Evidence Of Mental Disorder Research Articles

Is the long-term poor prognosis of acute myocardial infarction in patients with mental illness mediated through their poor adherence with recommended healthcare?

Compared with patients without evidence of psychiatric symptoms, those with mental disorders experience reduced adherence with recommended healthcare and poorer clinical outcomes. This study aimed to evaluate whether the worse prognosis of patients with mental disorders after experiencing acute myocardial infarction could be fully or partially mediated by their reduced adherence to recommended healthcare. In this retrospective cohort population-based study, 103 389 residents in the Italian Lombardy Region who experienced acute myocardial infarction in 2007-19 were identified. Among them, 1549 patients with severe mental illness (SMI) were matched with five cohort members without evidence of mental disorders (references). Recommended healthcare (cardiac medicaments and selected outpatient services) was evaluated in the year after the date of index hospital discharge. The first occurrences of cardiovascular (CV) hospital admissions and any-cause-death were considered as endpoints. Mediation analysis was performed to investigate whether post-discharge use of recommended healthcare may be considered a mediator of the relationship between healthcare exposure and endpoints occurrence. Compared with references, patients with SMI had lower adherence with recommended healthcare and adjusted risk excesses of 39% and 73% for CV hospitalizations and all-cause mortality. Mediation analysis showed that 4.1% and 11.3% of, respectively, CV hospitalizations and deaths occurred among psychiatric patients was mediated by their worse adherence to specific healthcare. The reduced use of recommended outpatient healthcare by patients with SMI had only a marginal effect on their worse prognosis. Other key factors mediating the prognostic gap between patients with and without mental disorders should be investigated.

Suicide in the absence of mental disorder

This paper is the result of two decades of studies by a small group of clinician/academics, with an interest in the aetiology of suicide. We find the notion that all or almost all those who complete suicide are suffering a mental disorder to be too restricting. We developed the concept of Predicament Suicide, in which suicide is conceptualized as an escape from unacceptable predicaments. One of these is painful, unresponsive mental disorder. Another is distressing social circumstances. We have used the public record (historical texts through to newspapers and electronic resources) to demonstrate that people with no evidence of mental disorder may suicide in unacceptable predicaments. We have developed the Operationalized Suicide Predicaments (OPS) framework, a means of classifying suicide. The OPS allows for suicide to be classified (as appropriate) as triggered by social factors. It has been found to have face validity and acceptable correlation. It is hoped the OPS may encourage scholars and clinicians to think beyond the medical model.

Matricídio e transtorno bipolar

BACKGROUND: Matricide is the killing of one's own mother, and a type of homicide rarely seen on psychiatric practice. Matricide cases studies have shown the presence of mental disorders, such as schizophrenia, bipolar disorder, personality disorders and alcoholism, and have also found cases where there is no evidence of mental disorders. OBJECTIVE: We aim to report a case of a woman with bipolar disorder that murdered her own mother and had a psychiatric forensic evaluation to ascertain her penal imputability. METHODS: Psychiatric interview was carried out and the psychiatric diagnosis was established based on the interview and analysis of forensic and hospitalar records, using the DSM-IV-TR criteria. RESULTS: The examinee was considered not guilty by reason of insanity, due to the presence of a mental disorder that affected her entire understanding and determination of the practiced delict. She has been under inpatient forensic psychiatric care for two years. DISCUSSION: It is important that psychiatrists and other mental health professionals be alert to the risk of violent behavior in patients that present a long history of mental disorder and present episodes of violence during the acute phase, or threats against relatives and friends, or the lack of regular psychiatric treatment.

Never good enough--part 2: Clinical implications.

This paper is the second part of two papers that explore the affect of shame and its role in the manifestation of symptoms that could be regarded as evidence of mental disorder. The clinical implications for nursing a person with an overwhelming shame response are discussed in this paper. It is proposed that a discursive approach to nursing care may assist mental health nurses to provide care that best meets the needs of people experiencing these symptoms. The paper suggests that this nursing care involves recognizing the impact of shame; making connections between how the person has learned to cope with shame and their current mental distress; situating shame in its socio-cultural context; focusing on subject-object differentiation and promoting acceptance of difference and exploring alternative subject positions for managing feelings of shame. The focus of these interventions is to encourage awareness of interactions with others, how the person positions her or his self in relation to others, and the communication patterns that perpetuate feelings of shame. It also involves helping the person to integrate the ideal image of her or his self with subject positions that are more flexible.

The admissibility of expert evidence of mental disorder in criminal law and the application of the evidence act 1995 (NSW)

The Evidence Act 1995 (NSW) (hereafter EA) commenced on 1 September 1995. The Act sought to clarify and reform complex rules of evidence including the rules relating to the admissibility of expert evidence in criminal trials. In doing so however the legislation has raised its own complexities. The result is that the extent to which expert evidence may be admissible in the criminal trial requires a close analysis not only of the application of the opinion rule, but also other sections of the Act which impact upon it The application of expert evidence is particularly significant in the area of mental disorder in the criminal law, as demonstrated by reform of the law of diminished responsibility in New South Wales which (inter alia) emphasises a central role for the jury as the ultimate decision‐maker in the application of the defence. These developments in the law suggest a need for examination of the admissibility of expert evidence in trials where mental disorder of the accused, or sometimes the complainant or other witnesses, is raised. This article seeks to review the law of opinion evidence at common law and under the EA with a view to assessing the application of expert evidence in the field of mental disorder in the criminal law under the regime of the new legislation. The outcome reveals that each of the disciplines involved in this field need to come to grips with the application of the EA and the manner in which it shapes the relationship between evidence of mental disorder and the criminal law.

On the recording of mental illness for civil commitment.

The survey of 102 consecutive certificates for involuntary admission and a review of the case material demonstrated that in 78 cases the form was completed adequately. In 13 cases full description of evidence of mental disorder was lacking on the certificate but after reviewing the cases it would appear that clear evidence of mental disorder was probably present at the time of certification. In this survey, suicidal or homicidal risk alone was not considered evidence of mental disorder. In the full 11 cases the grounds for diagnosing mental disorder rested upon the presence of phenomena like anger, alcoholism, or mild mental retardation or the presence of a personality disorder, all of these being associated with risk to the patient or another person. Compelling evidence for the necessity of psychiatric commitment in these complex situations cannot be described briefly; thus it does not appear that an altered certification form would solve the problem.

Suicide Following Discharge From Psychiatric Hospital

It is often assumed that mental disorder is a usual, if not invariable antecedent to suicide. However, studies based on data derived from coroner's records, postmortem interviews with relatives, and like sources have given estimates of the proportion of individuals with overt psychiatric disorder at the time of the suicidal act which vary from 20% 1 to 94%,⁵and it seems likely that such a wide divergence stems more from differing criteria accepted as evidence of mental disorder than from true differences of sampling, culture etc. It is indeed difficult to formulate and apply reliable criteria of mental health even for a living population. Most, however, would agree that admission to a psychiatric hospital provides an objective if crude measure of the presence of overt psychiatric disorder. The question may be asked—"To what extent does the occurrence of a psychiatric illness necessitating admission