review is to summarize the evidence on the capacity of people with schizophrenia or bipolar disorder to make decisions about their treatment in real life to support medical practice. METHODS: Systematic search of observational studies on the assessment of capacity of patients with schizophrenia, psychosis, or bipolar disorder to make healthcare and treatment-related decisions, conducted in any clinical setting published up to January 31, 2020 was performed. Free text searches and medical subject headings in English were combined in PubMed, Scopus, CINAHL, and PsycInfo. Publications were selected as per inclusion and exclusion criteria. The Newcastle-Ottawa Scale for observational studies was used to assess the quality of publications. RESULTS: Thirty publications were reviewed. According to the Newcastle-Ottawa Scale criteria, the publications reviewed were good quality. Findings showed that more than 70% of schizophrenia and schizoaffective disorder outpatients understood treatment options at the point of making decisions about their illness and healthcare. Patients treated voluntarily had considerably better scores for decisional capacity than those treated involuntarily. The burden of psychiatric symptoms could compromise decisional capacity temporarily. Decision-making capacity improved over time from admission to discharge from hospital, and with treatment among psychiatry inpatients. Schizophrenia and bipolar disorder patients could be as competent as nonpsychiatric individuals in making decisions about their treatments in everyday life. CONCLUSIONS: This scoping review provides a body of evidence for healthcare professionals in need of assessing the capacity of schizophrenia and bipolar disorder patients for autonomously decide about their treatments. Decisional capacity judgements should consider variations in capacity over time and be based on the type of decision to be made, the severity of symptoms, and the specific phase of the mental disorder.

Factores asociados a la incapacidad laboral temporal en peritajes psiquiátricos / Risk factors for temporary work disability

Introducción. La relación entre dificultades laborales y trastornos psiquiátricos es estrecha y bidireccional. Sin embargo, los datos disponibles sobre patología psiquiátrica en los procesos de incapacidad laboral temporal (ILT) en España no son concluyentes. Por dicho motivo, los objetivos del presente trabajo son describir el porcentaje de decisión de revocar una ILT, tras un peritaje psiquiátrico de trabajadores de Cataluña, y comparar las características sociodemográficas, clínicas y terapéuticas en función de la decisión de revocar la ILT. Metodología. Se realizó un estudio descriptivo en pacientes en situación de ILT por trastorno mental peritados durante un año, que acudían a valoración psiquiátrica tras un período acumulado de ILT (media de 5 meses). Los peritos psiquiatras debían valorar la capacidad laboral en función de la interferencia de los síntomas psiquiátricos del diagnóstico psiquiátrico principal que motivó el inicio de la baja laboral. Resultados. Se incluyeron 380 pacientes (66,8% mujeres, 42±10,9 años). El 87,9% recibió el alta laboral. No existieron factores sociodemográficos y terapéuticos asociados a la continuidad de ILT. El diagnóstico mayoritario de los pacientes que recibían el alta laboral fue el trastorno adaptativo (66,2% vs 13%, p=0,001) y el de los pacientes con continuidad de ILT el trastorno depresivo mayor (45,7% vs 3,9%, p=0,001). Conclusiones. Existe un elevado porcentaje de pacientes que reciben el alta laboral tras un peritaje psiquiátrico. El trastorno depresivo mayor es el diagnóstico que más se asocia con la continuidad de ILT

Introduction. The relationship among labor difficulties and psychiatric disorders is important and bidirectional. However, current information about the influence of psychiatric disorders in temporary work disability in Spain is inconclusive. For this reason, we aimed to describe the prevalence of the conclusions of psychiatric expert’s reports including maintain o revoke the temporary disability (TD). We also aimed to compare sociodemographic, clinical and therapeutic variables according with the decision of maintain or revoke this condition. Methodology. A descriptive study was conducted in psychiatric patients that were examined by psychiatric experts during one year. At the examination time, the patients had a sick leave mean of 5 months. The psychiatric experts assessed their ability to work according to the interference of the psychiatric symptoms. Results. A total of 380 patients were included (66.8% women, 42±10.9 years), 87.9% had a result of revoke the temporary work disability. No sociodemographic or therapeutic factors were associated with the continuity of sick leave. The most common diagnosis of patients who obtained a revoked temporary work disability was adjustment disorder (66.2% vs 13%, p=0.001) and patients who maintained the temporary work disability was major depressive disorder (45.7% vs 3.9%, p=0.001). Conclusions. After a psychiatric expert’s examination the most of the results suggest to revoke the temporary work disability. Major depressive disorder is the most commonly diagnostic associated to continue sick leave

Risk factors for temporary work disability.

INTRODUCTION: The relationship among labor difficulties and psychiatric disorders is important and bidirectional. However, current information about the influence of psychiatric disorders in temporary work disability in Spain is inconclusive. For this reason, we aimed to describe the prevalence of the conclusions of psychiatric expert’s reports including maintain o revoke the temporary disability (TD). We also aimed to compare sociodemographic, clinical and therapeutic variables according with the decision of maintain or revoke this condition. METHODOLOGY: A descriptive study was conducted in psychiatric patients that were examined by psychiatric experts during one year. At the examination time, the patients had a sick leave mean of 5 months. The psychiatric experts assessed their ability to work according to the interference of the psychiatric symptoms. RESULTS: A total of 380 patients were included (66.8% women, 42±10.9 years), 87.9% had a result of revoke the temporary work disability. No sociodemographic or therapeutic factors were associated with the continuity of sick leave. The most common diagnosis of patients who obtained a revoked temporary work disability was adjustment disorder (66.2% vs 13%, p=0.001) and patients who maintained the temporary work disability was major depressive disorder (45.7% vs 3.9%, p=0.001). CONCLUSIONS: After a psychiatric expert’s examination the most of the results suggest to revoke the temporary work disability. Major depressive disorder is the most commonly diagnostic associated to continue sick leave.

Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries.

PURPOSE: Whilst formal coercion in psychiatry is regulated by legislation, other interventions that are often referred to as informal coercion are less regulated. It remains unclear to what extent these interventions are, and how they are used, in mental healthcare. This paper aims to identify the attitudes and experiences of mental health professionals towards the use of informal coercion across countries with differing sociocultural contexts. METHOD: Focus groups with mental health professionals were conducted in ten countries with different sociocultural contexts (Canada, Chile, Croatia, Germany, Italy, Mexico, Norway, Spain, Sweden, United Kingdom). RESULTS: Five common themes were identified: (a) a belief that informal coercion is effective; (b) an often uncomfortable feeling using it; (c) an explicit as well as (d) implicit dissonance between attitudes and practice-with wider use of informal coercion than is thought right in theory; (e) a link to principles of paternalism and responsibility versus respect for the patient's autonomy. CONCLUSIONS: A disapproval of informal coercion in theory is often overridden in practice. This dissonance occurs across different sociocultural contexts, tends to make professionals feel uneasy, and requires more debate and guidance.

Selling forensic psychiatry: recruiting for the future, establishing services.

BACKGROUND AND AIM: The Ghent Group - a group of European forensic psychiatrists - has discussed ways of informing fellow professionals and the wider public about their difficult and frequently misunderstood discipline, agreeing that the specialty may have to be 'sold' to those who pay for it and use it. Our aim was to consider the areas where this commonly occurs and the strengths and pitfalls of such promotion. DISCUSSION: Forensic psychiatrists need to be effective, accurate communicators. For court work, they need special training. High standards of work are the best selling technique. Outside court, the greatest challenge for forensic psychiatry is to reduce its stigma - it can easily be construed, wrongly, as excusing serious anti-social behaviour. Special attention should be given to writing for a wider audience, not just the inner circle of practitioners. Electronic social media should also be deployed for this task. Those who provide funds for academic work should be specifically but differently targeted. They need to be persuaded of the scientific merit of the subject. ETHICS: Temptation to claim more for the discipline than can be justified have to be resisted. An English case that led to a miscarriage of justice illustrates this. The limitations of science here have to be understood. Philosophical questions relating to responsibility and culpability cannot be resolved by physical science alone. Misuse neuroimaging in court, for example, can lead to miscarriages of justice. CONCLUSION: Selling forensic psychiatry to public and professionals is difficult but essential to counter anti-forensic psychiatry movements that have emerged. The discipline needs to persuade others of its unique skills and embrace good science, compassion, public duty and ethical practice. It needs to treat with politicians and funders as well as the medical, psychological and legal professions.

Objectivity and ethics in forensic psychiatry.

PURPOSE OF REVIEW: In this paper, we analyze the concept of objectivity as it is accepted in the 'standard position' on ethical practice in forensic psychiatry and confront it with the current trends of psychiatric nosology, specially the debate that we have now regarding the theoretical orientation of DSM-5, which is intended to be more based on neuroscientific more than on clinical data, as has been the tradition in psychiatry so far. RECENT FINDINGS: In view of those elements, we review the skeptical position about the ethics of forensic psychiatry and the obstacles that, in my opinion, are still standing according to Stone's proposal: the fact-value distinction, determinism vs. free will, the deconstruction of the self, the mind-brain problem, and the chasm between morality and normal science. In my opinion the objections made by Stone on the feasibility of forensic psychiatry in the courts continue in full force, to the extent that these objections are the heart of the debate about the theoretical orientation of the DSM-5. SUMMARY: The advocates of the standard position have an overly optimistic view of the capacity of objectification of forensic psychiatry. This problem has also been revealed in the intense debates on the direction of the DSM-5 in general psychiatry, a draft of which appears excessively based on neuroscience and little on traditional clinical practice.

On measuring incapacity.

PURPOSE OF REVIEW: We review the relevant literature published in the last year on assessing the capacity of mental patients to make decisions in different areas of their lives. We have analyzed the research relating to the development of capacity assessment instruments. RECENT FINDINGS: We examine recent studies focusing on the capacity of mental patients with mild to moderate dementia. Also we investigate how brief interventions affect patients' understanding of the implications of being enrolled in a particular research project. A new area of research has emerged in the field trying to elucidate which neuropsychological and clinical factors can help to predict present or future incapacity. There is still debate on the construct validity of capacity since different theoretical approaches can be used. SUMMARY: Unfortunately there is controversy regarding the utility of neuropsychological and clinical data as predictors of incapacity. It is still necessary, therefore, to use different capacity instruments to ascertain whether patients have sufficient capacity for a specific task or decision.

Do psychiatric patients improve their competency to consent to hospitalization after admission? A prospective study in an acute inpatient ward.

OBJECTIVES: Competency to consent to hospitalization has important clinical and ethical implications. However, there are no follow-up studies that evaluate improvement in competency during psychiatric hospitalization. The authors sought to determine whether patients admitted to a psychiatric ward as incompetent to consent to hospitalization improve their competency during hospitalization. METHOD: A total of 160 consecutively admitted patients were administered the Competency Questionnaire (CQ), a structured scale designed to assess competency to consent to psychiatric hospitalization. The CQ was administered both upon admission and at discharge. Severity and acuity of the psychiatric disorder were assessed with the Severity of Psychiatric Illness Scale and the Acuity of Psychiatric Illness Scale. RESULTS: Of the 160 assessed patients, 70 (43.8%) were rated incompetent. Forty-five of these 70 incompetent patients completed the admission-to-discharge follow-up. Twenty-one of these 45 patients (46.6%) remained incompetent at discharge. Participation in the treatment process was the only variable that predicted improvement on competency during hospitalization. Severity of psychiatric illness at admission did not predict improvement on competency. CONCLUSIONS: Nearly half of the patients who upon admission were incompetent remained incompetent at discharge.

Aspectos éticos y legales en las demencias / No disponible

No disponible