[Extralegal coercive measures in psychiatric wards-- patients' perspectives]. / Ekstralegale tvangsforanstaltninger i psykiatrien--et patientperspektiv.

INTRODUCTION: A revision of the Danish Mental Health Act is planned to take place in 2005-2006. The Ministry of Health requires investigation into whether extralegal coercive measures take place in psychiatric wards. Extralegal coercion refers to restrictions and rules not included in the current Mental Health Act and considered by patients to be coercion. MATERIALS AND METHODS: Twenty-two psychiatric patients participated in four group interviews directed by two physicians at four University Hospitals in Copenhagen, Denmark. The patients were asked to define what they perceived as extralegal coercion, house rules and psychiatric treatment. RESULTS: The majority of patients perceived lack of single rooms, restrictions on leaving the ward and shielding, i.e., being confined to one's room, to be extralegal coercion. A few also found the pressure to take medication and collection of clothes items to be extralegal coercion. Rules on smoking, clothing, day and night routines, the use of radio and TV, drugs, alcohol, visits, eating and the use of telephones were considered not extralegal coercion but necessary house rules. House rules should be clear and stated in writing. Restrictions on the use of money and locking of the front door at night were accepted in certain situations, hence not considered to be extralegal coercion. DISCUSSION: Extralegal coercion does occur in psychiatric wards but in certain situations is accepted if documented. House rules are considered to be necessary and not extralegal coercion. Increased use of compulsory protocols for documenting coercive measures was not considered to be necessary, but documentation in patients' files was useful alternative.

Drug therapy of dementia in elderly patients. A review.

Today drug therapy of dementia in elderly patients is possible. Owing to a huge increase in the number of elderly people throughout the Western world in the coming years, evidence-based treatment of dementia in this group is needed. The article reviews double-blind, randomized trials on the effect in dementia of donepezil, galantamine, rivastigmine and memantine up to 2003. A total of 27 studies were included. Donepezil, galantamine, rivastigmine and memantine improve cognition and the global level of functioning in mild to moderate Alzheimer's disease (AD). Most evidence exists for donepezil and galantamine. The effect of rivastigmine is best documented in Lewy body dementia (LB). Galantamine, memantine and donepezil may improve cognition in vascular dementia (VD). Galantamine may improve behavioural psychological symptoms of dementia (BPSD). No solid evidence for drug therapy in severe dementia exists. Elderly patients with mild to moderate AD should be offered drug therapy. One should also consider expanding the indication of dementia treatment to LB and VD. An international consensus on what primary efficacy variables to use is needed.

[The occurrence of coercive measures towards non-hospitalized elderly]. / Forekomst af tvangsforanstaltninger over for aeldre uden for hospital.

INTRODUCTION: The study is a nation-wide investigation of the occurrence of coercive measures towards non-hospitalised elderly (+65 years) with dementia in Denmark. These measures include the use of alarm and tracking systems, use of physical force and protective devices, detention of the elderly in their own homes, and forced movement to another domicile e.g. nursing home. These types of coercive measures are regulated in the Danish jurisdiction, but not systematically recorded. MATERIAL AND METHODS: A questionnaire was sent to all counties in Denmark concerning occurrence of the coercive measurements mentioned above. RESULTS: All 14 counties reported a very low use of all types of coercion with only a total of 123 incidents reported in all in 2001. DISCUSSION: This modest number gives rise to concern about lack of sufficient care towards elderly with dementia. The autonomy of the demented is important, but must not overrule basic care with the aim of ensuring dignified living conditions and safety from harm. The jurisdiction in this area is complicated and sometimes unclear.

[Use and registration of coercion in psychiatry in the new millennium]. / Anvendelse og registrering af tvang i psykiatrien i det nye årtusinde.

INTRODUCTION: The Danish Mental Health Act of 1989 emphasized that the use of coercion should be recorded. The National Board of Health has published statistics on this issue since 1990. This study investigates the use of coercive measures at all Danish psychiatric departments from 1990 to 1998. MATERIAL AND METHODS: The official statistics published by The National Board of Health was collected and analyzed. RESULTS: There was an increase in the use of forced medication and mechanical restraint. No increase was found in the use of involuntary commitment or detention. DISCUSSION: Some of the increase found as regards forced medication and mechanical restraint could be due to problems in recording the correct number of episodes. The Mental Health Act does not take into account problems concerning elderly with dementia. Extralegal coercion or hidden coercion can take place outside a psychiatric ward, for instance in nursing homes or somatic departments. More empirical studies in this area are needed before the decision to record extralegal coercion is taken.

Auto-vampirism in schizophrenia.

Vampirism and auto-vampirism have been reported for centuries as very rare features. A relationship between vampirism auto-vampirism and mental disorders has been established, especially with regard to schizophrenia. This case study reports auto-vampirism in a 35-year-old schizophrenic woman. The Present State Examination was used to obtain a valid diagnosis. Auto-vampirism proved to be part of a bizarre delusion of a purification process. This patient reported experiences of depersonalization and auditory commanding hallucinations that made her strive for auto-vampirism. Although rare, auto-vampirism can be detected as a symptom in schizophrenia and can be treated.