Relationship between Competency to Consent to Treatment and Psychological Well-Being: Mediating Effect of Empowerment and Emotion.

This study was conducted to evaluate the competency to consent to the treatment of psychiatric outpatients and to confirm the role of empowerment and emotional variables in the relationship between competency to consent to treatment and psychological well-being. The study participants consisted of 191 psychiatric outpatients who voluntarily consented to the study among psychiatric outpatients. As a result of competency to consent to treatment evaluation, the score of the psychiatric outpatient's consent to treatment was higher than the cut-off point for both the overall and sub-factors, confirming that they were overall good. In addition, the effect of the ability of application on psychological well-being among competency to consent to treatment was verified using PROCESS Macro, and the double mediation effect using empowerment and emotional variables was verified to provide an expanded understanding of this. As a result of the analysis, empowerment completely mediated the relation between the ability of application and psychological well-being, and the relation between the ability of application and psychological well-being was sequentially mediated by empowerment and emotion-related variables. Based on these findings, the implications and limitations of this study were discussed.

The impact of coercion on treatment outcome: one-year follow-up survey.

OBJECTIVE: This study examined whether coercive measures or perceived coercion experienced by mentally disabled patients in the hospitalization process could be justified under paternalism. To find out whether coercion can be justified by paternalism, a year of follow-up research was conducted to examine the impact of coercive measures and perceived coercion experienced during hospitalization on the patients' therapeutic benefit. METHODS: A 6-month period and a 1-year period of follow-up research was conducted with 266 patients to assess whether the coercion they experienced during hospitalization (coercive measures and perceived coercion) had an effect on changing the patients' mental symptoms and insight. RESULTS: The results showed a decrease in both mental symptoms and insight over time. However, it was found that neither coercive measures nor perceived coercion had a significant effect on the change of mental symptoms and that, thus, coercion had little contribution to the declining of symptoms. Coercive measures had no effect on the change of insight but perceived coercion was shown to have a positive effect on a change in insight. Patient insight was shown to improve with increased perceived coercion. CONCLUSIONS: Paternalism provides a partial explanation to serve as a basis for justifying perceived coercion. Limitations and suggestions for further study are discussed.

Coercion in psychiatric care: can paternalism justify coercion?

BACKGROUND: It has long been debated whether coercion can be justified as paternalism in the field of mental health and it is still a continuing issue of controversy today. AIMS: This study analyses whether coercive intervention in mental health can be justified by the basic assumptions of paternalists: the assumption of incompetence, the assumption of dangerousness and the assumption of impairment. METHOD: This study involved 248 patients: 158 (63.7%) were diagnosed with schizophrenia and 90 (36.3%) were diagnosed with mood disorder. In this study, experiences of coercion were divided into legal status, subjective (perceived coercion) and objective experiences (experienced coercion). RESULTS: The assumption of incompetence was justified in all three categories of coercion whereas the assumption of dangerousness was not justified in any. The assumption of impairment was not justified in legal status and perceived coercion, but provided a partial explanation to serve as a basis for justifying experienced coercive measures. CONCLUSIONS: It can be noted that mental health experts who support paternalism without question must reconsider their previous methods. Above all, the reason why the assumption of dangerousness was not justified in any of the categories of coercion was because coercive intervention used to prevent harm to oneself and others must be very carefully carried out.

Developing a Tool to Assess Competency to Consent to Psychiatric Hospitalization (KATOC): Reliability and Validity.

OBJECTIVE: The justification of informed consent requires that a patient be provided with the information necessary for deciding treatment and able to use such information based on reasonable thinking. The clinical decision to consider anyone who has mental disorder as incompetence without objective assessment does not only encroach human rights of the persons with mental illness, but seriously prevent them from being recovered. Hence the objective assessment of competency is needed in mental health. Our study aimed to develop the Korean Tool of Competency to Consent to Psychiatric Hospitalization and to analyze the reliability and validity of this tool. METHODS: Totally 98 patients with mental illness who were hospitalized in mental hospital, participated in this study. For the subjects a questionnaire composing of 22 questions of understanding, appreciation, reasoning and expression of a choice was used. To investigate validity of this tool, MMSE-K, insight test, estimated IQ, BPRS were conducted. Its reliability and usefulness were examined with Cronbach's alpha, ICC and ROC analysis respectively and criterion related validation performed. RESULTS: As results, this tool shows that agreement between raters is relatively high and the confirmatory factor analysis for constructive validation shows that the tool is valid. Also, for criterion related validation, estimated IQ, insight and MMSE are significantly correlated to understanding, appreciation and reasoning. However competence to express a choice did not show any significant correlation with criterion variables, nor showed BPRS any significant correlation with sub-competences. CONCLUSION: Our study developed the Korean Tool of Competency to Consent to Psychiatric Admission Treatment in the Mentally Ill, verified the reliability and validity of the tool and analyzed the optimum cutoff to distinguish between competence and incompetence in sub-competences. Korean Assessment Tool of Competency to Consent to Psychiatric Hospitalization (KATOC), analyzed the reliability and validity of this tool and presented the cutoff points by subarea. As a result, the reliability and validity of satisfactory levels were verified, the ROC analysis was implemented based on the clinical assessment and the cutoff points were found in understanding, appreciation, expression of a choice and reasoning. Such findings showed that the tool developed by researchers could be very favorably used in Korea.

Variables influencing antidepressant medication adherence for treating outpatients with depressive disorders.

OBJECTIVE: Medication adherence is associated with the treatment outcomes. The reported consequences of non-adherence for patients with depressive disorders include chronification, poor psychosocial outcomes and increased suicide rates. The aim of this study is to determine whether insight is directly associated with the medication-taking adherence of patients with depressive disorders. In addition, we compared the various kinds of adherence measures for the depressive patients. METHOD: Consecutively 76 patients with depressive disorders were recruited from the outpatient clinic of our center. All patients were on mono-antidepressant therapy during at least 4-weeks' evaluation period, and evaluated with 17 item Hamilton Rating Scale for Depression (HRSD), Multidimensional Scale of Perceived Social Support (MSPSS) and Mood Disorders Insight Scale (MDIS). Medication adherence was assessed by using medication event monitoring system (MEMS), clinician rating scale of antidepressant adherence, pill count and patient's self-report. Agreement among the three continuous adherence measures was evaluated. The relationship between the adherence variables and the other clinical scale scores was assessed by using partial correlation correcting for age. RESULTS: The patients perceived poor social support from other people in relation to increasing severity of depression. The adherence rates for the MEMS, the pill count, the clinician rating scale of compliance and self-report were 51.9%, 71.4%, 79.2% and 75.3%, respectively. The HRSD scale score negatively correlated with the MDIS scores. No correlation was found between the adherence variables and the clinical scale scores (MDIS, HRSD and MSPSS). CONCLUSION: Patients with more severe depression tend to have greater insight. However, the increased insight of depressive patients was not associated with an increase in treatment adherence.

Association study between glutathione S-transferase GST-M1, GST-T1, and GST-P1 polymorphisms and tardive dyskinesia.

OBJECTIVES: Data from several studies suggest that oxidative stress may play a role in the pathophysiology of tardive dyskinesia (TD). Glutathione S-transferase (GST) enzymes play important roles in protecting cells against oxidative stress. In the present study, we investigated the hypothesis that polymorphisms in genes for these detoxifying enzymes can influence susceptibility to TD in patients with schizophrenia. METHODS: The GST-M1, GST-T1, and GST-P1 loci were analyzed by polymerase chain reaction (PCR)-based methods in 83 schizophrenic patients with TD and 126 schizophrenic without TD who were matched for antipsychotic drug exposure and other relevant variables. The multifactor dimensionality reduction (MDR) approach was used to analyze gene-gene interactions. RESULTS: There were no significant differences in the distributions of the GST-M1, GST-T1, and GST-P1 genotypes between the TD and non-TD groups (p > 0.05). However, in comparison of the severity of TD among genotypes using Poisson regression showed that Ile/Ile genotype of GST-P1 had higher AIMS score compared to Ile/Val + Val/Val genotypes (X(2) = 7.13, p = 0.008). MDR analysis did not show a significant interaction between the three GST gene variants and susceptibility to TD (p > 0.05). CONCLUSIONS: These results suggest that GST gene polymorphisms do not confer increased susceptibility to TD in patients with schizophrenia but TD severity might be related with GST-P1 variants.